Fainting on Center Stage

A 29-year-old woman presents to the emergency department after a transient loss of consciousness. She reports feeling lightheaded shortly after beginning a presentation at an academic conference. Four minutes into her presentation, she felt a vague flushing sensation and nausea while standing at the podium. She was able to steady herself at the podium but then fell to the floor. She did not sustain any significant trauma, and her colleagues who witnessed the event reported that she was only unconscious for a "few moments." When she regained consciousness, other than feeling profoundly fatigued, she was alert and oriented to herself and her surroundings. She has no prior history of syncope or known seizure disorder, and no significant past medical history.

Vital signs upon presentation include temperature 36.2°C, heart rate 64 bpm, and blood pressure 112/72 mm Hg. She does not have orthostatic vital sign changes. Her electrocardiogram (ECG) reveals sinus rhythm with a normal QRS axis in the frontal plane, normal intervals, no evidence of pre-excitation, no suggestive signs of chamber enlargement, and no ST/T-wave abnormalities. A complete blood count and metabolic panel are within normal limits. Her echocardiogram reveals normal left ventricular (LV) size, thickness, and systolic function with no significant valvular pathology.

She reports that her 35-year-old male cousin was diagnosed with Wolff-Parkinson-White syndrome 6 months earlier, after he presented with palpitations and near-syncope and underwent catheter ablation. She is anxious about her faint and is inquiring about the next steps of her care.

Which one of the following should be pursued?

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