Oral syncope

- Good afternoon, I'm Inès Tebboune I'm your doctor
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- Good afternoon, I'm Inès Tebboune I'm your doctor
- Hello I'm Anna Saliver
- So what brings you here today?
- 2 days ago I have been hiking with my friends up a steep hill, and the next thing that I remember was waking up, lying on the trail
- I will ask you a few question , anything we discussed remain confidential within the medical teams well. So, are you ready to go ahead?
- yes absolutely
- how old are you? When were you born?
- I'm 18 years old , I was born in 18/02/2004
- Ok so you tell me you've been lying on the trail, did you feel like you were falling
- No, i don't remember anything
- Did you bite your tongue or have incontinence at the time of the event?
- No ,but I remember feeling briefly dazed. This feeling resolved quickly without any intervention. After a period of rest, I was able to finish the hike without further problems.
- Did anyone see you fall?
- No my friends were all in front, nobody saw me fall
- Ok and before falling, have you have any chest pain, shortness of breath, palpitations, or dizziness?
- No
- And now do you have pain somewhere?
- No, I have nothing
-Are there people in your family who had a similar episode?
- I don't know if it's the same episode but my mum did a syncope 3 years ago
- Ok and are there people in your family who ever had a stroke, myocardial infarction, or cancers?- No, except my mum who had a syncope, my whole family is healthy- Well , have you ever had any surgery?- I had surgery on my right shoulder- Have you ever had other health problems like hypertension, cardiovascular disease ,diabetes mellitus, hyperlipidemia?- No I have nothing!- Have you ever had some accidents or procedure?- I don't think so... hmm yes sorry I had a similar episode a few years ago that also started while I was exerting myself. Well, this episode isn't that important because I skipped breakfast in the morning.-Do you have any treatment?- No, but I take a multivitamin every day- Well, do you have allergy?- Yes I am allergic to pollen- What do you do for living?- I'm a high school senior- Well, Do you smoke?- No- Do you take illicit drugs?- No, I never tried!- OK perfect, Do you drink?- Yes only when I'm on a party , so occasionally- Ok and do you practice some sport?- Yes I love it! I go to the gym twice a week and I play tennis on Saturday- Have you ever been pregnant?- No- Well, let's start the physical exam. How tall are you and how much do you weigh ?- I am 5 feet 5 and 154 lbs- Okay. Have you lost or gained any weight recently ?- No , I try to pay attention to my diet- Well all seems good... (prendre un carnet et noter en mode ordonnance) We're going to do some complementary exams to know more. I'm going to prescribe a complete blood cell count with a chest radiograph and an electrocardiogram.- Your biologicals assessments are normal , your chest radiograph is likewise normal.But your ECG demonstrates prolongation of the QT segment. - This ECG suggest a congenital long QT syndrome (LQTS).- Ok but what I suppose to do now?- now the purpose is to prevent your episode of syncope. In fact there is no known prevention? However, with proper treatment, we can prevent the dangerous heartbeats that can lead to long QT syndrome complications. I'm going to prescribe magnesium and beta blockers. This medications won't cure long QT syndrome, but they can help protect against possible life-threatening heart rhythm changes.- Ok thank you doctor- Is it ok for you to come back in a month for routine exam and check if all is ok?- Yes it's ok for me, thanks you! Goodbye