An 85-year-old man has had 2 separate syncopal episodes that occurred suddenly and without warning. On the fi rst occasion, he was talking to his daughter on the phone—then he was lying on the fl oor....

An 85-year-old man has had 2 separate syncopal episodes that occurred suddenly and without warning. On the fi rst occasion, he was talking to his daughter on the phone—then he was lying on the fl oor. Recovery was immediate, but he injured his left hand. On the second occasion, he was in the kitchen making a sandwich. His daughter was present and was able to break his fall. She noted that both arms made jerking movements, which resolved when he was placed into a recovery position on his left side. On both occasions, a full recovery occurred within a few minutes without sequelae. On examination, the patient was fully orientated and appeared younger than his age. His heart rate and blood pressure were satisfactory, but his systolic pressure decreased by 10 mm Hg on standing. Bilateral carotid bruits and a harsh 3/6 ejection murmur were present. Th e murmur was loudest at the left sternal border, with some radiation into the neck. Reversed splitting of the second heart sound (separation during expiration rather than inspiration) was also present, but no diastolic murmur was heard. Th ere was no evidence of jugular venous distention, and his lungs were clear, but a small amount of peripheral edema was present. Gait was normal and there were no neurologic signs of note. Th e electrocardiogram is shown in Figure 2.Q3. Th is patient’s presentation is most consistent with which of the following? a. Cardiogenic syncope b. A possible seizure disorder c. Stroke or transient ischemic attack d. Neurocardiogenic syncope e. Orthostatic response