H1n1-Associated Sinus Node Dysfunction

A 51-year-old previously healthy man presented to the emergency room following an episode of presyncope. He had a history of fever, pleuropericardial chest pain and dyspnoea accompanied by important myalgia evolving over several days. His past medical history was negative for any cardiovascular or pulmonary disease, and he was a lifelong non-smoker. He was previously very active with an excellent exertional capacity. His physical exam showed no frank heart failure, and he was haemodynamically stable.Laboratory results showed increased inflammatory markers including an erythrocyte sedimentation rate of 35 mm/h (normal 2–26 mm/h) and a C-reactive protein of 17 mg/L (normal 0.2–7.6). There was also a leucopenia at 3.7×109/L (normal 4.0–11.0) with a subtle lymphopenia of 0.9×109/L (normal 1.0–4.0) and a light thrombocytopenia of …