pre-syncope

Miss NFA, 22 year old uni student went to palliative ward round with Dr. R today. at first, the palliative session was held at the Klinik Unit Palliatif, ground floor. a handsome palliative care specialist, Dr. RL from Selayang Hospital came over to join them. there, they saw a few patients with advance cancer. after that, they went to 6th floor to see another patient. Miss NFA started to have 'strange' feeling. then, they went down again to see next patient. while standing and listen to the handsome Dr talking, Miss NFA started to feel giddy, her vision became cloudy and she felt unstable. she went to a corner and sit down on a chair (luckily there was a chair, if not, i think she will pass out). all her friends said that she looked very pale. after another half-an-hour talk by Dr. RL, NFA felt better. with the help from her friend, Miss NIMA, they used the digital BP set to check NFA's vital signs.
BP: 89/61mmHg, pulse rate:88 bpm. according to her, that was the lowest BP reading she ever had, n it was a first attack. no history of loss of consciousness before. she is actually fasting today.


Dx: pre-vasovagal attack
it can happened after standing for too long, due to reflex bradycardia +/- peripheral vasodilatation. (luckily she realized what was happening. if not, there wl b an admission to casualty)



DDx: hypoglycaemia
boley ke? our body has its own way to counteract low blood sugar such as lipolysis, glycogenolysis, proteolysis n gluconeogenesis. this NFA is not that thin, she has a lot of fat n protein to b burned up, ok.



comment from Miss NFA: "x penah2 sy jd macam ni. seb baik sy sedar cepat. mmg kelabu la pandangan sy, n it happened gradually. sakit kepala xde tp rasa mcm blood vessels mengembang dlm otak. xde lak rasa nk muntah, tremor, palpitation, sweating, or lapar ke. agak terkejut la, 1st time kan. owh, cmni ke rasenye nk pitam. slalu sy je yg tnya patient all the symptoms/signs of syncope, which can b caused by many things. now i know how it feels. n it is not nice at all :( Alhamdulillah, sy da ok skrg"