Question

A 67-year-old man with no significant medical problems passes out at a cookout soon after standing up to go to the bathroom. He had recently finished his barbecue dinner and admits to having consumed three beers. He denies any previous syncopal episodes. His complete physical examination reveals a very healthy-appearing man with no abnormal findings. His ECG is normal. What should you do?

1) Admit him to the hospital for telemetry monitoring.
2) Refer him to a cardiologist for intracardiac electrophysiologic studies.
3) Schedule an exercise treadmill cardiac stress test.
4) Reassure him and follow up with him in clinic again later in the week.

Answer 1

The man's fainting episode is possibly due to orthostatic hypotension or a vasovagal response, and an initial conservative approach with follow-up is advised. Invasive cardiac evaluations or immediate hospitalization are not necessary based on the information provided. A stress test could be considered if symptoms recur or worsen.

Step-by-step explanation:

A 67-year-old man with no significant medical problems faints after standing up post-meal and alcohol consumption. With a normal ECG and physical examination, the most likely cause of syncope could be orthostatic hypotension or a vasovagal response, potentially exacerbated by the effects of alcohol and a postprandial state. Immediate hospitalization or invasive cardiac investigations might not be necessary unless further symptoms are observed. Instead, reassuring the patient, advising on moderate alcohol consumption, and scheduling a follow-up appointment can be appropriate actions. Additionally, monitoring for recurrent episodes and considering other noninvasive evaluations, if symptoms persist or worsen, would be prudent.

If further investigation is warranted, a stress test like administering thallium-201 during a treadmill exercise could be beneficial in assessing cardiac function and blood flow under stress. However, this should be guided by further clinical assessments and should not be the first course of action in this case.