Cases reported "Syncope"

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1/40. syncope two years after hysterectomy.

    A 61-year-old woman presented to the emergency department after experiencing palpitations, shortness of breath, and syncope while taking a shower. Her husband revived her with mouth-to-mouth resuscitation. She had had a similar episode three days earlier while making her bed and had lost consciousness for about 10 sec. She did not appear to have had a seizure. Five months earlier, while taking a walk, she had experienced dizziness, dyspnea, and chest pressure lasting about an hour. A workup at that time included cardiac catheterization, lung scanning, and esophagogastroduodenoscopy, but no abnormality was found. lower extremity edema was noted.
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ranking = 1
keywords = chest
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2/40. A case of vasospastic angina presenting Brugada-type ECG abnormalities.

    An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.
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ranking = 48.181538255412
keywords = chest pain, chest
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3/40. pulmonary embolism presenting as syncope: case report and review of the literature.

    syncope as an initial presentation of pulmonary embolism occurs in about 10% of patients. A 68-year-old woman was admitted to the hospital with syncope. A right lower lobe infiltrate was found on a chest x-ray film, and results of a ventilation-perfusion scan were interpreted to mean that a high probability of pulmonary embolism existed. Other causes of syncope were excluded. A Doppler scan of the lower extremities revealed deep venous thrombosis. Intravenous heparin was administered, and then an inferior vena cava filter was placed to prevent pulmonary embolism from recurring. The patient has been well for 16 months since that episode. A review of 20 case reports in the literature of 10 women and 10 men with pulmonary embolism presenting as syncope revealed that female patients were younger than male patients and that the outcome was fatal in 40% of all cases. syncope as a presenting symptom of pulmonary embolism is difficult to diagnose. physicians must be vigilant with patients who have syncope, because this symptom may be the "forgotten sign" of life-threatening pulmonary embolism. The need for prompt diagnosis is clear, because with appropriate treatment the majority of patients may survive.
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ranking = 1
keywords = chest
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4/40. mesalamine-induced chest pain: a case report.

    Cardiac side effects of mesalamine are uncommon. A young man with ulcerative colitis who developed recurrent chest pain and electrocardiographic changes while on mesalamine is presented. Various causes of mesalamine-induced chest pain are discussed.
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ranking = 144.54461476624
keywords = chest pain, chest
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5/40. Demonstration of myocardial ischemia by an internal loop recorder.

    An internal loop recorder (ILR) implanted to evaluate syncope was activated during an episode of chest pain. Analysis of the recorded event revealed a marked increase in the amount of ST-segment depression over baseline. In addition to rhythm analysis, the ILR may be able to assess myocardial ischemia. Further refinements of filtering may make analysis more accurate.
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ranking = 24.090769127706
keywords = chest pain, chest
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6/40. Recurrent pericardial chest pain: a case of late right ventricular perforation after implantation of a transvenous active-fixation ICD lead.

    A 36-year-old woman with a history of recurrent syncopal episodes presumably due to ventricular tachyarrhythmia in mitral valve prolapse underwent implantation of a transvenous ICD system. During a 23-month follow-up, she developed recurrent pericardial chest pain with pericardial friction rub. The first episode of chest pain occurred without any detectable change in pacing or sensing parameters. The second episode was associated with an increase in pacing threshold and drop in intracardiac signal amplitude. Right ventricular perforation was suspected fluoroscopically and confirmed by right ventriculography. This case report emphasizes the key steps in the diagnosis of this rare complication of an ICD implantation.
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ranking = 121.45384563853
keywords = chest pain, chest
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7/40. Painless acute aortic dissection and rupture presenting as syncope.

    Acute aortic dissection is an emergency that may not only cause significant morbidity but often results in death. A timely diagnosis can prove difficult in the event of an atypical presentation. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature. This article reports on a case of a completely painless acute dissection and rupture in a middle-aged man who presented with syncope. The diagnosis was made by a combination of clinical suspicion, emergent bedside echocardiography, and computed tomography scan. This patient underwent immediate surgery, and ultimately had a successful outcome.
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ranking = 1
keywords = chest
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8/40. Adverse reaction characterized by chest pain, shortness of breath, and syncope associated with verteporfin (visudyne).

    PURPOSE: To report a serious adverse reaction associated with verteporfin infusion. DESIGN: Observational case report. methods: Case report of a single individual undergoing photodynamic therapy (PDT) with verteporfin. RESULTS: A 77-year-old man with long-standing asymptomatic atrial fibrillation, but no known coronary artery disease experienced severe chest and neck pain, shortness of breath, and syncope while undergoing a fourth photodynamic therapy (PDT) treatment with verteporfin. This infusion had been preceded by three prior infusions; the first two were uneventful, and the third was associated with milder, but similar symptoms. Evaluation demonstrated that the chest pain was noncardiac in origin. CONCLUSION: As verteporfin continues to be used around the world, physicians must be alert to the possibility of serious adverse side effects associated with its use.
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ranking = 121.45384563853
keywords = chest pain, chest
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9/40. Aortic dissection and rupture presenting as suprasternal bruising and neck swelling.

    BACKGROUND: a 76-year-old man presented with transient loss of consciousness associated with swelling of the neck, bruising in the suprasternal notch and an absent left carotid pulse. blood pressure was equal in both arms and chest x-ray was normal, but computed tomography of the neck and thorax showed dissection and rupture of the thoracic aorta with extensive intra-mediastinal bleeding. OUTCOME: surgical intervention was inappropriate in this situation and the patient died within 4 hours of presentation. CONCLUSION: syncope is a common presentation to hospital in older people and its cause may be difficult to elucidate, particularly if the patient is unable to provide a reliable history. syncope without pain is a rare presentation of aortic dissection and the occurrence of anterior chest wall bruising has not been described previously. pulse deficits and abnormal chest x-ray findings are often cited as indicative of aortic dissection but are rare manifestations and their absence should not be used to exclude this diagnosis.
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ranking = 3
keywords = chest
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10/40. water drinking as a potential treatment for idiopathic exercise-related syncope: a case report.

    We report a 20-year-old sportsman with frequent attacks of lightheadedness, chest pain, blurred vision and falls during and shortly after exercise. Cardiac and pulmonal evaluation and routine autonomic function tests were normal apart from a relatively high resting heart rate (70 bpm) compared to endurance-trained men. In view of the relation to exercise, the patient was asked to cycle with maximal effort on an ergometer with continuous blood pressure (BP), heart rate (HR) and electroencephalogram (EEG) registration. Immediately after cessation of exercise a brief hypotensive period (75/45 mmHg) occurred together with sinus tachycardia (180 bpm) during which the patient experienced his typical complaints. We hypothesized that our patient's symptoms were primary related to sympathetic failure. As water drinking has been demonstrated to raise sympathetic activity rapidly, we undertook a second cycling test after ingestion of 1000 mL tap water. Symptoms nor hypotension recurred. Because of the short lasting pressor effect and its minimal side effects, we suggest water drinking as simple and possible effective therapy for idiopathic exercise-related syncope.
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ranking = 24.090769127706
keywords = chest pain, chest
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