MR wrapup for Apr 5 - 9

Diogenes Syndrome Case:

An elderly female admitted with progressive ulcerations over her body.  House was in disarray, she was covered in feces, and had experienced a similar episode one year prior.  She likely has Diogenes Syndrome:  Adult self neglect syndrome, also known as messy house syndrome.  She refused all attempts at placement for skilled nursing care, and denies that any help is needed.  This is a difficult condition to address and there does not appear to be any pharmacologic or behavioral therapy of any great effect.

Sick Sinus Syndrome / Tachy Brady:

A patient with syncope had some episodes of flutter/RVR alternating with sinus pause / sinus bradycardia.  His bradyarrhythmias were only occasionally present on telemetry.  This syndrome is common in older adults with other risk factors for CAD.  Sick sinus syndrome and tachy brady are felt by some to be variants of the same disorder, but in pure sick sinus syndrome the tachycardia is not often seen. 

Other interesting features of this case was the presence of sotalol toxicity.  In this case the patient was a hemodialysis patient and was taking sotalol.  His admit ECG was bizarre with alternating wide and narrow complexes and a prolonged QT > 600msec.  Sotalol toxicity often produces torsades, but this was not seen in this patient and his QT interval normalized with dialysis and discontinuation of sotalol.