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From Bradycardia to Tachycardia: Complete Heart Block

      Syncope in the setting of heart block is usually, but not invariably, due to bradycardia. This point was underscored when a patient's telemetry data proved surprising. The patient, a 74-year-old man with no history of cardiac disease, initially presented to an urgent care facility after noting an elevated reading on his home blood pressure monitor. He described a 4-week history of dyspnea on exertion and poor exercise tolerance but denied dizziness, syncope, chest pain, orthopnea, lower-extremity edema, or other symptoms. His medical history included obstructive sleep apnea, prostate cancer in remission, and gastroesophageal reflux disease, for which his only medication was ranitidine. He denied any use of tobacco or illicit drugs. His brother died of sudden cardiac death before the age of 50 years. The patient was a resident of the Pacific Northwest, and he had recently travelled to South America.
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