Sunday, February 21, 2016

An 82 Year Old Female Presents With Several Episodes Of Dizziness

An 82-year-old white female is admitted to the hospital for observation after presenting to the emergency department with dizziness. After being placed on a cardiac monitor in the ER, the rhythm strip below was recorded.

There is no past history of cardiac disease, diabetes, or hypertension. When asked in more detail the patient discloses several prior episodes of transient dizziness and one episode of brief syncope in the past. Physical examination is unremarkable.

What is the diagnosis and how will you manage this patient?

Answer And Discussion:

Diagnosis: The patient in question has symptomatic tachycardia-bradycardia syndrome.

Pathophysiology: In this condition the sinus node automaticity is suppressed by the tachyarrhythmia and results in a prolonged sinus pause following termination of the tachycardia.

Management: The patient in this case is symptomatic, and pacemaker placement is warranted, Although a pacemaker will prevent bradycardia, it does not prevent tachycardia. The patient may need medication to prevent tachycardia if she continues to be symptomatic after pacemaker placement.
The tachy-brady syndrome does increase the patient’s risk of cardioembolic event, and anticoagulation should be considered.

1 comment:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: you can also write him on WhatsApp +2348104990619.