A 70 YR OLD MAN WITH RECURRENT EPISODES OF SYNCOPAL ATTACKS

LONG CASE

HALL TICKET NO. 1601006149


This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through a series of inputs available global online community of experts with the aim to solve the patient's clinical problems with the collective current best evidence based inputs. This E-log book also reflects my patient centred online learning portfolio and your valuable inputs in the comments section.

A 70 YEAR OLD MAN WITH RECURRENT EPISODES OF SYNCOPAL ATTACKS

A 70 year old man, who is a Weaver from Nakrekal, was rushed to the ER at Kamineni Institute of Medical Sciences, Narketpally on 23/04/2021, following an episode of loss of consciousness for 1 minute that very same evening. 

HISTORY OF PRESENTING ILLNESS:

- Patient was apparently symptomatic earlier yesterday afternoon, then at 04:00 PM, when he was weaving clothes he had sudden onset of giddiness as he pushed his table aside to stand up. 

- Giddiness was sudden in onset and associated with profuse sweating, blurring of vision and palpitations. 

- He had transient loss of consciousness for one minute. Patient says he remembers the start of the episode but doesn't recall anything that happened thereafter. 

- He had post syncopal generalised weakness and confusion. 

- He had three more episodes. One at 10:00 PM on 23rd April, the other two at 12:00 AM and 6:30 AM on 24th April for which was present in the hospital. The last episode lasted for longer and the patient had post syncopal weakness for half hour. 

- Not associated with any chest pain, blackouts, photophobia, phonophobia, involuntary movements, involuntary micturition, froth from mouth, tongue bite, uprolling of eyes. 

- No history of trauma or lifting of heavy weights. 

- No postural drop of blood pressure, no history of seizures and motor/sensory deficits. 

- No history of fever, neck pain, ear pain, discharge or tinnitus. 


PAST HISTORY:


- No similar complaints in the past. 

- He is a known case of Diabetes Mellitus-2 since 15 years and Hypertension since 10 years. 

- No history of Thyroid disorders, Epilepsy, CVD, Bronchial asthma, TB. 

TREATMENT HISTORY:

- Patient has been on medication for Diabetes Mellitus-2 since 15 years- Glimiperide OD (2 PM) 

- For Hypertension- Telmisartan OD

- Atorvastatin + Aspirin (75 mg) 


FAMILY HISTORY:

Not significant


PERSONAL HISTORY:


- He consumes a Mixed diet. 

- His appetite is normal. 

- His sleep is adequate and undisturbed. 

- His bowel and bladder movements are regular. 

- Occasionally consumes alcohol; doesn't smoke. 

- No known allergies. 


PHYSICAL EXAMINATION (after taking informed consent from the patient) 

GENERAL EXAMINATION:

- The patient is conscious, coherent and cooperative, sitting comfortably on the bed.

- He is well oriented to time, place and person.

- He is moderately built and moderately nourished.

- No sign of Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy and Edema. 



Vitals:

The patient is afebrile. 

- Pulse rate: 84 beats per minute, regular, normal in volume and character. There is no radio-radial or radio-femoral delay. The condition of the arterial wall is normal.

- Respiration: 18 cycles per minute

- Blood Pressure: 

   - Left arm: 140/80 mm Hg

   - Right arm: 160/80 mm Hg

- JVP is normal and not elevated. 



SYSTEMIC EXAMINATION:

CARDIO VASCULAR:

 - On inspection, his chest wall is normal and symmetrical. JVP is normal not elevated



- On palpation, carotid pulse felt on both sides; Apex beat felt at left fifth Intercostal space medial to mid clavicular line. 

- On auscultation, S1 S2 heard, no cardiac murmurs. 





RESPIRATORY SYSTEM:

- On inspection, chest moves evenly with respiration. No use of accessory muscles of respiration, no intercostal retractions. Trachea is central with no deviation. 

- Inspection findings are confirmed on palpation. 

- On percussion, lungs are resonant. 

- On auscultation, vesicular breath sounds heard; bilateral air entry is present. No dyspnea/wheeze.


ABDOMINAL EXAMINATION:

- On inspection, all abdominal quadrants are moving evenly with respiration. Not visibly distended, no visible organomegaly. No engorged veins or sinuses. 

- On palpation, inspection findings are confirmed. Liver is not enlarged, non tender. Spleen is not palpable. 

- On auscultation, no bruits are heard. Bowel sounds are normal. 

- On percussion, there is no shifting dullness.

 

CENTRAL NERVOUS SYSTEM EXAMINATION:

- Patient is conscious. 

- His speech is normal.

- No signs of meningeal irritation. No nystagmus. 

- Motor system, Sensory system and Cranial Nerves- Normal


PROVISIONAL DIAGNOSIS:

SYNCOPE
- Cardiac syncope- arrythmias, heart failure
- Postural hypotension
- due to patient being on Antihypertensives. 


Comments

Popular posts from this blog

MEDICINE CASE DICUSSION

A 13 YEAR OLD BOY COMPLAINTS OF HIGH GRADE FEVER