Syncope

Syncope, ED Physician Note:

Clinical History:

A ??-year-old male with multiple cardiovascular risk factors (diabetes, dyslipidemia, hypertension, obesity, and smoking).

Chief complaint of; a sudden transient loss of consciousness (Syncope) lasting a few seconds while sitting/standing (specify). There was no preceding chest pain, palpitations, shortness of breath, or visual disturbances. He regained consciousness spontaneously and now feels well. No Hx of trauma, postictal confusion, incontinence, or tongue biting was reported.

No similar previous episodes were noted. He denies chest pain, headache, focal weakness, or numbness. No recent medication changes or excessive alcohol use.

Medication;  Metformin 1000 mg twice daily, Amlodipine 5 mg daily, Atorvastatin 20 mg daily, Aspirin 81 mg daily.

Allergy; No known drug allergies,

Family History; Father died of a myocardial infarction at age 60, Mother has hypertension and diabetes.

Review of Systems:

General: No recent fever, weight loss, or fatigue.

Cardiac: No chest pain, orthopnea, paroxysmal nocturnal dyspnea, or edema.

Neurological: No headache, vision changes, weakness, or seizures.

Endocrine: No hypoglycemic symptoms reported.

Respiratory: No shortness of breath or cough.

Physical Examination:

Appearance: Alert, oriented, in no distress.

Vital Signs: BP: 130/80 mmHg, HR: 78 bpm, regular, RR: 16/min, Temp.: 36.8°C, O₂ Sat.: 98% on room air.

General: Obese male, not in distress.  

Cardiovascular: Normal S1/S2, no murmur or gallop. Peripheral pulses intact.  

Respiratory: Clear breath sounds bilaterally.  

Neurological: Cranial nerves and motor exam normal, no focal deficits.  

Skin: Warm, dry, no diaphoresis or pallor

Syncope, Disposition Consultant Note:

A 55-year-old man with multiple cardiac risk factors presented after a self-limited episode of syncope, now hemodynamically stable and symptom-free. [9][10]

Problem List:

1. Syncope: Resolved, unclear etiology, high-risk profile

2. Type 2 Diabetes: Controlled

3. Hypertension: Controlled

4. Dyslipidemia

5. Obesity

6. Active tobacco use

Differential Diagnosis 

1. Cardiac arrhythmia (most likely given risk profile).

2. Ischemic cardiac event (ACS or MI).

3. Vasovagal/neurocardiogenic syncope.

4. Orthostatic hypotension (autonomic dysfunction from diabetes).

5. Hypoglycemia.

6. Pulmonary embolism (if dyspnea develops).

7. Seizure (less likely without postictal signs).

Assessment  

Given his comorbidities (diabetes, hypertension, obesity, smoking) and age, this patient is at elevated risk for cardiovascular causes of syncope, particularly arrhythmias or silent ischemia. His normal initial evaluation and stable status are reassuring but do not exclude underlying pathology.

Plan

- Continue cardiac monitoring, repeat ECG if any changes.

- Await initial lab results, including troponin.

- Monitor for recurrence of symptoms.

- Maintain IV access, consider echocardiogram if indicated.

- Educate patient and family on warning signs for return.

- Consult cardiology for risk stratification and disposition guidance. 

If cardiac or neurological cause identified, admit to monitored unit; otherwise, consider short-term observation with outpatient follow-up once serious causes excluded.