28yr / M, salesman at Pharmaceutical Retail, non Smoker, non Alcoholic, non HTN or DM. Presented with H/O "Blackout" in bath this morning, no weakness or memory impairment. On admission his Hb% 15.3, TC 6800 P57 L38 M2 E3, Na+ 135.85 K+ 4.65. His ECG, CXR and NCCT Brain enclosed. Please discuss further evaluation and management.



ECG. Early repolrization with is Bennie. Otherwise basic ECG is normal.. CXR. Mild Diletated cardiomyopathy. Both lungs field are normal. NCCT. Normal . No any abnormalities are seen. For blackout . Put on Holtermonitaring.

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ECG:T wave upright in lead 1,2,3 & V2-V6,q wave in lead 2,3,avF,V3,V4, baseline ST elevation in lead 2,avF,V6 seems to be normal varient ? Early repolarization. X-ray:B/L hilar calcification R>L, unfolded aorta,. MRI Normal. There is no post syncopal bradycardia.Sir go for EEG,TMT

Reports seem normal. Check out RBS Look for postural hypotension If had a bath wth cold water thn possibility of vaso vagal attack. At last carotid Doppler. And if h/o black out in past then holter monitoring

Can be Inferior wall MI causing hypotension and syncope. Lead 1 is not showing any ST elevation. 2 3 avf having ST elevation, Serial ecg, 2d echo, cardiac enzymes

ECG is having early repolarisation changes. This seems to be Neuro-cardiogenic syncope. Tilt table test may be useful.

Could be vasovagal or micturition syncope. also see for any unprescribed drugs history as he is working in pharmacy.

Why no one is putting BPPV in differential diagnosis? Non of the above test will be positive in BPPV. This is rainy season, many times the pH imbalance in ear can cause this type of symptoms, and the patient will feel no problem the next moment. My suggestion is to check and confirm the diagnosis and start with betahestine 16 mg bid .


Chest x-ray shows oligaemic lungfields. Cardiac shadow is WNL.

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