A 20-year-old female college student was seen in the university student health center following a fainting spell while walking to class, and the third episode in 2 months. The social history was negative for recreational drugs. She was not taking any medications on a regular basis. On physical examination, her blood pressure was 110/70 mm Hg, pulse 70/min, respirations 18/min, height 5 ft 5 in (1.63 m), and weight 120 lb (54 kg). Carotid sinus pressure or massage failed to produce an attack. Chest X-rays, electrocardiogram (ECG), and echocardiogram were negative. Laboratory tests revealed sedimentation rate and high-sensitivity C-reactive protein (CRP) at normal levels. A 24-hour Holter monitor revealed no rhythm or repolarization abnormalities. The patient was reassured and told to return to the health center if symptoms recurred. Approximately 1 month later, the student was jogging on campus...

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