Presentation: A 56-year-old retail manager complained of lightheadedness when he

Question

Presentation: A 56-year-old retail manager complained of lightheadedness when he awoke in the morning and occasionally throughout the day. He comments that he does not sweat as much as his friends when they play basketball at the local gym. The patient is 5’11”, 178 lbs. His blood pressure is 86/67 and heart rate is 72 bpm. He is afebrile and has no other complaints. A neurological exam did not demonstrate any other deficits. There is no significant family history. The patient is not currently on any medications.

Question 1: What is important about when the patient felt lightheaded? Question 2: If blood pressure is low, how can the autonomic nervous system correct that, normally? Is that happening in this patient? Explain your answer. Question 3: What toxic molecule would accumulate in the affected cells in this disease (and also in cells in Parkinson's disease)? Question 4: What prognosis (look that word up if you don't know what it means) would there be for a patient diagnosed with PAF?

Explanation / Answer

1.When a patient feels light hearted, it is important to think about the heart related problems because cardiac problems are the most important cause of light headedness. An ECG should be done. Neurological causes also should not be ignored. Some of the clues can be obtained by clarifying the following -

1) Whether he is feeling the same when he is standing

2) Whether it is occuring constantly or at intervals

3) Whether during the feeling he is experiencing any other symptoms like nausea or hearing problem

2. If blood pressure is low the autonomic nervous system can correct that by a number of ways. It may cause vasoconstriction i.e constricts the blood vessels and thereby increase the blood pressure.

ANS may also increase the cardiac output, means it increases the amount of blood pumped by heart in one minute.

Compared to normal blood pressure of 120 / 80, the blood pressure of this person is low. Though some individuals have low blood pressure everytime, they do not show any symptom. But in this case, the manager is complaining of light heartedness during morning and also occasionally throughout the day. So, his Autonomic Nervous System is not correcting the blood pressure.

3. Protein Synuclein is accumulated in cells in PAF and in Parkinson's disease.

4. Patients with PAF survive 20 years or more after the diagnosis. They respond well to treatment and show low risk of stroke.

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