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 …show more content…
• 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 …show more content…
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
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Presented is Milton Larsen, a 84 year-old African American veteran who lives with his step-daughter Dina in a small home. Mr. Larsen’s bedroom is located in the basement, where he spends most of his time with his cat Snuggles. The objective data gathered from Milton Larsen’s case scenario is as followed: a medical diagnosis of hypertension and left knee osteoarthritis. He is prescribed metoprolol tartrate and spironolactone for his hypertension and he takes ibuprofen for aggravation of the left knee related to frequent trips to the upstairs bathroom. At a recent visit to his primary care physician Milton Larsen stated the following subjective data “Dina gets mad at my cat and takes it out on me.”
The only known heart problems were rheumatic fever and "soldier's heart". Doctors would rely on the methods of percussion and
1. There are several outcomes anticipated for Mr. A. Foremost, stabilizing a number of conditions reported to be fluctuating is the first prioritized outcome. Such conditions include: respiratory rate (12-20 breaths/min), blood pressure (below 120/80 mm Hg), complete ceasing of crackles in the bases, normalized heart rate (60-100 beats/min), reduced and stable body temperature (97.8-99o F), hemodynamic stability, and general normalized parameters determined via ABG analysis (that is, arterial pH in the ECF of about 7.35–7.45, PaO2 of 80–100 mm Hg, PaCO2 of about 35 – 45 mm Hg, HCO3 21–28 mEq/L, and SaO2 or 95%-100%. Also, all possible infections have to be prevented and/or treated. Finally, fluid balance maintenance is also an outcome.
Due to the loss of inhibition from the substantia nigra through the basal ganglia there is detrusor hyperactivity (American College of Physicians, 2012). This causes urinary symptoms related to difficulty in voiding, nocturnal polyuria, incontinences, and urinary retention. Sexual dysfunction in men and women is reportedly related to the length and severity of the disease; men have more difficulty with erectile dysfunction and women with inability to reach an orgasm. Complications would be urinary tract infection related to voiding problems such as incontinence and retention. There are dysfunctions of the thermoregulatory system due autonomic system and the presence of Lewy bodies in the hypothalamus (American College of Physicians, 2012).
Vasovagal Syncope, Pediatric Syncope, commonly known as fainting or passing out, is a temporary loss of consciousness. It occurs when the blood flow to the brain is reduced. Vasovagal syncope, also called neurocardiogenic syncope, is a fainting spell in which the blood flow to the brain is reduced because of a sudden drop in heart rate and blood pressure. Vasovagal syncope occurs when the brain and the cardiovascular system (blood vessels) do not adequately communicate and respond to each other. This is the most common cause of fainting.
This type of shock occurs when the heart is unable to pump blood effectively. This is evident to patients who have had myocardial infarction, such as John’s case. In this illness, the heart has decreased contractility resulting to decreased cardiac output. Such decrease will stimulate the sympathetic nervous system to activate the compensatory mechanism by increasing the heart rate as evident in John’s vital sign to increase the peripheral pressure and ventricular
Many problems can lead to lack of blood some include: problems with the lungs, airways leading to the lungs, heart problems, drug overdose, and exposure to cold water or air. One is “Tetralogy of Fallot, Which is the most common cyanotic heart defect seen in children beyond infancy. Tetralogy of Fallot is also the most common cyanotic congenital lesion that is likely to result in survival to adulthood and thus is the most common complex lesion to be encountered in the adult population after repair. The original anatomic description of tetralogy of Fallot included a tetrad of malformations: ventricular septal defect, right ventricular outflow tract obstruction, aorta overriding the ventricular septum, and right ventricular hypertrophy.” (Jacobs,
But the staff understood and Dr. Westwood got an ambulance and reached to ED. He presented with diaphoresis, motor dysfunction, paresthesia, nausea, and ascending paralysis from his leg to the upper body, arms, face and head. He became cyanotic and hyperventilating and it turned to be bradycardiac with a BP 90/50mmHg. After five hour long clinical treatment procedures were followed for tetrodotoxin poisoning, his vital signs were
The patient is a 56 year old woman who is brought to the emergency room by her family because of change in mental status. This patient has had previous admissions for similar episodes with change in mental status. She has a past history of a hypoglycemic coma, as well as the sequelae of dementia and the old chart relates that she has had dramatic brain injury with severe depression. She has been on Paxil in the past. EEG done recently in this past May shows normal wave sounds with any proximal features but she does have significant sequelae as her baseline although findings in the past noted her to be only oriented x1.
Later during discussion with the team to rule out the reason of Brady arrest, patient history was reviewed. Through that I came to know that patient came with the complain of chest pain and SOB in ER .Initially angina protocol was conducted and patient was diagnosed with NSTEMI according to the 2010 AHA guide line .After initial diagnostic procedure and after initial management, patient was shifted to CCU for further management .while reviewing patient 24 hours condition .I was identified that in routine ECG .There was ST elevations in inferior leads that is T wave inversion in leads 2 ,3 and AVF .This