Patient's Case Study: Syncope

CASE STUDY
INTERNAL MEDICINE: SYNCOPE

MICHAEL RAMARA
27419399
22 SEPTEMBER 2014
Table of Contents
1. Patient’s Case Information.
2. Introduction to Syncope.
3. Epidemiology.
4. Pathophysiology and Etiology.

4.1. Vasovagal Causes.
4.2. Orthostatic hypotension.
4.3. Cardiac causes.
4.4. Cerebrovascular causes.
4.5. Other causes.

5. Approach to the diagnosis.

5.1. Is it cardiac or not?
5.2. Investigations.

6. Treatment.
7. Prognosis.
8. Conclusion.
9. References.

1. PATIENT’S CASE INFORMATION

A 19 year old black male patient (Siyabonga Nkosi, from Tembisa) was admitted to SBAH Internal medicine with history of syncope (2 episodes on different occasions), now occurring for the third time, it is associated with loss of consciousness and
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• Inefficient pumping action.
• Loss of arteriolar tone.
• Abnormalities in volume and constituents of circulating blood.
• Local disorders of the central nervous system.

>These are the causes in order of the most common to the less common:

4.1. Vasovagal causes:

This group is the most common etiology of syncope as it accounts for approximately 30–80% of all syncope episodes . It can be caused or provoked by several stimuli. The specific stimulus can be difficult to characterize, can be highly individualized, and can vary by physical and emotional state. Emotional stresses alone are common triggers and distinctly human (examples such as perception of danger, fear, or anxiety).The responsible reflex causing syncope can be “normal” and may be self-limited.

4.2. Orthostatic
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Orthostatic hypotension has many etiologies but the baseline is that it is generally caused by a dysautonomic syndrome, drugs, volume depletion or a combination of a variety of factors.

Peripheral autonomic (sympathetic) denervation, resulting from systemic diseases can prevent needed peripheral vasoconstriction with standing, diseases such as diabetes and amyloidosis. Other diseases are Parkinsonism , and Addison’s, porphyria, tabes dorsalis, syringomyelia, spinal cord transection , Guillian–Barré syndrome, Riley–Day syndrome, surgically induced sympathectomy, pheochromocytoma, multisystem atrophy, Bradbury–Eggleston syndrome, and the Shy–Drager syndrome (which is also known as idiopathic orthostatic hypotension). There is a variety of medications that can cause syncope by causing orthostatic hypotension and other mechanisms also leading to syncope. These are vasodilators (such as hydralazine, nitrates, angiotensin-converting enzyme inhibitors), adrenergic blockers and adrenergic stimulants, diuretics, tricyclic antidepressants, phenothiazines, and others, can cause orthostatic