Case 3: A Rare Cause of Syncope in an Adolescent Boy.

Abstract

1. Yalile Perez, MD* 2. Ruchi Gupta, MD† 3. Richard Mazzaccaro, MD* 1. *Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA 2. †Department of Pediatric Cardiology, Children’s Hospital of Philadelphia Cardiac Center Allentown, Allentown, PA A 17-year-old Hispanic boy is admitted to the PICU for evaluation after a syncopal episode. He was walking at the mall when he suddenly collapsed and was unresponsive for approximately 30 seconds. The boy has no history of syncope, chest pain, or palpitations but reports occasional dizziness during exertion. He quit smoking cigarettes about 5 months ago but admits to using cannabis. There is no family history of sudden cardiac death or early coronary artery disease. His pulse rate is 72 beats/min, respiratory rate is 12 breaths/min, right arm blood pressure is 137/56 mm Hg, pulse oximetry reading is 99% on room air, and body mass index is 24.8. Physical examination reveals an alert adolescent in no acute distress. He has a small laceration on his lower lip and chin, and both upper central incisors are fractured. His cardiovascular examination yields a grade 2/6 systolic ejection murmur heard best at the left lower sternal border. On palpation, the point of maximal impulse is displaced laterally. The remainder of his examination findings are normal. His comprehensive metabolic panel is notable for a creatinine level of 1.08 mg/dL (95.47 μ mol/L) and normal electrolyte levels. A complete blood cell count is normal. Urine toxicology screen is positive for cannabinoids. His initial troponin is elevated …