Syncope

[Rutherfordernest]

86year old episode of syncope male conscious after1-3 min according to relative
Maybe seizure but no history of such BP 144/100 on arrival toER 30 min after Collapse PVCs on ECG for
On 8mg of cardura (alpha blocker) forBP
eltroxin 75mg for hypothyroidism
Serc16 for balance
75 mg aspirin
History of asthma 30 years on SABA prn and ICS
And pernicious anemia for 20 years
Local cardiologist moving straight for pacemaker without angio just echo
Interested in comments.Many reasons for syncope in this age

[rnangel]

Hmmm..no holter monitor or angio. Partial occlusion of the carotid artery is a common cause of syncope. A pacemaker will not reverse this problem. The only rationale to this decision is that the patient is not a surgical canditate for invasive surgery and the pacemaker is only for symptom management. Of course the patient should be involved in making an informed decision. If you are a health care provider involved with this patient, you have every right to ask the cardiologist for the rationale for which he is basing his decision. You offered a great critical reflection.

[caregiver222]

Well, for starters, the alpha blocker prevents the heart from increasing blood, pressure to compensate for low oxygen levels. From the information provided there seems no reason to jump to a pacemaker, however there are "missing pieces".to the story. What was the story with cardiac enzymes, for example? Was there ST depression on the EKG? How many PVC's per minute were there? Was there any other abnormality in the rate or rhythym (i.e. skipped beats, Wenkebach etc.?) Were orthostatic vitals taken? Was the patient dehydrated? What was the hematocrit? What were the arterial blood gas readings? Were there any previous episodes of unconsciousness? Did the patient have an MRI/MRA ?

A pacemaker isn't the worst thing in the world, nor is the decision necessarily irrational. I suggest you get a medical proxy and request the medical records and get a second opinion if you are not provided with a satisfactory explanation for the decision.