Maharaj Akshay, Teelucksingh Joel
Internal Medicine, Port of Spain General Hospital, Chaguanas, TTO.
Internal Medicine, San Fernando General Hospital, San Fernando, TTO.
Cureus. 2023 Mar 26;15(3):e36716. doi: 10.7759/cureus.36716. eCollection 2023 Mar.
Aortic stenosis is a common valvular pathology and may also have atypical presentations outside the classic triad of chest pain, syncope, and shortness of breath. Some patients may not present with the symptoms of the triad. This patient instead presented with syncope and vomiting. Statistically, the most common cause of syncope at rest in the setting of aortic stenosis is due to an arrhythmia rather than the valve itself limiting cardiac output. In a comorbid Alzheimer's patient who has developed hyperorality, postprandial hypotension can also result in syncope at rest. Therefore, syncope at rest should raise alarm for nonvalvular etiologies such as arrhythmia. This case study also aims to establish an association between syncope at rest and hyperorality in the setting of aortic stenosis, a first study so far. Additionally, it highlights an unusual presentation of aortic stenosis where syncope occurs at rest associated with vomit in the absence of chest pain or shortness of breath.
主动脉瓣狭窄是一种常见的瓣膜病变，其临床表现可能也会超出胸痛、晕厥和呼吸急促这一经典三联征。部分患者可能并无三联征症状。该患者反而表现为晕厥和呕吐。从统计学角度来看，在主动脉瓣狭窄情况下，静息时晕厥最常见的原因是心律失常，而非瓣膜本身限制心输出量。在患有共病阿尔茨海默病且出现贪食症的患者中，餐后低血压也可导致静息时晕厥。因此，静息时晕厥应警惕心律失常等非瓣膜性病因。本病例研究还旨在确立主动脉瓣狭窄情况下静息时晕厥与贪食症之间的关联，这是迄今为止的首个此类研究。此外，它突出了主动脉瓣狭窄的一种不寻常表现，即静息时出现晕厥并伴有呕吐，而无胸痛或呼吸急促。
