Syncopal episodes follow a partial gastrectomy

A patient presents for investigation of his fainting spells

Laurence, 71, is a retired accountant and long-standing patient whose wife, Cheryl, has brought him in because he has experienced syncopal episodes on two evenings in the past week, without any warning.

Laurence has little memory of these events; he recalls feeling light-headed and then waking up some minutes later “feeling washed out”.