An 82-year-old Male with Syncope

An 82-year-old man with a history of bilateral carpal tunnel syndrome presented following a sudden syncopal event without a prodrome. Upon admission, an electrocardiogram revealed tri-fascicular heart block requiring a cardiac pacemaker implantation. An echocardiogram demonstrated concentric left ventricular hypertrophy and grade II diastolic dysfunction (figure 1); these findings, coupled with the absence of hypertension, prompted consideration of an infiltrative cardiomyopathy.