An unusual case of syncope

A 65 year old female with diabetes and hypertension presents to your emergency department after an episode of syncope.  She was sitting, holding a baby, when she suddenly lost consciousness and fell forward onto the floor.

What more do you want to know?  What would you order at this point?

She had no preceding symptoms and no history of similar. Per family, she did not have any seizure-like activity or a period of confusion following the incident. Her review of systems is negative aside from occasional shortness of breath following a coughing fit.

Her exam is unremarkable aside from a blood pressure of 164/52.

CBC, BMP, chest x-ray, and troponin are unremarkable.

EKG:  Sinus bradycardia at 58bpm, no ectopy, no ST changes, no TWI, normal intervals, no delta wave, no Brugada.

What would you do next?

You spot the ultrasound in the next room over and decide to take a look:

You are concerned the hyperechoic mass you see on the mitral valve may have caused her syncope, so you consult Cardiology and admit the patient for further workup.

Cardiac MRI reveals a 12mmx13mm lateral annular mitral calcification.


Annular Mitral Calcification


  • Chronic degenerative changes to mitral valve that occurs with aging
  • Occurs in people over the age of 65
  • Same risk factors as CAD
  • Can interfere with AV node and lead to brady dysrrhythmias
  • Often asymptomatic, requiring no treatment

Your patient does well in-house and is soon discharged home with an implantable loop recorder and close Cardiology follow up.



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