sunny2
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A 28 year old woman presents with lethargy, dizzy spells and occasional syncope. Dusring a dizzy spell the heart rate is 32 beats/ min. and the BP is 85/60 mmHg.
Your diagnosis and / or explanation:
A. Addison disease
B. Insulinoma
C. Structural disease of the cardiac conducting system (Sick sinus syndrome)
D. Sinus tachycardia with 4:1 atrioventricular block
E. Iron deficiency
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| Jinx
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thinking its c
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| guayoman
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Sounds like C. I can't see the rest of choices producing the bradycardia.
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| Jinx
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exactly
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| sunny2
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take an educated in depth guess guys, you won't be penalised for wrong answer here, infact you would learn a new concept everytime you go wrong and sombody corects you, atleast I learn that way 
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| achilles
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sick sinus syndrome.
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| sunny2
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C. is not the answer
Structural disease of the cardiac conducting system- the sick sinus syndrome could produce episodic heart block and dizziness but would be very uncommon in a woman of this age group-28 years
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| vuks
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What about Addison's disease ?! It can produce Hypotension 80/50, Syncope (but only 16%), HyperKalemia can produce AV conduction delay and hypercalcemia, which is rear in Addison's, can produce first degree AV block and bradicardia ?!?
And you said it isn't Sick sinus, and Insulinoma and Iron deficiency produce tachycardia. 4:1 atrioventricular block is associated with bradicardia not tachycardia but I may be wrong.
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| achilles
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agree with sick sinus been rare in this age. it usually occurs in older females(>50yrs) but the other options did not seem to me as the best answer. anyways looking forward to know the right answer.
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| AAAAA
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Addision's Disease can present in both acute and
chronic fashion. The most common manifestation of
Addison's Disease (Adrenal insufficiency, hypocorticol-
ism) is due to autoimmune disease and is most
common among American women in late 20's to 30's
age group. "The most common cause of primary
adrenal insuffiency in the United States is
autoimmune adrenalitis. This is a medical emergency.
It can present as acute-on-chronic adrenal
insufficiency in which there is no hyperpigmentation.
Pt. can present with fatigue, weakness, severe
hypotension 90/60, but initially tachycardia, but
later can turn into bradycardia in adrenal crisis !
Acute-on-chronic adrenal insuffiency may not
present with hyperpigmentation or hyperkalemia !
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| AAAAA
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Sick sinus syndrome is possible due to atherosclerotic
calcific aging effect and mostly affects elderly in their
60's and 70's years old.
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| AAAAA
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This 28 year old woman may have chronic Addison's Disease
triggered by sepsis and coagulopathies and present with
hypotension and bradycardia !
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| ruhighazi
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I choose D
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| CampNou
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D. AV block
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| Jinx
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post the answer sunny
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| sunny2
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Answer. D
Addison diesease may be associated with mild bradycardia, but not a pulse rate of 32 bpm, a rate which strongly suggests a significant degree of heart block.
Iron deficiency that produces anemia will tend to produce a mild tachycardia rather then a supraventricular tacharrythmia with block. I nsulinomas can present with hypoglycemia and syncope but are not associated with such a low pulse rate.
Structural disease of the cardiac conducting system- the sick sinus syndrome could produce episodic heart block and dizziness but would be very uncommon in a woman of this age group like this pt-28 years.
Sinus tachycardia with a 4:1 atrioventricular block would be the MOST likely cause.
I hope this helps .
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| achilles
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good questions sunny. keep posting more pls.
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| sunny2
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achilles, thank you for the encouragement.
when are you writing the exam , i mean tenetative date !
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| AAAAA
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Thanks. Actually acute adrenal disease does not present bradycardia/
Most patients I saw are tachycardia with rate around 108-120/min !!
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| guayoman
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Good question sunny!! Where are you getting them?
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