Problem:
Clinical Presentation: A 71-year-old man presents to the ER after a syncopal episode witnessed by the patient's wife and friend at church this morning (approximately 25 minutes prior to arrival). He had stood up to sing a hymn and then suddenly lost consciousness and began to fall, but he was caught by his friend standing next to him. His wife also witnessed the event and states he was unconscious for approximately 5 minutes after being lowered to the floor. His wife states that prior to the event the patient stated that he "wasn't feeling well" but he could not specifically state what was bothering him. When he woke with brief post-syncopal confusion without prolonged postictal state for less than a minute but then appeared to be himself. There were no abnormal movements seen before or after the syncopal episode, he did not strike his head/neck, and has no prior history of syncope. Over the last several months his wife reports the patient's progressive fatigue, lightheadedness, and decreased exercise tolerance over several months raise concern for chronotropic incompetence associated with underlying conduction system disease. He no longer can mow the grass or rake the leaves due to feeling weak and lightheaded. He denies chest pain/pressure, headache, fever/chills, nausea, or vomiting. He denies any medical history except mild osteoarthritis and only takes Tylenol as needed for pain. Vital signs: Temp 97.0F, heart rate is regular 32 bpm, blood pressure 98/68 mmHg. Need Assignment Help?