A 47-Year-Old Man Develops Sudden Onset of Mid-Sternal Chest Pain

A 47-year-old man develops sudden onset of mid-sternal chest pain and diaphoresis during a meeting in his office.  While waiting for emergency medical personnel to arrive, he complains of dizziness and becomes unresponsive.  His coworkers perform cardiopulmonary resuscitation and he regains consciousness after 60 seconds.  The patient has a history of diet-controlled type 2 diabetes mellitus, hypertension, and hyperlipidemia.  In the emergency department, his blood pressure is 142/88 mm Hg and pulse is 92/min.  Electrocardiogram shows normal sinus rhythm, ventricular premature complexes, and a 3-mm ST-segment elevation in leads V1-V3.  What is the most likely primary pathophysiologic mechanism responsible for this patient's syncopal episode?

A) Asystole
B) Atrial fibrillation
C) Atrio-ventricular conduction block
D) Paroxysmal supraventricular tachycardia
E) Pulseless electrical activity
F) Reentrant ventricular arrhythmias

Correct Answer:

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