An 80-Year-Old Man With Lightheadedness

Ryland P. Byrd, Jr, MD;  Ehab S. Kasasbeh, MD;  Jonathan W. Burress, DO


December 08, 2017

Physical Examination and Workup

Upon physical examination, the patient is afebrile, with a blood pressure of 125/67 mm Hg, a pulse of 75 beats/min, a respiratory rate of 20 breaths/min, and an oxygen saturation of 91% while breathing room air. The patient appears younger than his stated age. He is in no acute distress.

The neck examination shows no appreciable jugular venous distention or carotid bruits. His heart sounds are remarkable for a regular heart rhythm, with frequent skipped beats and a slightly accentuated second heart sound. No murmurs, rubs, or gallops are appreciated. Auscultation of his chest reveals distant breath sounds with no wheezing, crackles, or rhonchi. No peripheral edema of the lower extremities is observed. The remainder of the physical examination is unremarkable.

A panel of preoperative blood tests and an ECG are ordered. While the patient is waiting in the preoperative holding area, he experiences an episode of lightheadedness. Upon noting a rapid pulse, a technician attaches leads to obtain a cardiac rhythm strip and an ECG. The patient's blood pressure is recorded at 80/46 mm Hg. A 12-lead ECG is obtained (Figure 1).

Figure 1.


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