Solve the Medical Riddle: She Has Been Fainting Often Since She turned 68, Although She Never Passed Out Before That, Fourth 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.
The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
A=Assessment or Analysis
P=Treatment Plan or Recommendation
Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month
The Doctor Reveals the Diagnosis
Susan P. is correct! Vasovagal syncope is a sudden and temporary loss of consciousness. It is an overly sensitive or abnormally low blood pressure and pulse response from an imbalance in the nervous system (you described earlier). Fainting then occurs when someone with the sensitivity gets up too quickly and blood goes to the lower legs rather than the brain.
A rule of thumb is that the younger you are, the more likely fainting is from a benign cause, and the older you are, the more likely the fainting has a serious cause such as heart disease, Parkinson’s, diabetes, or stroke. But for anyone who faints, the risk of injury from the fall can be serious.
Patients with neurally mediated or orthostatic syncope usually require no additional testing beyond blood pressure and pules, and a routine exam. But in Maureen’s case, because she is 68 years old and her episodes are rather frequent, the doctor did recommend the tilt test. A small study done in October of 2015 by the European Society of Cardiology found that patients who were instructed to sniff or gasp with their mouths closed during a tilt test. This prevented the typical drop in blood pressure and pule rate. Maureen could try this tactic if she ever feels an episode coming on,
She was also advised to avoid standing up quickly and standing for long periods of time. If she develops any warning symptoms such as weakness, sweating or visual disturbances, she can do things like leg crossing and hand grips to increase the heart rate and blood pressure, or squatting down. The goal is to avoid the possibility of injuries from falling down.
Here’s what Maureen had to say about her diagnosis:
“I feel so lucky! I was convinced I had some terrible disorder, but it turns out that all I need to do is employ a few simple strategies to keep from fainting. Who knew that passing out had a mouthful of a name like vasovagal syncope? You learn something every day! My husband is really happy he made me go to the doctor. I was afraid to go because I didn’t want bad news. I’ve always been like that, and he knows me well. Now he’s just relieved that I’m pretty much hale and hearty, and that I’ve learned ways to keep myself from fainting in case he’s not around to catch me!”