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4MB Clinical Problem-Solving

4MB Clinical Problem-Solving. Dr. Gerard Flaherty Dept. of Medicine. Presenting Complaint: Syncope. Is it Syncope?. Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous. Any precipitants? Any aura?

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4MB Clinical Problem-Solving

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  1. 4MB Clinical Problem-Solving Dr. Gerard Flaherty Dept. of Medicine

  2. Presenting Complaint: Syncope

  3. Is it Syncope? • Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous.

  4. Any precipitants? Any aura? What was the patient doing at the time? ?Turning head ?Standing up suddenly ?Exertional syncope Any previous episodes? Any sweating or nausea? Palpitations? Rhythmic movements? Any headache? Any arm exercise? ?Confused after episode ?Family history of sudden death History of Presenting Complaint

  5. Physical Examination • Heart rate and rhythm • Lying and standing BP • BP in both arms • Loud P2 • Heart murmurs • Tumour plop (?atrial myxoma)

  6. Investigations • ECG • Holter monitor • Event monitor • Echocardiogram • FBC • SMAC • Electrophysiologic studies • Tilt testing (?carotid sinus hypersensitivity) • EEG • CT Brain

  7. HOCM

  8. Vasovagal syncope Situational syncope Carotid sinus hypersensitivity Postural hypotension Medications Arrhythmias Aortic stenosis Mitral stenosis Hypertrophic cardiomyopathy Complete heart block Long QT interval Atrial myxoma Transient ischaemic attack Vertebrobasilar ischaemia Subclavian steal Basilar migraine Pulmonary embolism Pulmonary hypertension Psychiatric illness Differential Diagnosis

  9. Atrial Fibrillation

  10. Complete Heart Block

  11. Permanent Pacemaker

  12. Long QT Syndrome

  13. Next Week….Chest Pain

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