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(Circulation. 1995;91:231-235.)
© 1995 American Heart Association, Inc.

Articles

37-Year-Old Woman With Progressive Fatigue, Syncope, and Chest Pain

Presented at The University of Texas Medical School at Houston on October 24, 1994.

Albert E. Raizner, MD; Kent A. Heck, MD

From the Departments of Internal Medicine (A.E.R.), Baylor College of Medicine, and Pathology and Laboratory Medicine (K.A.H.), The University of Texas Medical School at Houston, The University of Texas–Houston Health Science Center, Houston, Tex.

Correspondence to L. Maximilian Buja, MD, Professor and Chairman, Department of Pathology and Laboratory Medicine, The University of Texas Medical School at Houston, 6431 Fannin St, MSB 2.136, Houston, TX 77030.

Key Words: Clinicopathological Conference • syncope • diagnosis

	Case Presentation

 
A 37-year-old woman was referred to Hermann Hospital from a local health maintenance organization clinic for the evaluation of fatigue, chest pain, and syncope.

The patient was in her normal state of health until approximately 6 months before admission, when she began suffering mild fatigue. Her fatigue initially consisted of effort intolerance. She reported having an increased amount of breathlessness when climbing the flight of stairs to her second-floor apartment. Approximately 4 months before her hospital admission, she had the first of four syncopal episodes. The first episode occurred as she proceeded to walk after a long period of standing. At that time, she sensed the onset of chest tightness and dizziness before losing consciousness.

She did not initially seek medical attention for her fatigue and syncope. She reported having dizzy spells that were initially associated with chest tightness and mild breathlessness. Her dizzy spells, which initially occurred weekly, became more frequent such that they occurred daily during the month before her hospital admission. Her chest discomfort was described as a squeezing sensation that was substernal in location without radiation to any other position. It was usually associated with dizziness and breathlessness but never with nausea, vomiting, or diaphoresis. Her chest discomfort occurred at rest and with exertion.

The three syncopal episodes that followed the first occurred approximately 1 month apart. Each of these episodes occurred as she proceeded to stand and walk from a sitting or lying position. Her syncope was always preceded by substernal chest pressure, dizziness, and . . . [Full Text of this Article]