Cardiology
CASE 1: DIZZINESS
History
A 75-year-old man is brought to hospital with an episode of dizziness. He still feels unwell
when he is seen 30 min after the onset. He was well until the last 6 months, since when
he has had some falls, irregularly. On some occasions he lost consciousness and is unsure
how long he has been unconscious. On a few occasions he has fallen, grazing his knees,
and on others he has felt dizzy and has had to sit down but has not lost consciousness.
These episodes usually happened on exertion, but once or twice they have occurred while
sitting down. He recovers over 10–15 min after each episode.
He lives alone and most of the episodes have not been witnessed. Once his granddaughter
was with him when he blacked out. Worried, she called an ambulance. He looked so pale
and still that she thought that he had died. He was taken to hospital, by which time he had
recovered completely and was discharged and told that he had a normal electrocardiogram
(ECG) and chest X-ray.
There is no history of chest pain or palpitations. He has had gout and some urinary fre-
quency. A diagnosis of benign prostatic hypertrophy has been made for which he is on no
treatment. He takes ibuprofen occasionally for the gout. He stopped smoking 5 years ago.
He drinks 5–10 units of alcohol weekly. The dizziness and blackouts have not been asso-
ciated with alcohol. There is no relevant family history. He used to work as an electrician.
Examination
He is pale with a blood pressure of 96/64 mmHg. The pulse rate is 33/min, regular. There
are no heart murmurs. The jugular venous pressure is raised 3 cm with occasional rises.
There is no leg oedema; the peripheral pulses are palpable except for the left dorsalis pedis.
The respiratory system is normal.
- The patient’s ECG is shown in Fig. 1.1.
INVESTIGATIONS
aVR V1 VVV3 VII aVL VIII aVFRhythm strip:II
25 mm/s; 1 cm/mV
Figure 1.Questions
- What is the cause of his blackout?
- What does the ECG show?