So the other night I took care of this guy who came in to the ER after having a couple syncopal episodes at home. He was a healthy guy with minimal medical history. Didn't take any meds at home, nothing. He even looked ridiculously healthy... tanned, muscled... looking in much better health in his late 40s than I am in my late 20s.
So he had these two syncopal episodes at home. One was unwitnessed; he just woke up on the floor feeling sweaty, but felt better so quickly he didn't even mention it to his wife. The second episode was witnessed by his wife... she described his eyes rolling back in his head and a period of unresponsiveness for approximately one minute. Again, he returned to normal very quickly, but since this had now happened twice (he told her about the first episode at this point...) the smart wife made him go to the ER.
So why am I writing a whole post about a guy having syncopal episodes? Because as the ER discovered and then I got to witness a bit later... this gentleman's fainting spells were actually 15 to 35 second asystolic events. For real. Legit asystole. Pulseless, apneic, flatline asystolic events. He even got some CPR a couple times.
Like sinus rhythm... sinus rhythm... sinus rhythm ______________ _______________ asystole _____________ ___________________ _________________ sinus rhythm... sinus rhythm...
I saw it with my own two eyes. He didn't brady down. He didn't go into any sort of block. He didn't have any ventricular escape beats or errant P waves. It was just sinus rhythm straight into asystole straight back into sinus rhythm. As if both his SA and AV nodes both just decided to simultaneously take a break and then come back.
We put a transvenous pacer in him ASAP. Then he got a real pacemaker in the am.
What do we think caused this? Seems neuro to me...? Seems like an odd cardiac coincidence for both the SA and AV node to not work simultaneously and come back simultaneously.
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