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

By Marie Savard MD

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

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

 Last week, Maureen learned the results of a tilt test during which she was strapped to a table that was quickly tilted upright to mimic the standing position. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“Maureen might have a heart valve problem she was born with but didn’t know about. My husband had congenital aortic stenosis, a blockage of the aortic valve that got tighter with age. This turned out to be a very serious, potentially life threatening condition. He had to have a valve replacement. But we learned that Maureen didn’t have a heart murmur, so my guess could be wrong. My husband did have a murmur. Happy ending: He’s healthy now!”

— Kelly G.

“I noticed that the doctor asked Maureen to drink plenty of fluids. Maybe she was dehydrated. I used to get lightheaded or faint when I stood up, but upping my intake of water every day cured me! I admitted to my doctor that I was limiting how much water and other liquids I drank because I was afraid of having an incontinence episode in public. My doctor is a woman and she said she could relate, but that wearing incontinence underwear is a perfect solution. Her confession impressed me. I got over my embarrassment about buying the products!”

— Lucille T. (great)

“I know the fancy medical term for fainting. It’s vasovagal syncope. My sister got this diagnosis when she was about Maureen’s age and started passing out every now and then for no apparent reason. Her doctor said vasovagal syncope occurs as a result of an imbalance of the parasympathetic system, which slows pulse and blood pressure, and the sympathetic ‘fight or flight’ system that raises the pulse and blood pressure. The doctor said the problem is not serious and requires no medication. My sister just makes sure not to jump out bed the minute the alarm rings. She hasn’t fainted for several years now. I hope Maureen has this. It’s harmless and easy to live with as long as you learn to prevent falls.”

— Susan P.

“My brother started gaining weight as the years went by, but he didn’t want to admit it. He kept wearing the same size shirt even though he could barely button it at the neck. Then he would put on a tie and pull it tight. Guess what? He ended up fainting! I wonder whether Maureen wears anything tight. I’ve read that one reason Victorian ladies fainted might be because they wore corsets! That didn’t constrict their necks the way the shirt did for my brother, but still . . .”

— Doris R.

To be continued . . .

Come back to thirdAGE.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.