Syncope in a 20-something woman

A 20-something was outside exerting herself.  She states that  it was hot outside and that she was probably dehydrated. At one point, she felt lightheaded and then can ' t remember anything until waking up in the ambulance.  Her friends saw her lose consciousness and fall on the ground.  She regained consciousness spontaneously before responders arrived. Fire department was on scene first, who noted a cyanotic color to the patient ' s face.  EMS arrived and also noted cyanotic color which improved en route to HCMC. She denies head pain, neck pain, back pain, abdominal pain or any pain at this time.  There was no nausea or vomiting.In the ED her exam was normal.  All vital signs were normal, with a pulse of 65.Here is her ECG:Computer interpretation: borderline long QT intervalWhat do you think?Physician assessment (who apparently took the computer read as truth): "ECG had borderline prolonged QT interval, but otherwise did not have signs of arrhythmia or RH strain (Pulmonary embolism) that would be underlying cause of syncope. "Should we believe the computer ' s assessment?  Never!  When you have ANY suspicion that the QT is prolonged on visualizing the ECG, you must measure it.  The computer is often wrong.Here I measure the QT:One should measure the longest QT of the 12 leads.I did not do that, but just chose one that looked longSee the 2 black lines at the beginning of the QRS and end of the T-wave.This measures a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs