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Lookup NU author(s): Dr Joseph Harbison, Emerita Professor Julia Newton, Dr Colette Seifer, Professor Rose Anne Kenny
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A 71-year-old woman was admitted for investigation of collapses of unknown cause. She had a history of occasional faints since childhood, but in the previous 6 months the collapses had become more sinister. Collapses occurred without warning, at least once per week, and were associated with transient loss of consciousness. A witness account stated that the woman became very pale during the collapses but the witness did not recall the woman flushing on recovery. The patient was assigned a provisional diagnosis of Stokes Adams attacks and referred for further cardiovascular investigations. The woman's previous history was unremarkable apart from a diagnosis of mild hypertension treated with bendroflumethiazide. She was normotensive and results of cardiovascular examination were otherwise normal. Her electrocardiogram showed normal sinus rhythm and no abnormalities. Cardiovascular investigations showed a transient, symptomless 15 mm Hg postural drop in systolic blood pressure resulting from 3 min of standing unaided. Carotid sinus massage resulted in a sinus pause of 4.1 s, with reproduction of the patient's syncopal symptoms. A diagnosis of cardioinhibitory carotid sinus syndrome was made, the patient was referred for Insertion of a permanent pacemaker, and has had no further collapses since this procedure.
Author(s): Harbison J, Newton JL, Seifer C, Kenny RA
Publication type: Editorial
Publication status: Published
Journal: Lancet
Year: 2002
Volume: 359
Issue: 9301
Pages: 158-160
ISSN (print): 0140-6736
ISSN (electronic): 1474-547X
Publisher: The Lancet Publishing Group
URL: http://dx.doi.org/10.1016/S0140-6736(02)07376-2
DOI: 10.1016/S0140-6736(02)07376-2
