Syncope

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for an episode of syncope that occurred ‍ ‍days ago

Onset was ‍gradualsudden, while ‍ ‍

Preceded by ‍none

Lasted for ‍ ‍secminhoursan unclear duration, ‍witnessed byunwitnessed

Recovery was ‍fastslow with confusion, alleviated by ‍lying down

Associated injury: ‍nonehead injuryneck injury ‍



Associated symptoms: *Try using right-click for negatives*

‍dizziness

‍blurred vision

‍nausea

‍sweating

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍lower extremity edema, ‍rightleftsymmetrical

‍confusion

‍seizure



Contributing factors:

‍risk factors for CAD

‍risk factors for PE

‍dehydration

no history of: ‍arrhythmias, ‍CAD, ‍valvular heart disease, ‍seizure disorder, ‍orthostatic hypotension, ‍Parkinson's disease, ‍anemia

no use of: ‍antihypertensives, ‍anticoagulants, ‍antidepressants, ‍new medication



Occupation: ‍ ‍lowhigh risk of injury for self or others

Driving license: ‍yesno





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Syncope ‍likelysuspectedpossible

DDx: vasovagal syncope, orthostatic hypotension, cardiac arrhythmia, valvular heart disease, cardiomyopathy, aortic stenosis, pulmonary embolism, myocardial infarction, neurogenic syncope, seizure, stroke, subarachnoid hemorrhage, hypoglycemia, dehydration, anemia, hemorrhage, drug-induced syncope, carotid sinus hypersensitivity, postural tachycardia syndrome, adrenal insufficiency, heat exhaustion





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH, ‍calcium, ‍magnesium, ‍albumin, ‍troponin, ‍d-dimers, ‍β-hCG

- ECG

- Cardiac monitoring

- Echocardiogram

- Holter monitor

- Carotid ultrasound

- Tilt table test

- CT scan of the head

Treatments:

- Encourage hydration

- Increase salt intake

- Compression stockings

- Avoid heat and long periods of standing

- If symptoms occur, lie down and elevate legs

- Avoid driving

Further care:

- Referral to cardiologist

- Referral to neurologist

- Follow-up in ‍ ‍daysweeks

- Return if syncope recurs or if new symptoms develop such as chest pain or shortness of breath