A peculiar case of palpitations and syncope

A 20-year-old woman presents with a history of frequent palpitations and has been diagnosed with premature ventricular complexes (PVCs). She reports episodes of presyncope associated with fatigue, dizziness, and blurred vision. She has been diagnosed with dysautonomia syndrome, with episodes of tingling, weakness, abrupt loss of motor tone, and a history of cleft palate repair. Her symptoms occur with exertion or prolonged sitting and have been treated with rest and neck/leg braces. An electrocardiogram (ECG) is recorded at rest and during palpitations (Figure 1).