Recurrent loss of consciousness

doi:10.1136/bmj.a2703

Published 10 December 2008, doi:10.1136/bmj.a2703
Cite this as: BMJ 2008;337:a2703

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Recurrent loss of consciousness

John Cooke, specialist registrar (geriatric medicine/general (internal) medicine), Sheila Carew, registered general nurse, Aine Costello, clinical nurse manager, Tina Sheehy, clinical nurse specialist (functional gerontology), Declan Lyons, professor of medical science

¹ Clinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle, Limerick, Republic of Ireland

Correspondence to: J Cooke johncooke_cork@yahoo.com

The first 150 words of the full text of this article appear below.

An electrocardiograph and beat-to-beat blood pressure recordingswere performed during right sided supine carotid sinus massageon a 78 year old man (figure). He reported frequent episodesof loss of consciousness, which were typically of sudden onsetfollowed within minutes by rapid recovery to full health. Somewere associated with jerking movements of his limbs. He linkedsome of these episodes to turning his head. He had no importantcomorbidities but had recently fallen and sustained a fracture.

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Simultaneous beat-to-beat blood pressure (above) and electrocardiograph (below) tracings performed during right sided supine carotid sinus massage. Arrow indicates onset of 5 second carotid sinus massage. Image created with BeatScope software, using data obtained from a Finometer device

1 What is the most likely cause for this patient’s recurrentepisodes of loss of consciousness?

2 Outline the assessmenthe should have before carotid sinusmassage.

3 Outline thetreatment options available.

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