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62YO female fainted on the MRT (Post-incident (Cardiac parameters…
62YO female fainted on the MRT
Pre-incident
Dizziness/light-headedness
Nausea, diaphoresis, pallor, yawning => vasovagal syncope. Other Sx: visual "blurring" preceding temporary darkening
Tunneling vision (loss of peripheral vision)
Palpitations => Cardiac syncope: often unprovoked. Other Sx: known cardiac disease, family h(x) of sudden cardiac death
Past medical history
Multiple comorbids, poor oral intake => Postural hypotension. REFER TO POST-INCIDENT FOR PE. Other causes: autonomic dysfunction, medications, volume depletions
Volume depletion usually due to hyperglycemic polyuria, GIT fluid losses, drugs, adrenal insufficiency
Iatrogenic: vasodilators (e.g. calcium channel blocker), anti-hypertensives, antidepressants, diuretics causing iatrogenic volume depletion
Use of pacemaker => Pacemaker malfunction
Frequent episodes of syncope: correlate s(x) with rhythm with Holter monitor (24-48h ECG) etc. Infrequent: insert implantable loop recorder
Post-incident
Blood pressure
Postural hypotension => Decrease in SBP at least 20mmHg or decrease in DBP at least 10mmHg on standing for 3 min. Might have compensatory increased HR. Absence => autonomic failure or blockade (beta-blocker)
Cardiac parameters
Tachycardia => SVT, VT if HR > 200
Bradycardia => Stokes-Adams attack.
Carotid sinus massage positive (ventricular pause longer than 3 seconds/decrease in SBP of at least 50mmHg) => Carotid sinus hypersensitivity
Abnormal cognition, speech disturbance, sensory-motor deficiencies => neurologic etiology, e.g. vasovagal
Recovery is complete and rapid, patient alert when awake => Syncope. Post-ictal confusion, drowsiness, headache => Seizure. Other Sx: tongue laceration, witnessed abnormal posturing
Fatigue for extended period => vasovagal/reflex syncope. Refer to PRE-INCIDENT for other s(x).
Abrupt-onset syncope, short duration, no autonomic-mediated prodrome/post-episode fatigue => syncope associated with arrhythmia