Aug 19 Syncope and Pulmonary Hypertension

This case was an elderly female with previously repaired aortic stenosis (mechanical AVR 15 years prior) who presented with recurrent syncope over the past 1 - 2 years.  The syncope occured with exertion and was increasing in frequency.  She carried a diagnosis of hypoxemic "COPD" but no PFT records were available.  PaO2 was low, and there was no evidence of CO2 retention.  She was suspected of having pulmonary hypertension by ECHO but had refused R heart catheterization to confirm. 

Will not go into discussion of syncope workup here - see this post from July 7.

Effort syncope has been described as a common symptom in primary pulmonary hypertension for quite some time.  An early effiort to identify the mechanism found progressive decreases in blood pressure ultimately resulting in acute R heart failure accounted for the syncopal attacks.  Tachy or brady arrhtyhmias occured but did not seem to be responsible for the acute drop in BP.

A nice review of primary pulmonary hypertension from AAFP is here.