Cardio Case Challenge: Syncope in a 53-Year-Old Woman With Dyspnea and Morning Chest Pain

Maria Cristina Bravi, MD, PhD


April 18, 2022

Editorial Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 53-year-old woman with a history of hypertension, hyperlipidemia, active tobacco use, and obesity presents to the emergency department (ED) with a 1-week history of chest pain and dyspnea. She notes associated symptoms of weakness, dizziness, and syncope. The symptoms have been gradually progressive over the course of the week. On the day of presentation, she had an episode of chest pain at rest during the early morning hours, which prompted her to seek medical attention.

She has not taken any medications for her symptoms outside of her chronic angiotensin-converting enzyme (ACE) inhibitor and statin therapy. The patient does not report any significant family history of arrhythmias, cardiomyopathy, or sudden cardiac death. She does note use any illicit drugs.


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