Syncope, Final Year Oral Exam

[Samer Q N]

One of the questions that were asked last year in that final exams to 6th graders was this one:

A final year female medical student complained fo two simillar attacks beginning with palpitations and briefly afterwards loss of consciousness, the patient was taken to the ER both times, Clinical exam was normal, ECG was normal. The patient would wake normally after each attack complaining of nothing.

[COLOR=purple]How do u manage this patient?[/COLOR]

[cytotoxic]

This girl is having syncopal attacks due to anxiety ( as most other 6th graders do ! )
Reassurance of the girl is enough , I think!

DDx of syncpal and presyncopal attacks include :
1- Cardiogenic
( involving severe pallor of patient and rapid recovery)
2-Vasovagal
( with nausea and recovery lasts minutes )
3-Neurogenic
( with confusion )


am I right samer or i went far away?

[Aljubouri83]

Could be :
- Thyrotoxicosis ..
- Epileptic fit ( palpitation was the aura ) ..

That's all I can give ..

[Samer Q N]

Ok the question doesnt give us much, but the palpitations make us think of cardiogenic syncope which is probably arrhythmia occuring in a paroxysmal manner.

I think that the patient should be put on Holter monitor [24 hour ECG recording], but should we give her an antiarrhythmic drug like amiodarone or not i dont really know, what i know is that ventricular arrhythmias are the commenest cardiogenic cause of syncope. And these are pretty serious.

any Ideas?

[alisagban]

You went so far my friend; thing of simple causes first and remeber; don't perscribe any antiarryth dgs to asymptomatic patients. Although, the question hasn't given much information but think of Aortic stenosis especially in young patients who faint after tachycardia

I don't kno... first line of management is ABCDE; attache moniter and listen for the heart, but echo will give the final answer if we tempt to thing of AS

I don't kno........ i am ent man

[Samer Q N]

Hi ali, in cases of aortic stenosis patients often develop syncope with exertion and this patient doesnt have such a history plus the physical examination of a symptomatic aortic stenosis will often be revealing.

anyhow, the doctor wanted the arrhythmia answer but the management is bothering me.

[Dr.Leo1984]

thanx doctors for this discussion... but i thing it's vasovagal shock..

[Nader]

transit attacks of SVT or AF due to exessive coffe intake

because now she is asymtomatic,we cant use any Antiarhythmic drugs unless we have definte Dx.
so put her on 24h ECG
otherwise do nothing unless you want to do ECHO if u suspect stractureal abnormality

[kenzo]

i think it is TIA caused by AF
we saw a similar case, mx is by putting the patient on Holter monitor to confirm the diagnosis and then start treatment..

regards,

[dr_cardio]

[SIZE=14]VASOVAGAL ATTACKs ...sure