Holiday Heart Strikes Again?

Posted by Patrick Lickiss on Nov 30, 2010 in Assessment, General, Treatment | 1 comment

THE CALL
Here’s the scenario:  A 58 year old female has just finished a family dinner and has admittedly overeaten.  While sitting and talking with family, the patient has a few sips of wine (which is out of the ordinary for her) and has a witnessed syncope.  The patient is assisted to the ground and does not experience any trauma.  The patient’s syncope lasts approximately four minutes and her level of consciousness does not improve when she is placed supine.  Upon EMS arrival, the patient is altered, with absent radial pulses and a carotid pulse in the 50’s.  Blood pressure is 80 systolic with a slow respiratory rate.  When placed on the ECG monitor, a sinus bradycardia with a first degree AV block is shown.  A 12 lead ECG shows similar findings.

The patient has a history of syncope after a large meal with wine (though not every time) and hypertension.  The patient does not normally drink alcohol and is generally healthy.  She takes medication for hypertension but cannot recall the name.  She has no known drug allergies.

The patient is placed on high flow oxygen (SpO2 does not register) and an IV is started with a 250cc bolus given.  En route to the emergency department, the patient’s skin signs improve, as does her level of mentation.  By the time the unit arrives at the hospital, the patient’s vital signs have improved and her follow-up ECG shows a sinus rhythm with a first degree block.

WHAT’S THE DIAGNOSIS?
So the question is this, what is wrong with this patient?  Is this a situation we should be aware of?  What are some possible causes?  Sure there’s increased vagal tone from too much to eat.  And holiday heart syndrome (more on that later).  But what about something else? Something underlying.  I have a few ideas, but I’d like to hear your thoughts.  Give me your ideas and stay tuned later in the week for my thoughts on the subject.  I look forward to your insights.

Image via Flickr