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SYNCOPE IN ELDERLY: HOW ABOUT CHECKING CAROTID HYPERSENSITIVITY???
2318 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making SYNCOPE IN ELDERLY: HOW ABOUT CHECKING CAROTID HYPERSENSITIVITY??? Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Arrhythmias and Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1206-406 Authors: Zachary Port, Sameer Chaudhari, Marc Roelke, Constantinos Costeas, RWJ Newark Beth Israel Medical Center, Newark, NJ, USA Background: Despite the advancement in medicine, syncope in elderly commonly presents as a challenging but poorly defined entity. Besides the variable yield of modern diagnostic modalities, simple bedside maneuvers like Carotid sinus massage can prove crucial to identify etiology. Case: A 94 year old woman presented after a syncopal episode which started with weakness while standing, making her sit down with a transient loss of consciousness for 3 seconds. Initial examination, EKG, lab markers, carotid duplex, brain imaging, rhythm monitor and 2D-Echocardiogram revealed no significant abnormalities.
Decision‐Making: With no significant arrhythmia on telemetry, patient underwent an Upright tilt-table test without any orthostatic changes/ arrhythmia. Team decided to perform a carotid massage to check carotid hypersensitivity. It induced a sinus pause/arrest lasting 6 seconds which spontaneously converted back to normal sinus rhythm. Patient had an exact sequential symptomatology- lightheadedness followed by syncope and spontaneous recovery. With informed discussion, patient underwent a permanent pacemaker placement with no further syncopal recurrence. Conclusions: In the era of ever-advancing diagnostic techniques, bedside physical examination and diagnostic skills are becoming a lost art. This case illustrates the importance of evaluation for carotid hypersensitivity by carotid sinus massage in patients with syncope before diverting to expensive and often inconclusive workup.
FIT Clinical Decision Making SYNCOPE IN ELDERLY: HOW ABOUT CHECKING CAROTID HYPERSENSITIVITY??? Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Arrhythmias and Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1206-406 Authors: Zachary Port, Sameer Chaudhari, Marc Roelke, Constantinos Costeas, RWJ Newark Beth Israel Medical Center, Newark, NJ, USA Background: Despite the advancement in medicine, syncope in elderly commonly presents as a challenging but poorly defined entity. Besides the variable yield of modern diagnostic modalities, simple bedside maneuvers like Carotid sinus massage can prove crucial to identify etiology. Case: A 94 year old woman presented after a syncopal episode which started with weakness while standing, making her sit down with a transient loss of consciousness for 3 seconds. Initial examination, EKG, lab markers, carotid duplex, brain imaging, rhythm monitor and 2D-Echocardiogram revealed no significant abnormalities.
Decision‐Making: With no significant arrhythmia on telemetry, patient underwent an Upright tilt-table test without any orthostatic changes/ arrhythmia. Team decided to perform a carotid massage to check carotid hypersensitivity. It induced a sinus pause/arrest lasting 6 seconds which spontaneously converted back to normal sinus rhythm. Patient had an exact sequential symptomatology- lightheadedness followed by syncope and spontaneous recovery. With informed discussion, patient underwent a permanent pacemaker placement with no further syncopal recurrence. Conclusions: In the era of ever-advancing diagnostic techniques, bedside physical examination and diagnostic skills are becoming a lost art. This case illustrates the importance of evaluation for carotid hypersensitivity by carotid sinus massage in patients with syncope before diverting to expensive and often inconclusive workup.