The patient is a 78-year-old man who says he has felt dizzy for several hours. He denies chest pain, shortness of breath, or diaphoresis.

Upon exam, you find:

  • General: Alert and oriented; breathing comfortably
  • Lungs: Clear bilaterally
  • Cardiovascular: RRR without m/r/g
  • Abdomen: Soft and nontender, no pulsatile mass
  • Extremities: No pain or swelling, pulses normal and equal in all 4 extremities


Review the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.


A 78-Year-Old with Dizziness and No Chest Pain, Shortness of Breath, or Diaphoresis
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