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An elderly woman with recurrent syncope
  1. Anunay Gupta,
  2. Gaurav Kumar Arora,
  3. Hermohander Singh Isser
  1. Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
  1. Correspondence to Professor Hermohander Singh Isser, Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India; drhsisser{at}

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Clinical introduction

A woman in her 70s without any prior cardiac illness presented with recurrent syncope for a week. There was no history of prodrome, emotional stressors or palpitations. Her blood pressure was 130/88 mm Hg, with a regular pulse rate of 70 per minute. She has not been on any medication previously. She had a witnessed syncope in the emergency room. A 12-lead surface ECG was recorded (figure 1). Her laboratory investigations, including full blood count, renal function tests, serum electrolytes and liver function tests were normal. A bedside echocardiogram showed a structurally normal heart and normal biventricular function.

Figure 1

12-lead ECG at presentation. aVF, augmented vector foot; avL, augmented vector left; aVR, augmented vector right.


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  • Contributors AG and GKA contributed equally to the manuscript and are joint first authors. All authors contributed to the design, data collection and draft preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.