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MKSAP 17 Q&A
A 59-year-old man is evaluated in the emergency department for an episode of syncope. He experienced lightheadedness upon arising from a chair, which was followed by a witnessed transient loss of consciousness. He was immediately arousable and alert within 10 seconds. There was no loss of bladder or bowel function. He was otherwise asymptomatic prior to the event. Medical history is significant for hypertension and poorly controlled type 2 diabetes mellitus. Medications are benazepril, insulin glargine, and rosuvastatin.
On physical examination, the patient is afebrile. Blood pressure is 147/72 mm Hg supine and 120/76 mm Hg standing, pulse rate is 72/min supine and 94/min standing, and respiration rate is 14/min. BMI is 27. There is no jugular venous distention. Cardiopulmonary and abdominal examinations are normal. On neurologic examination, he is alert and oriented. Neurologic examination is unremarkable except for decreased sensation to touch in the feet bilaterally.
Laboratory studies are significant for a plasma glucose level of 338 mg/dL (18.8 mmol/L).
A 12-lead electrocardiogram shows normal sinus rhythm with normal axis and intervals and no acute ST- or T-wave changes.
Which of the following is the most likely cause of this patient's syncope?
A: Orthostatic hypotension
B: Seizure
C: Silent cardiac ischemia
D: Ventricular arrhythmia