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SYNCOPE CAUSED BY LEFT ATRIAL MASS
1263 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making SYNCOPE CAUSED BY LEFT ATRIAL MASS Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1264-318 Authors: Aswathy Vaikom House, David Danford, University of Nebraska Medical Center, Omaha, NE, USA
Background: Syncope is a common presentation in the pediatric population. Most events are vasovagal but result in significant resource utilization. The approach to syncope begins with a meticulous history and physical (H&P) to determine which events warrant further evaluation.
Case: A 17-year-old previously healthy female presented with recurrent episodes of dizziness that began 5 months ago. They mostly occurred at school with activity, lasting 2-3 mins, but were getting longer and more frequent. Over the past month she also had exertional dyspnea and the dizzy spells culminated in her feeling flushed, buckling to her knees and passing out. Physical examination showed a pale teenager, with normal S1, S2 and ¼ diastolic murmur at the mitral area. She did not have jugular venous distension or hepatomegaly. Decision Making: ECG showed left atrial enlargement. The history of exertional dyspnea, abnormal cardiac exam, ECG findings and lack of a ‘typical prodrome’ for vasovagal syncope prompted echocardiography. This revealed a left atrial mass (7.3 x 3.8cm) prolapsing into the left ventricle causing obstruction of the mitral valve (mean mitral inflow gradient 14mmHg). She also had increased right ventricular pressure (estimated 70mmHg) due to left atrial congestion. She was referred for surgical resection. Conclusions: This case highlights the importance of a meticulous H&P in the evaluation of syncope and emphasizes the need to identify ‘atypical’ presentations that warrant further cardiac evaluation.
FIT Clinical Decision Making SYNCOPE CAUSED BY LEFT ATRIAL MASS Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1264-318 Authors: Aswathy Vaikom House, David Danford, University of Nebraska Medical Center, Omaha, NE, USA
Background: Syncope is a common presentation in the pediatric population. Most events are vasovagal but result in significant resource utilization. The approach to syncope begins with a meticulous history and physical (H&P) to determine which events warrant further evaluation.
Case: A 17-year-old previously healthy female presented with recurrent episodes of dizziness that began 5 months ago. They mostly occurred at school with activity, lasting 2-3 mins, but were getting longer and more frequent. Over the past month she also had exertional dyspnea and the dizzy spells culminated in her feeling flushed, buckling to her knees and passing out. Physical examination showed a pale teenager, with normal S1, S2 and ¼ diastolic murmur at the mitral area. She did not have jugular venous distension or hepatomegaly. Decision Making: ECG showed left atrial enlargement. The history of exertional dyspnea, abnormal cardiac exam, ECG findings and lack of a ‘typical prodrome’ for vasovagal syncope prompted echocardiography. This revealed a left atrial mass (7.3 x 3.8cm) prolapsing into the left ventricle causing obstruction of the mitral valve (mean mitral inflow gradient 14mmHg). She also had increased right ventricular pressure (estimated 70mmHg) due to left atrial congestion. She was referred for surgical resection. Conclusions: This case highlights the importance of a meticulous H&P in the evaluation of syncope and emphasizes the need to identify ‘atypical’ presentations that warrant further cardiac evaluation.