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PREZENTARE DE CAZ

PREZENTARE DE CAZ. Lavinia Magdalena Fisteica Medic rezident medicina interna Spitalul Clinic Colentina , Bucuresti. Pacientul U.O ,64 ani. MOTIVELE INTERNARII episoade sincopale recurente Debut la 30 ani frecventa 2-3 ani 1 episod la 10 zile (in ultimele 6 luni )

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PREZENTARE DE CAZ

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  1. PREZENTARE DE CAZ LaviniaMagdalena Fisteica Medic rezidentmedicinainterna Spitalul Clinic Colentina, Bucuresti

  2. PacientulU.O ,64 ani MOTIVELE INTERNARII • episoade sincopale recurente • Debut la 30 ani • frecventa 2-3 ani • 1 episod la 10 zile (in ultimele 6 luni) Prodromcu • ameteli • tulburari de echilibru • In ortostatism • In spatiideschise • Neasistat • Revenirespontana • Durataneprecizata • Fararelaxaresfincteriana

  3. Antecedentepersonalepatologice :Ulcer gastric operat (2012), episoade de fibrilatieatrialaparoxistica ,AIT ? • Antecedenteheredo-colaterale: nesemnificative

  4. Tratament actual • Anticoagulant oral • Amiodarona 1tb/zi • Clopidogrel 1tb/zi

  5. Examenobiectiv • mucoasa linguala cu depozite • Cracmentela mobilizareacoloaneicervicale • pulmonar in limite normale • TA=115/80 mmHg ;farahipoTAortostatica • AV=55 bpm Examenneurologic:normal

  6. DIAGNOSTIC DE ETAPA

  7. Analize de laborator

  8. Radiografie cord-pulmon

  9. Cauzacardiaca ?

  10. Cauzacardiaca? • Ecocardiografie: • Ao= 30mm • AS=35 mm • VS= 41/30mm • SIV=14 mm • PP=13.5 mm • FE= 60%. • Cinetica VS normala. Calcificare valva mitrala si aortica. Regurgitare mitrala usoara. Disfunctie diastolica (relaxareintarziata). Pericard normal.

  11. Holter/24 ore Ritmul sinusalcu conducere atrioventriculara normala Variabilitatea RR a fost normala. Cateva extrasistole supraventriculare izolate Bradicardie sinusala in 26% din timpul inregistra farabradiaritmii sau tahiaritmii Intervalul QTc a fost in limite normale.

  12. Sincopaortostatica-Disautonomieprimara? Consult neurologic • EEG-in limitenormale • CT cerebral:Fara leziuni recente sau formatiuni expansive infra sau supratentorial. • Ecografie Doppler arterecarotide: ateromatozacarotidiananestenozanta

  13. Cauzareflexa ? • Test Tilt Faza faraprovocare: dupa 38 de minute de ortostatism tensiunea arteriala a scazut sub 60 mmHg,iar pacientul a devenit simptomatic(ameteala,greata,transpiratii);frecventa cardiaca s-a mentinut in aceeeasi parametrii ,insa ritmul a fost jonctional.

  14. DIAGNOSTIC POZITIV

  15. Tratamentsirecomandari • Sistareatreptata a medicatieiantiaritmicesiintrerupereamedicatieiantiagreganteplachetare • Anticoagulant oral conform schemei • Evitarea ortostatismului prelungit in caldura , aglomeratie si spatii inchise. • Regim alimentar echilibrat,evitareaalcoolului • Hidratare cca 2l/zi • Recunoaştereaprecocea simptomelorpremonitorii

  16. PROGNOSTIC SI EVOLUTIE • Sincopele reflexe(mediate nervos) au prognostic favorabil • Pacientul nu a prezentat episoade sincopale pe parcursul internarii si nici la o luna dupa externare

  17. VA MULTUMESC!

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