Jesse is a 26-year-old office worker and a new patient. He is a walk-in and requests an appointment after experiencing a brief syncopal episode 30 minutes earlier.

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<p>Jesse is a 26-year-old office worker and a new patient. He is a walk-in and requests an appointment after experiencing a brief syncopal episode 30 minutes earlier.</p><p>Jesse reports a three-day history of sore throat and fever but he attended work despite this because of an important meeting.</p><p>Immediately prior to the syncopal episode, which occurred while seated, Jesse developed shortness of breath, nausea and dizziness. This was followed by loss of consciousness lasting less than a minute, witnessed by co-workers, with no associated seizure or post-syncopal confusion.</p><p>Jesse is usually well. He reports he has previously had a similar episode shortly after a swim session, which was thought to be vasovagal and not further investigated. He takes no medications. There is a family history of sudden death of unclear aetiology in a maternal uncle aged 30.</p><p>The practice nurse performs an ECG and vital signs — which show a regular heart rate of 96bpm, blood pressure of 100/64mmHg and temperature of 37.8°C — before the GP’s review. The result is pictured.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.