A 32-year-old man presents to the emergency department for a syncopal episode that occurred while standing and waiting to use the bathroom about 2 minutes after having sexual relations with his spouse. She was sitting on the toilet with the door ajar and saw him lose consciousness and fall. There was both incontinence of urine and “shaking” that the wife thinks was a seizure.
The patient denies any injury, headache, chest pain, palpitations, or other complaints. He has no history of seizure or fainting and is otherwise healthy and takes no medications.
Vital signs including temperature were normal. Head and neck exam showed no evidence of trauma or tongue biting. The lungs were clear and the heart regular with normal valvular sounds. The rest of his physical exam including a thorough neurologic exam was normal.
-- Vasovagal episode
Laboratory studies: CBC and chemistry including magnesium were all within normal limits.
ECG: Tracing shown below in Figure 1. It was read by the computer as atrial fibrillation.
1. Do you agree with the computer read?
2. Do you note other ECG findings?
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