WEEKLY CASE #2

 A 52-year-old man presents to the emergency department with recurrent episodes of dizziness and near syncope for the past 2 months. These episodes are often triggered while turning his head to the right. He also reports a dull, intermittent pain in the right side of his neck which goes to his ear, and worsens if his partner touches it.

On examination:

• Pulse: 48/min (regular)
• BP: 110/70 mmHg
• Mild tenderness over the right tonsillar fossa

An ECG shows:

• Sinus bradycardia
• Occasional second-degree AV block (Mobitz type I)

Cardiac enzymes are normal. Echocardiography is unremarkable.

A carotid sinus massage reproduces his symptoms along with further slowing of heart rate.

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❓ What INVESTIGATION would you do for the symptoms involved? What explains the symptoms?

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