Patient case (clinical description): A 23-year-old man comes to the emergency department following an episode of syncope.  He was working out when he felt dizzy and passed out without head injury.  He has had 3 other episodes of light-headedness over the last year, all happening during physical activity. He never had this experience while resting. He has no other medical conditions.  The patient does not use tobacco, alcohol, or illicit drugs.  His father died suddenly at age 35.  Vital signs are within normal limits.  On physical examination, the patient has a harsh systolic murmur.  The lungs are clear with no peripheral edema. Echocardiography shows asymmetric interventricular septal hypertrophy.

Patient's own account: I'm 23, and I got admitted to the ER because I fainted all of a sudden. I was in the gym, working out, when all of a sudden, I just got dizzy and passed out. Hopefully, I didn't hit my head. It's not my first time having that kind of dizziness at the gym, never when I'm chilling at home tho. I don't have any special medical conditions and I'm not even smoking, drinking or doing drugs! My dad died suddenly when he was 35, so I'm kind of scared. My vitals were normal while at the ER and they did a physical exam and they told me my heart sounds abnormal. My lungs are ok, but I had to do an echography of my heart, and they told me it is bigger than average.

Clinical trial: Practical Approaches to Care in Emergency Syncope

Eligibility criteria:
Inclusion Criteria:

          -  Adult patients 40 years of age or older who present to the Emergency Department with
             syncope or presyncope.

          -  Subjects must read and speak English or Spanish.

          -  Subjects must have a working phone number and fixed address.

        Exclusion Criteria:

          -  Patient who have a syncope mimic such as seizure, stroke, head trauma with loss of
             consciousness, altered mental status, hypoglycemia, intoxication, or require an
             intervention to restore consciousness.

          -  Patients who have a new serious diagnosis found in the Emergency Department, such as
             death, significant cardiac arrhythmia (see below), myocardial infarction, significant
             structural heart disease, stroke (both ischemic and hemorrhagic), pulmonary embolism,
             aortic dissection, hemorrhage or anemia requiring blood transfusion, subarachnoid
             hemorrhage, cardiopulmonary resuscitation, acute surgical illness, pregnancy, or major
             traumatic injury.

          -  Significant cardiac arrhythmia includes Ventricular Fibrillation, Ventricular
             tachycardia (>30 secs), Symptomatic ventricular tachycardia, (<30 secs), Sick sinus
             disease with alternating sinus bradycardia and tachycardia, Sinus pause > 3 seconds,
             Mobitz type II atrioventricular heart block, Complete heart block, Symptomatic
             supraventricular tachycardia (including PSVT, rapid atrial fibrillation/ flutter),
             Symptomatic bradycardia (pulse<40), Pacemaker or implantable
             cardioverter-defibrillator malfunction with cardiac pauses.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 40 Years old.


Eligibility (NLI label): Contradiction