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(Circulation. 1996;93:380-386.)
© 1996 American Heart Association, Inc.

Articles

A 73-Year-Old Man With Hypertension and Syncope

Presented May 8, 1995, as Clinical Case Conference, Section of Cardiology, Department of Medicine, University of Chicago, University of Chicago Medical Center, Chicago, Ill.

Athena Poppas, MD; Roderick Sawyer, MD; Charles Kinder, MD; Philippe Vignon, MD; James Bednarz, BS; Bryan K. Lee, MD; Ted Feldman, MD; Seymour Glagov, MD; Roberto M. Lang, MD

From the Section of Cardiology, Department of Medicine (A.P., R.S., C.K., P.V., J.B., T.F., R.M.L.), the Department of Pathology (S.G.), and the Department of Surgery (B.K.L.), University of Chicago (Ill) Medical Center.

Correspondence to Athena Poppas, MD, Noninvasive Cardiac Imaging and Physiology Lab, Section of Cardiology, University of Chicago Medical Center, 5841 S Maryland Ave, MC5084, Chicago, IL 60637.

Key Words: Clinicopathological Conference • aorta • syncope • echocardiography • cardiovascular diseases

	Case Presentation (R. Sawyer and A. Poppas)

 
A 73-year-old man presented to the University of Chicago Hospital Emergency Department on April 9, 1995, with a syncopal episode. The patient had been in his usual state of health until earlier that morning when he experienced an acute loss of consciousness during micturition. He fell and hit the left side of his head but sustained no other injuries. He was unable to tell how long he had been unconscious, although he thought that it had only been a few seconds. The event was not witnessed. He did not remember any premonitory symptoms such as palpitations, chest pain, dyspnea, headache, visual changes, or olfactory sensations or any confusion, grogginess, or bowel incontinence after the event. The patient had not noted any recent or remote episodes of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, dizziness, numbness or weakness, nausea, vomiting, diarrhea, fever, chills, cough, abdominal pain, back pain, or lower-extremity claudication. One month before this admission, the patient had experienced a similar episode of micturition syncope, but he had not sought medical attention. The previous episode also occurred immediately after awakening and was not preceded by any unusual symptoms.

His past medical history was significant for long-standing systemic hypertension, chronic atrial fibrillation, a cerebral vascular accident in 1983 without any residual defects, and a bowel obstruction due to volvulus that required surgery in 1992. He was a retired maintenance worker and part-time minister. He did not smoke, drink alcohol, or use recreational drugs. He was not taking any prescription or over-the-counter . . . [Full Text of this Article]