摘要
Syncope and near syncope are great diagnostic challenges in medicine. On the one hand, the symptom may result from a benign condition and pose little or no t hreat to health other than that related to falling. On the other hand, syncope o r near syncope can be the manifestation of a serious underlying condition that poses an imminent threat to life. Patients with a cardiac cause of syncope are a t far greater risk of dying in the first year after an episode of syncope or nea r syncope than individuals with a noncardiac cause. A cardiac cause of syncope should be considered in every patient with syncope or near syncope, but it is p articularly common in older patients or in patients with known structural heart disease, arrhythmia, or certain electrocardiographic abnormalities. Although man y diagnostic tests may be helpful in the evaluation of syncope and near syncope , the history, physical examination, and electrocardiogram pinpoint the cause in many circumstances. Syncope after exercise may be due to left ventricular outfl ow tract obstruction from aortic stenosis or hypertrophic obstructive cardiomyop athy but can also suggest the diagnosis of postexercise hypotension in which an abnormality in autonomic regulation of vascular tone or heart rate results in va sodilation or bradycardia after moderate intensity aerobic activity. The patien t discussed in this case highlights the importance of the clinical history in th e evaluation of this condition, since the diagnosis was revealed as the patient s story was described and eventually acted out.
Syncope and near syncope are great diagnostic challenges in medicine. On the one hand, the symptom may result from a benign condition and pose little or no t hreat to health other than that related to falling. On the other hand, syncope o r near syncope can be the manifestation of a serious underlying condition that poses an imminent threat to life. Patients with a cardiac cause of syncope are a t far greater risk of dying in the first year after an episode of syncope or nea r syncope than individuals with a noncardiac cause. A cardiac cause of syncope should be considered in every patient with syncope or near syncope, but it is p articularly common in older patients or in patients with known structural heart disease, arrhythmia, or certain electrocardiographic abnormalities. Although man y diagnostic tests may be helpful in the evaluation of syncope and near syncope , the history, physical examination, and electrocardiogram pinpoint the cause in many circumstances. Syncope after exercise may be due to left ventricular outfl ow tract obstruction from aortic stenosis or hypertrophic obstructive cardiomyop athy but can also suggest the diagnosis of postexercise hypotension in which an abnormality in autonomic regulation of vascular tone or heart rate results in va sodilation or bradycardia after moderate intensity aerobic activity. The patien t discussed in this case highlights the importance of the clinical history in th e evaluation of this condition, since the diagnosis was revealed as the patient s story was described and eventually acted out.
