Chapter

Case 35

Rajkumar Rajendram, Javed Ehtisham and Colin Forfar

in Oxford Case Histories in Cardiology

Published on behalf of Oxford University Press

Published in print March 2011 | ISBN: 9780199556786
Published online November 2012 | e-ISBN: 9780191753305 | DOI: http://dx.doi.org/10.1093/med/9780199556786.003.0281

Series: Oxford Case Histories

Case 35

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A 48-year-old violinist presented to his GP after feeling faint whilst playing a solo piece in a concert. His wife also mentioned that his face would occasionally drain of colour but would return to normal a few seconds later. This symptom of intermittent facial pallor had developed over the preceding 2 months and had increased in frequency. It was particularly severe when he was under stress, when it could occur several times a minute. He denied palpitations, chest pain, breathlessness, or syncope. His exercise tolerance was unrestricted. There was no past medical or surgical history. He did not take any medications regularly. Examination revealed intermittent changes in facial appearance with episodes of pallor followed by flushing (Fig. 35.1), an irregularly irregular pulse, BP 140/75 mmHg, but otherwise unremarkable. His GP arranged blood tests and referred him for a 12 lead ECG (Fig. 35.2).

Chapter.  1794 words.  Illustrated.

Subjects: Cardiovascular Medicine

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