A patient with normal EKG four days prior presents with syncope and elevated troponin I. What management is indicated based on the EKG findings?

In patients experiencing syncope accompanied by elevated troponin I, this can indicate potential underlying cardiac issues, including significant arrhythmias or electrical disturbances. The normal EKG four days prior helps establish a baseline but does not negate the possibility of acute changes or conditions emerging that can lead to the decreased cardiac function observed with syncope and elevated troponin levels.

The key management step indicated—urgent placement of a cardiac pacemaker—is particularly relevant when there is a suspicion of bradyarrhythmia or heart block as the cause of the syncope. Bradycardia or significant conduction delays may not be immediately evident on a prior EKG, but can arise suddenly due to ischemia or myocardial damage, which can subsequently lead to syncope and elevated troponins resulting from myocardial injury.

While continuous monitoring is often warranted in unstable patients and might be indicated in other scenarios involving arrhythmias, in this specific context where there is strong suspicion of a rhythm disturbance that could be catastrophic, the urgent placement of a pacemaker addresses the immediate need to stabilize the heart’s rhythm and prevent further episodes of syncope. Other treatments such as thrombolytics or radiofrequency ablation would not be appropriate in this acute situation where stabilization is paramount. Thus, the