Syncope in a middle-aged man

Clinical introduction

A 46-year-old African-American man presented to the emergency room after having a syncopal episode. The patient was at a friend's house when he stood up, felt lightheaded, had associated chest discomfort that has been described as 'elephant sitting on my chest' and then collapsed. There was loss of consciousness transiently but no seizure-like activity. There was no personal or family history of arrhythmia or sudden cardiac death. He was a heavy smoker but denied other medical histories. The patient was not tachycardic and did not have any haemoptysis, calf pain or tenderness or symptoms to suggest malignancy.

Question

Considering the clinical presentation and ECG, which of the following investigation is most appropriate?

Left heart catheterisation

Pulmonary CT angiography

Flecainide drug challenge

Electrophysiology study

Answer/discussion

Answer: B. This patient presented with syncope and chest discomfort. Using the Wells Criteria, this patient would...

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