Marie A Savard MD

Solve the Medical Riddle: She Has Been Fainting Often Since She turned 68, Although She Never Passed Out Before That, First Week

Editor’s note: Welcome to our thirdAGE feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told her PCP and how the doctor proceeded with the examination. Next week, the PCP will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

The Patient Reports Her Symptoms

Maureen started fainting once or twice a month soon after her 68th birthday, although she had never passed out before that.

As always in thirdAGE Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Maureen told the PCP:

 “Two days after my family gave me a big party to celebrate my 68th birthday, I passed out when I got out of bed in the morning. I had jumped out of bed quickly, but I almost always do that. Luckily I fell back onto the bed and I wasn’t injured. I was scared, though, and so was my husband. My fall woke him up. He said he was very concerned. He wanted me to get checked out right away, but I told him I was probably just overtired from all the excitement of the party, and staying up later than usual that evening. Overall, I’m very healthy. People usually guess me for younger than I am. I’m still teaching visual art — my life’s passion — at the local community center, and I’m having an exhibition of my own watercolors this summer. Also, my husband and I swim at the Y and play with our three grandchildren. I’m pretty active! However, two weeks after the first time I fainted, it happened again. Three weeks later, I was in the kitchen standing cutting vegetables, and I fainted. I would have hit my head on the floor except that my husband was there. He caught me in his arms. That’s when he insisted that I make an appointment to see you, so here I am. I come to within a few seconds after each episode, but my husband says that might not mean I’m OK!”

Subjective:

Maureen said she fainted with almost no warning. She denied any other symptoms. She had no chest pain or palpitations, no heart disease, no chronic illness such as diabetes or Parkinson’s. She wasn’t taking any new medications such as those for high blood pressure or Parkinson’s that can cause orthostatic changes, meaning those related to standing up. Maureen does take multivitamins and extra vitamin D and calcium, but nothing else.

Objective:

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