Strelow Brittany, Middleton Hayden, Young Kathleen A, Olson Nicole, Boucher Lauren, Cera Alanna, Boswell Christopher L
Mayo Clinic, Rochester, MN, USA.
M Health Fairview, St. Paul, MN, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241308025. doi: 10.1177/21501319241308025.
Syncope is a common presenting complaint in the outpatient setting and requires a thoughtful and meticulous approach to history-taking skills. This is crucial in discerning cardiac versus non-cardiac etiologies, underscoring the pivotal role of healthcare professionals in the diagnostic process.
This is a case of a 76-year-old male who presented to the primary care clinic following an episode of syncope with abrupt loss of consciousness. Given the presentation, there was a high suspicion of cardiac etiology, and further testing was pursued. An electrocardiogram (ECG) demonstrated normal sinus rhythm with a pre-existing first-degree atrioventricular (AV) block. The Holter monitor was without sustained arrhythmias. A dobutamine stress echocardiogram was negative for myocardial ischemia, though a resting transthoracic echocardiogram demonstrated findings consistent with cardiac amyloidosis. Further evaluation with cardiology confirmed the diagnosis of transthyretin (ATTR) cardiac amyloidosis. He was initiated on appropriate treatment and underwent a dual chamber implantable cardioverter defibrillator (ICD) given his presentation. The patient ultimately succumbed to his disease 5 years after his diagnosis.
If the cardiac etiology of syncope is suspected, further cardiac structural evaluation is necessary. Cardiac amyloidosis, although rare, is a cause of cardiogenic syncope that should not be overlooked. It should be considered in the differential diagnosis in the appropriate clinical setting, highlighting the need for a broad and comprehensive approach to diagnosis.
晕厥是门诊常见的就诊主诉，需要采用周全且细致的病史采集技巧。这对于区分心脏性与非心脏性病因至关重要，凸显了医疗保健专业人员在诊断过程中的关键作用。
这是一例76岁男性患者，因一次晕厥伴意识突然丧失前来基层医疗诊所就诊。鉴于其临床表现，高度怀疑为心脏病因，并进行了进一步检查。心电图（ECG）显示正常窦性心律，存在既往一度房室（AV）阻滞。动态心电图监测未发现持续性心律失常。多巴酚丁胺负荷超声心动图检查心肌缺血呈阴性，尽管静息经胸超声心动图检查结果与心脏淀粉样变性相符。心内科进一步评估确诊为转甲状腺素蛋白（ATTR）心脏淀粉样变性。鉴于其临床表现，开始给予适当治疗并植入了双腔植入式心脏复律除颤器（ICD）。该患者最终在确诊5年后死于该病。
如果怀疑晕厥的病因是心脏性的，则需要进一步进行心脏结构评估。心脏淀粉样变性虽然罕见，但却是心源性晕厥的一个病因，不应被忽视。在适当的临床环境中，应将其纳入鉴别诊断，这凸显了采用广泛而全面的诊断方法的必要性。
