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A 62-year old female fainted on the MRT (Non-Syncope (Seizure (Tongue…
A 62-year old female fainted on the MRT
Non-Syncope
Coma
Sleep Disorder
Seizure
Tongue laceration, head turning, abnormal posturing "Did you cut your tongue?"
Metabolic Disorder
Trauma
Stroke
Syncope
Neurologic
Neurogenic
PE: neurologic examination
Psychogenic
Hx of depression, anxiety panic disorder
Cerebrovascular (steal syndrome)
Doing arm exercise before event
Neurally Mediated (Most common)
Situational
Micturition, post-exercise, postprandial, gastrointestinal stimulation, cough, phobia of needle or blood
No heart disease, Hx of similar syncope, prolonged standing, eating a meal or voiding, sudden startle or pain
Vasovagal
(stress, fear, heat)
Premonitory symptoms or precipitating factors
Carotid Sinus (pressure on carotid)
Unexplained falls, abrupt neck movements
Orthostatic
Primary Autonomic Failure
Parkinson disease/parkinsonism, multiple system atrophy (i.e., Shy-Drager syndrome), multiple sclerosis, Wernicke encephalopathy
Occurs after standing up
Secondary Autonomic Failure
Diabetes mellitus, amyloidosis, uremia, spinal cord injury, chronic inflammatory polyneuropathy, connective tissue diseases
Occurs after standing up
Drug Induced
Initiation or change in meds
Volume Depletion (vomiting, diarrhea, poor intake, blood loss)
Hx of blood loss, hypotension PE: Hypotension, tachycardia, dehydration
Prolong sitting/standing, antihypertensive and other meds, Change in position
Cardiac (Rule out 1st)
Obstructive
Hypertrophic Cardiomyopathy
Shortness of breath, chest pain, arrhythmia
Systolic murmur (@ squatting to standing or Valsalva maneuver/)
Structural
Acute Aortic Dissection
Severe sharp chest pain (may radiate to back), hypotension or shock,
history of hypertension
Pulmonary Hypertension
SOB and fatigue
Pulmonary Embolus
Acute SOB, chest pain, hypoxia, sinus tachycardia or right heart strain
Aortic Stenosis
Severe:congestive heart failure, syncope, or angina (exertional)
Pulmonary Stenosis
Association with congenital defects Shortness of breath (exertion) CHF
Acute MI/Ischemia
Exertional chest pain, nausea, diaphoresis and SOB
Arrhythmic
Presence of heart disease, F Hx of sudden death, symptoms during or after exertion, sudden onset of palpitations, unexplained fall
Unknown/Idiopathic