A 68-year-old man is brought in by his wife after his third collapse in a month. Each time he has been sitting watching television, has suddenly gone grey and slumped without any warning, and has come round within a minute, fully alert and able to continue the conversation. He denies palpitations or chest pain and has never collapsed on exertion. He takes amlodipine for hypertension. Examination is unremarkable, with no murmur and no postural fall in blood pressure. His electrocardiogram in the clinic shows sinus rhythm at 58/min, a PR interval of 0.24 seconds, a QRS duration of 0.14 seconds with an rSR' pattern in lead V1, and a frontal-plane axis of −45 degrees.
Which one of the following is the most likely cause of his collapses?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Cardiovascular
See allA 76-year-old man reports that for three months he has felt light-headed and has twice nearly fainted walking up the hill to the shops, together with a tight fe…
Pre-internship · common
A 34-year-old man who injects heroin presents with two weeks of fevers, sweats, a cough and pleuritic chest pain on both sides. His temperature is 39.2 °C, puls…
Clinical rotations · middle twist
A 52-year-old Aboriginal woman from a community in Cape York presents with a week of palpitations and breathlessness on walking to the store. She had several ep…
Pre-internship · middle twist
A 79-year-old woman is admitted with ongoing lower gastrointestinal bleeding and a haemoglobin concentration of 72 g/L (reference range 115–155). She is receivi…
Pre-internship · middle twist
A 52-year-old man attends for a health assessment. He does not smoke, has no diabetes, chronic kidney disease or established cardiovascular disease, and his fat…
Clinical rotations · middle twist