Please HELP - case study

[Christian_SN]

Not ur normal post! In hopes that maybe some of you will have information to help with this patient. There is not much written about the subject... and I am dying to get your thoughts on what might be going on with this patient. Physicians are not able to give much information on what might be going on with the patient or prognosis.

Case Study

First diagnosis - Neurocardiogenic-syncope

Hypotension

Bradycardia

26 yr old male with episodes of syncope. Over the last few years the syncope episodes have become more frequent. Patient is always pallor with fatigue.

Tilt table test was positive - 6 min into the test, patient went "asystole" x30 sec.

Patient had pacemaker placement. 1 mo later patient is still having episodes of pre-syncope and a heart drop >256x's. Patient is unable to have intercourse with wife.

Stress test duration lasted 7 min.

Echo - normal

EKG- normal

Lab values - normal

[Dinith88]

I thought if it was heart it could be the ONLY thing that could explain the *astyloic >5 sec (which he had 30 sec) on the table test? I thought I read that in my research, is this right?

So he would need an angiogram? He is scheduled for a stress test on tues.

Yes his heart was 'stopping' (pausing) for 30 seconds...however, it could be from various reasons. When someone 'vagals', the vagus nerve is responsible for inducing this pause (thus the 'neurogenic' origin). Ischemia is another possible cause (thus the coming stress-test/possible angio.) because if you're denying blood-flow to certain areas of your heart (ie. AV-node, etc) an asystolic event could happen (certainly a possibility given his chest pain). There're other possible causes of syncope (ie tight carotids, tia's, epilepsy, etc.) but if he's failed a tilt-test (had a 30 second pause) then the docs are obviously on the right track.

From what you've given us, it sounds as though the poor fellow is vagaling. And this guy may be in denial, but if he passes out at the wheel and kills innocent people he'll have even bigger problems. Someone needs to remind him of this...

[Christian_SN, RN]

Yes his heart was 'stopping' (pausing) for 30 seconds...however, it could be from various reasons. When someone 'vagals', the vagus nerve is responsible for inducing this pause (thus the 'neurogenic' origin). Ischemia is another possible cause (thus the coming stress-test/possible angio.) because if you're denying blood-flow to certain areas of your heart (ie. AV-node, etc) an asystolic event could happen (certainly a possibility given his chest pain). There're other possible causes of syncope (ie tight carotids, tia's, epilepsy, etc.) but if he's failed a tilt-test (had a 30 second pause) then the docs are obviously on the right track.

From what you've given us, it sounds as though the poor fellow is vagaling. And this guy may be in denial, but if he passes out at the wheel and kills innocent people he'll have even bigger problems. Someone needs to remind him of this...

WOW - the 'ischemia'... never knew. he has great physicians (he has the best in the area), just needed more information and the diagnosis seem more like a weak diagonosis to me.

still learning and will every day in this life. thank you so much for your time and knowledge.

the next time i see the patient, i will let him know the do's and don't's of his condition (i just do not want to over-ride the RN - i'll talk with her about how we can approach it together with him),,, there's an idea.

thanks, jen.

[Christian_SN, RN]

patient had stress test with no st slope decellerations, just a passing out episode.

[Christian_SN, RN]

pt has PVCs

[dianah, ASN]

Did the MDs decide the PVCs are what are causing the sycope/passing out spells?? Are they isolated PVCs (which most ppl have) or did they come in bursts or groups, and are they directly the cause of the passing out? Has an EP study or ICD implantation been considered? Just curious . . .