A Case of Recurrent Syncope
AAPA ePoster library. Forest C. 05/17/17; 180560; 242
Christopher Forest
Christopher Forest
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Abstract
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A 63-year-old Hispanic male presented with episodic dizziness and his third episode of syncope. The dizziness would appear suddenly, occurring about once a week for the past four months, and each episode lasted about 15 seconds. It sometimes occurred after standing quickly. He denied any preceding exertion or chest pain. After the syncopal episodes, the patient was alert without confusion, amnesia or deficits. He denied headaches, vision changes, nausea, vomiting, bloody stools or weakness. The patient had a history of stroke and myocardial infarction in 2014 and a traumatic subdural hematoma in 2012. He also had a history of hyperlipidemia, controlled hypertension, and chronic obstructive pulmonary disease, and no significant family history. He was currently taking aspirin, lisinopril, metoprolol, atorvastatin, nifedipine, and albuterol. The patient smoked half a pack a day for 50 years and quit 5 months ago. He admitted to drinking five beers a week and denied illicit drug use. PHYSICAL EXAMINATION The patient's blood pressure (supine) was 152/82 mm Hg. All other vital signs were unremarkable. Upon standing, his blood pressure dropped to 132/72 mm Hg with subjective lightheadedness. He had a regular cardiac rhythm without murmur or ectopy. Bruits were heard over the left carotid artery. Cranial nerves II-XII were grossly intact. Sensation to light and sharp touch were intact throughout. He had full active range of motion in bilateral upper and lower extremities with 5/5 strength. An electrocardiogram (EKG), complete blood count, stool guaiac, and carotid duplex ultrasound were ordered. DIFFERENTIAL DIAGNOSIS •...
A 63-year-old Hispanic male presented with episodic dizziness and his third episode of syncope. The dizziness would appear suddenly, occurring about once a week for the past four months, and each episode lasted about 15 seconds. It sometimes occurred after standing quickly. He denied any preceding exertion or chest pain. After the syncopal episodes, the patient was alert without confusion, amnesia or deficits. He denied headaches, vision changes, nausea, vomiting, bloody stools or weakness. The patient had a history of stroke and myocardial infarction in 2014 and a traumatic subdural hematoma in 2012. He also had a history of hyperlipidemia, controlled hypertension, and chronic obstructive pulmonary disease, and no significant family history. He was currently taking aspirin, lisinopril, metoprolol, atorvastatin, nifedipine, and albuterol. The patient smoked half a pack a day for 50 years and quit 5 months ago. He admitted to drinking five beers a week and denied illicit drug use. PHYSICAL EXAMINATION The patient's blood pressure (supine) was 152/82 mm Hg. All other vital signs were unremarkable. Upon standing, his blood pressure dropped to 132/72 mm Hg with subjective lightheadedness. He had a regular cardiac rhythm without murmur or ectopy. Bruits were heard over the left carotid artery. Cranial nerves II-XII were grossly intact. Sensation to light and sharp touch were intact throughout. He had full active range of motion in bilateral upper and lower extremities with 5/5 strength. An electrocardiogram (EKG), complete blood count, stool guaiac, and carotid duplex ultrasound were ordered. DIFFERENTIAL DIAGNOSIS •...
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