A 42-ycar-old man with idiopathic cardiomyopathy is hospitalized after an episode of syncope 1 hour ago. The event occurred while he was sitting in a chair: he did not have any symptoms before the episode, and he was alert and had no incontinence afterward. He had previously been well and exercises regularly without difficulty. Idiopathic cardiomyopathy was diagnosed 6 months ago. Echocardiography at that time showed left ventricular enlargement and a left ventricular ejection fraction of 30%. Coronary angiography showed normal coronary arteries and decreased left ventricular systolic function. His medications are furosemide (diuretic), carvedilol (beta blocker), and lisinopril (ACEi). On physical examination, heart rate is 60/min and blood pressure is 100/60 mm Hg when supine, and heart rate is 66/ min and blood pressure is 45/58 mm Hg when standing. Cardiac examination reveals an enlarged point of maximal impulse that is laterally displaced and regular cardiac rhythm. Results of the neurologic examination are normal shows normal sinus rhythm without significant change compared with his last tracing Which of the following is the most likely cause of his syncope?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: E. Ventricular arrhythmia
Sudden syncope while sitting, with no prodrome, in a patient with dilated cardiomyopathy and EF 30% is cardiac (arrhythmic) syncope until proven otherwise; ventricular arrhythmias are the leading cause of sudden death in HFrEF, and EF <35% is an ICD indication. Orthostatic and vasovagal syncope occur on standing/upright with premonitory symptoms, complete heart block is unlikely with normal sinus rhythm on ECG, and there was no post-ictal state to suggest a seizure. The standing BP in the stem looks garbled.
ليش كل خيار صح أو غلط
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A
ليش غلط
AV block is one of the listed arrhythmic causes of cardiac syncope, but his ECG shows normal sinus rhythm without change from his last tracing.
✓ Step Up To Medicine 6th, 2024 (Loss of conciousness).pdf · p. 6 -
B
ليش غلط
Seizure is not a cause of syncope; it produces acute encephalopathy by a different mechanism (he was alert afterwards with a normal neurological exam).
✓ Step Up To Medicine 6th, 2024 (Loss of conciousness).pdf · p. 6 -
C
ليش غلط
Vasovagal (neurocardiogenic) syncope has triggers (emotional stress, pain, fear) and premonitory symptoms; he had no symptoms before the episode.
✓ Step Up To Medicine 6th, 2024 (Loss of conciousness).pdf · p. 6 -
D
ليش غلط
Orthostatic hypotension is precipitated by sudden or prolonged standing and comes with premonitory symptoms (lightheadedness, nausea); his syncope happened seated with no warning.
✓ Step Up To Medicine 6th, 2024 (Loss of conciousness).pdf · p. 7 -
E
ليش صح
In heart failure the most common cause of death is sudden death from ventricular arrhythmias, and a primary-prevention ICD is advised when EF is 35% or less; his EF is 30%.
✓ Step-Up To Medicine 6th (HF).pdf · p. 8
- المصدر
- Step Up To Medicine 6th, 2024 (Loss of conciousness).pdf · p. 6
Step-Up To Medicine 6th (HF).pdf · p. 8
Step Up To Medicine 6th, 2024 (Loss of conciousness).pdf · p. 7 - المحاضرة
- Tachy- & Bradyarrhythmia Emergencies · Cardiology · Module B
- ظهر في
- Cardio bank