Wrap Up

• Mrs. R's ECG showed complete AV block with a ventricular rate of 29 when she arrived at the hospital.
• Her syncope was likely caused by a prolonged period of ventricular asystole (with high degree of AV block). She regained consciousness because of the resumption of an escape rhythm, although quite slow.
• The possibility of a "silent" myocardial infarction was ruled out and a permanent pacemaker was implanted.
• Her history was consistent with cardiogenic syncope due to a profound bradyarrhythmia.
  • Advanced age
  • Single episode
  • Sitting postion
  • Instantaneous onset with no warning
  • Injury to head and arm
  • Loss of bladder control
  • Brief recovery time