A 76 Year Old Female With Recurrent Syncope, Lightheadedness, Palpitations and Negative Stress Test

Written by Lucas Goss MD, peer reviewed by Meyers, Smith, BraceyA 76 year old female with a history of arial fibrillation not on anticoagulation, non-obstructive CAD found on coronary CTA 2 years prior, HTN, HLD, recurrent lightheadedness, and syncope status post loop recorder placement, presented for another episode of feeling lightheaded, diaphoretic, and feeling like she “was going to die.” She was discharged just the day prior for her second hospitalization for similar episodes. She was actually at the pharmacy to pick up her medicines the day after discharge when this episode occurred, and pharmacy staff sat her down in a chair while they awaited the ambulance . Her symptoms were mostly gone by the time of arrival.Vital signs on arrival: BP 143/89, HR 63, RR 18.During her recent hospitalizations she had a negative CT pulmonary angiogram (CTPA), negative nuclear stress test, normal echo, and her loop recorder did not identify any concerning findings when interrogated. During the first of two prior recent hospitalizations for similar symptoms, her troponin I rose from undetectable to 219 ng/L and trended back down, and the notes seem to attribute this to her blood pressure which was in the 200/110 range. During her second hospitalization (from which she was just discharged yesterday), she had multiple troponins all undetectable, less than 6 ng/L. Smith comment on troponins:the definition of myocardial infarction is 2 of the following:1. Troponin rise and/or f...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs