Case of a 65 years old female with syncope .

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This is the case of a 65 years old lady ,housewife resident of Chinatunalgudam.

The patient presented to the casualty after an episode of loss of consciousness .

 Patient was apparently asymptomatic two days ago , when she had an episode of loss of consciousness  , associated with sweating , and after walking for a long time . 

Not associated with palpitation , flushing , chest pain , muscle weakness , slurring of speech, headache  . 

The patient was brought to the casualty and given medication and recovered completely  .

6 days ago - History of chest pain ( sudden onset , in the centre of chest , squeezing type , non progressive , not radiating ) with shortness of breath following exertion , which were both relieved on rest . 

She went to an RMP and was given an anti hypertensive agent .( which she consumed for the first time 3 days ago )

PAST HISTORY 

No similar complaints in the past 

She is a known case of hypertension since 3days 

Not a known case of diabetes mellitus , asthma , tb , cerebrovascular accidents , coronary artery disease .

No blood transfusions .

History of treatment for cellulitis of leg . 

FAMILY HISTORY 

3 siblings with DM

PERSONAL HISTORY 

Mixed diet , normal appetite 

Adequate sleep 

Normal bowel and bladder movements 

No allergies 

Addiction - sutta- 4 cigarettes/ day since 40 years 

Alcohol or toddy - 1 glass daily 

Daily routine 

Wake up - 7 am

8 am - breakfast (rice )and tea 

Afternoon (2:30pm)- lunch ( rice and curry ) 

Dinner - 9pm -rice and curry .

Sleep - 10 pm

GENERAL EXAMINATION 

The patient is conscious , coherent and cooperative 

Moderately built and moderately nourished 

There is absence of Pallor , icterus cyanosis,  koilonychia, lymphadenopathy . 

Pedal edema present 

VITALS 

BP- 120/80mmHg in sitting position with cuff in the right hand at the level of the heart 

PR- 67 bpm, normal rhythm , 

RR- 20cpm

Temp- Afebrile 

SYSTEMIC EXAMINATION 

CNS 

Higher Mental Functions 

Normal speech and language 

Normal memory 

No delusions or hallucinations 

Cranial nerve examination 

- I : Intact bilaterally 

III, IV, VI : Extraocular movements free and full bilaterally 

V : Intact bilaterally 

VII:Intact bilaterally 

VIII: No nystagmus, intact bilaterally 

IX,X : Intact bilaterally 

XII : Intact bilaterally 

MOTOR SYSTEM 

Bulk- normal  

Power : normal  power of 

- Shoulder , Elbow , Wrist , Smalll muscle of hand and hand grip bilaterally 

- knee , ankle  bilaterally 

Muscle tone :normal 

Reflexes -normal  : Biceps , triceps , knee jerk , ankle jerk bilaterally 

Cerebellar signs : Normal 

Sensory system examination 

Upper limb : Normal 

Lower limb 

- Crude touch , temperature , fine touch ,vibration sensation present bilaterally 

- Pain sensation is normal bilaterally  

CVS 

S1 S2 heard , no murmur 

No thrill 

Apical impulse felt 

RESPIRATORY 

Crepts in bilateral infrascapular and infraaxillary areas 

Trachea central in position 

PER ABDOMEN 

Obese abdomen, umbilicus central and everted 

Soft , non tender 

No hepatomegaly no splenomegaly 

PROVISIONAL DIAGNOSIS 

?Syncope 

?Hypotension

INVESTIGATIONS