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A 62-year old female fainted on the MRT this morning. (Neuro (Vasovagal…
A 62-year old female fainted on the MRT this morning.
High risk
Clinical history suggestive of arrhythmia syncope
Comorbidities (e.g., severe anemia, electrolyte abnormalities)
Abnormal ECG findings
Family history of sudden death
Older age
Severe structural heart or coronary artery disease
Orthostatic
Primary or secondary autonomic failure
Parkinson disease, multiple sclerosis, Wernicke encephalopathy, Diabetes mellitus, amyloidosis, uremia, spinal cord injury
Drug induced - Alcohol, insulin or antidiabetic agents, antihypertensives, antianginals, antidepressants, antiparkinsonian agents
cardiac
Arrhythmia
Fluttering or palpitations, Immediate complete recovery
Structural disease
Aortic/pulmonary stenosis pulmonary embolus
Aortic dissection
MI
Chest pain, shortness of breath, dyspnea
Neuro
Carotid sinus syndrome - Head movement, tight collars
Psychogenic- Depression, anxiety, panic disorder, somatization disorders, Eyes closed during event
Vasovagal
Warm/crowded area, pain, emotional distress, fear, Lightheadedness, dizziness, blurred vision, vertigo, nausea, ab pain, pale and clammy
low risk
Age younger than 50 years†
No history of cardiovascular disease
Normal electrocardiographic findings
Symptoms consistent with neurally mediated or orthostatic syncope
Unremarkable cardiovascular examination
seizure
Auras, Tonic-clonic movement, Prolonged confusion, Incontinence, Tongue biting
nutrition status
Volume depletion - Vomiting, diarrhea, poor intake, acute blood loss
Hypoglycemia - Hx of diabetes