Question

A 65-year-old female patient who is new to your practice

presents after one episode of syncope that was sudden
and without prodromal symptoms. She has hypertension,
hypothyroidism, and depression, all controlled on medication
per her report. Her physical examination reveals an
obese woman with 21 pretibial edema and a normal
cardiovascular and neurologic exam. Her ECG shows left
ventricular hypertrophy. Which of the following would be
reasonable as the next step in determining the etiology
of her syncope?
a. Carotid Dopplers
b. Transthoracic echocardiogram
c. CT scan of head
d. Tilt table testing

Answer 1

A transthoracic echocardiogram would be reasonable as the next step in determining the etiology of syncope in a 65-year-old female patient with left ventricular hypertrophy on ECG and symptoms suggesting possible heart failure.

Step-by-step explanation:

The appropriate next step in determining the etiology of syncope for a 65-year-old female patient presenting with sudden syncope, hypertension, hypothyroidism, depression, obesity, pretibial edema, and ECG showing left ventricular hypertrophy would be a transthoracic echocardiogram. This non-invasive test provides detailed images of the heart's structure and function, which can help diagnose potential cardiac causes of syncope such as structural heart disease or heart failure, especially since the patient is already showing signs of cardiac issues with evidence of left ventricular hypertrophy on ECG and edema suggestive of possible heart failure.

A carotid Doppler is less likely to be informative in this case as there are no neurological deficits suggesting a cerebrovascular cause. A CT scan of the head may be considered if there was suspicion of a neurological cause, which is not present in this scenario. Tilt table testing is typically reserved for cases where vasovagal syncope is suspected and there is no sign of cardiac, neurological, or other systemic causes, which does not fit this patient's presentation.