When the wiring wears out

Clinical scenario

A 65-year-old man with a background history of hypertension treated with a calcium channel blocker presents to your surgery the day after having a syncopal attack lasting 30 seconds.

This was associated with drinking four schooners of beer while at a barbecue on a hot summer’s evening when the temperature was above 30°C.

He felt hot and sweaty and then light-headed before going