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An 83-year-old female with past medical history of congestive heart failure and atrial fibrillation presents to urgent care with confusion and syncope. She reports intermittent dizziness, but denies chest pain or shortness of breath. There is no evidence of trauma on exam.              

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

Figure 1. Initial EGC

(Case presented by Jonathan Giordano, DO, MEd, McGovern Medical School Department of Emergency Medicine, UTHealth Houston.)

An 83-Year-Old Female with CHF, A-Fib, and New-Onset Confusion and Syncope