DATE OF PROCEDURE: MM/DD/YYYY
PROCEDURES PERFORMED:
- Tilt table testing.
- Carotid sinus massage.
OPERATOR: John Doe, MD
REFERRING PHYSICIAN: Jane Doe, MD
INDICATION FOR PROCEDURE: Syncope.
FINDINGS: Baseline sinus rhythm at 70 BPM with normal cardiac conduction intervals.
INDICATION:
- PR interval equals 160 milliseconds.
- QRS interval equals 80 milliseconds.
- QT interval equals 360 milliseconds.
- The patient was observed in a 70 degree head-up tilt position for a total of 30 minutes in a drug-free state, during which she remained asymptomatic with both stable blood pressure (BP equals 95-121/55-71) and heart rate (HR equals 75-112 BPM).
- The patient continued to be observed in a 70 degree head-up tilt position for additional of 5-minute period of time following sublingual nitroglycerin (0.4 mg) administration, during which she developed progressive dizziness, fatigue, and diaphoresis (similar to clinical symptoms) prior to development of complete loss of consciousness associated with profound hypotension (BP equals 61/33) and inappropriate normocardia (HR equals 91 BPM). The patient awoke, returned to the supine (0 degrees) position.
- No evidence for carotid signs of hypersensitivity with either right or left-sided carotid sinus massage.
COMPLICATIONS: None.
IMPRESSION:
- Neurocardiogenic syncope (mixed vasodepressor/cardiac inhibitory response).
- No evidence for carotid sinus hypersensitivity.
RECOMMENDATION: Consider a future empiric beta-blocker (Toprol XL 50 mg daily) therapy in place of current calcium channel blocker (verapamil 40 mg t.i.d.) for a combined management of retention and neurocardiogenic syncope.
