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Case discussion 28 yr old male with syncope


Well-known member
Quick one this time.

I have a 28 yr old who had a syncopal episode whilst at work. Describes standing with work mates (not for a long period), felt absolutely fine, and then suddenly blacked out. Regained consciousness on ground surrounded by people, told he was out for a few seconds. Denies any preceding symptoms. No SOB, palpitations, dizziness, sweating. No incontinence, tongue biting or confusion. This has never happened before or since. Totally fit and well otherwise.

He went to an ED on the day and had a (reportedly) normal ECG, CXR and baseline panel of bloods (haven't seen any of these myself).

Physical exam is unremarkable.

I sent him for an echo which was unremarkable other than a mildly dilated left atrium. No other significant structural or valvular abnormalities.

My plan from here was to consider a holter +/- cardiology opinion. I assume the holter will be normal, but was unsure as to whether this would be something that would be useful in any case. Not sure what to make of the mildly dilated left atrium in isolation either.


Would probably do the holter anyway, unlikely to pick up anything if he’s asymptomatic but worthwhile anyway. Not sure what the cardiologists would say though!