Syncopal Event with a Bruised Sternum
A 41-year-old African American man presents after a syncopal event that occurred while driving a car. The patient was involved in a head-on collision and had a bruised sternum.
The physical exam is remarkable for a well-developed 41-year-old man in no acute distress. Neck veins are not elevated and carotid pulses are symmetric and normal in caliber. Lungs are clear to auscultation bilaterally. Cardiac exam reveals a point of maximum impulse displaced to the anterior axillary line. There is a normal S1 and S2 with no murmurs, rubs, or gallops. There is no peripheral edema.
An echocardiogram is ordered to assess left ventricular (LV) systolic function (Videos 22-1 to 22-4).
QUESTION 1. Which of the following studies should be performed to clarify the diagnosis?
A. Repeat echocardiogram with LV contrast
B. Myocardial perfusion single-photon emission computed tomography
C. Coronary angiography
D. Coronary computed tomographic angiography
E. Tilt table test
View Answer
ANSWER 1: A. The patient has a markedly depressed LV systolic function with marked LV hypertrophy. Although working up ischemia with a myocardial perfusion study, coronary angiography, or coronary computed tomographic angiography may be indicated, the best first step would be to perform an echocardiogram with LV contrast (Videos 22-5 to 22-7). There is no indication for tilt table testing.
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