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docnikki
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02/19/08 - 01:43 PM

A 55-year-old man with a history of diabetes and hypertension is admitted after a syncope episode. He states that he has had two other syncopal episodes in the past. Both of these were moderately rapid in onset. His physical examination is unremarkable. An EKG is done and shows evidence of left ventricular hypertrophy. This is confirmed on echocardiogram. His ejection fraction is 55%. Tilt-table testing shows a drop in systolic blood pressure of 20 mm Hg without changes in heart rate. What would be the most appropriate action for this patient?

(A) Start beta-blockers
(B) Start an alpha-agonist (midodrine)
(C) Cardiac catheterization
(D) Stress test
([font size="2"]E) Event recorder[/font]

farnsworth
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02/19/08 - 02:28 PM

dr.wad
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02/20/08 - 01:51 AM

dont know ..... shaking head

sandra
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02/20/08 - 07:12 AM

c?

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docnikki
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02/21/08 - 07:00 AM

very good farnsworth!
The patient has autonomic dysfunction, resulting in orthostatic hypotension, as demonstrated by the abnormal tilt testing. Abnormal results include hypotension, bradycardia, or both. Patients with orthostatic hypotension-producing symptoms can be successfully treated with alpha-agonists such as midodrine. Syncope associated with left ventricular dysfunction or nonsustained ventricular tachycardia is best treated with beta-blockers. The test has a low sensitivity. Beta-blockers are also used in vasovagal syncope. They appear to have a role in suppressing the initial burst of tachycardia, which initiates a reflex bradycardia, resulting in hypotension. Cardiac catheterization is useful once an echocardiogram shows evidence of structural heart disease (e.g., aortic stenosis). Event recording is not particularly useful in patients with an abrupt optoms often prevents recording of the event. Stress testing is useful to detect ischemia and is not particularly useful in the evaluation of syncope.

sherry39
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02/21/08 - 07:44 AM

ddddddddd

simi
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02/21/08 - 10:27 PM

good qs docnikki...could u plz explain how this table tilt testing is done n the signicance of this test.

pyagnik
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02/26/08 - 04:14 AM

Good explanation docnikki, but can you explain that 'can we use alpha agonist for a hypertensive patient?'

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