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Hypotension due to straining in a patient with a high spinal cord lesion: Difference between revisions
Hypotension due to straining in a patient with a high spinal cord lesion (view source)
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About 1 minute later the patient felt nauseous and started sweating. Bradycardia developed. The patient then became asystolic for almost 50 seconds. He was put on the bed and cardiac massage was applied. When reviewing the ECG afterwards, the first escape beat was almost at the same moment of CPR initiation. After 2 minutes the patient regained consciousness with a normal blood pressure and bradycardia of 45 bpm (Figs. 1 and 2). Syncope due to an emotionally-evoked vasovagal response with extreme bradycardia was diagnosed. Considering the clear cause of fainting and with the patient’s age in mind, we decided not to implant a pacemaker but to refer the patient to the Pediatric Psychosocial Department. | About 1 minute later the patient felt nauseous and started sweating. Bradycardia developed. The patient then became asystolic for almost 50 seconds. He was put on the bed and cardiac massage was applied. When reviewing the ECG afterwards, the first escape beat was almost at the same moment of CPR initiation. After 2 minutes the patient regained consciousness with a normal blood pressure and bradycardia of 45 bpm (Figs. 1 and 2). Syncope due to an emotionally-evoked vasovagal response with extreme bradycardia was diagnosed. Considering the clear cause of fainting and with the patient’s age in mind, we decided not to implant a pacemaker but to refer the patient to the Pediatric Psychosocial Department. | ||
[[File:Bloodphobia_Fig1.jpg | thumb | left | | [[File:Bloodphobia_Fig1.jpg | thumb | left | 400px | Figure 1. EKG recording. Time (seconds) is taken from the original recording.]] | ||
[[File:Bloodphobia_Fig2.png | thumb right | | [[File:Bloodphobia_Fig2.png | thumb | right | 400px | Figure 2. Continuous blood pressure recordings during 50 seconds of asystole. Time (seconds) is taken from the original recording.]] | ||
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His blood-injury phobia was treated using systematic desensitization with muscle tensing and cognitive techniques [2,3] under surveillance of the pediatric resuscitation team. Cognitive behavioral therapy was used to teach him to apply realistic and reassuring thoughts to the physical symptoms he saw as alarming. | His blood-injury phobia was treated using systematic desensitization with muscle tensing and cognitive techniques [2,3] under surveillance of the pediatric resuscitation team. Cognitive behavioral therapy was used to teach him to apply realistic and reassuring thoughts to the physical symptoms he saw as alarming. | ||
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== References == | == References == | ||
<biblio> | <biblio> | ||
#Wieling pmid= | #VanDijk This case was published earlier as: Van Dijk N, Velzeboer SC, Destree-Vonk A, Linzer M, Wieling W. Psychological treatment of malignant vasovagal syncope due to bloodphobia. Pacing Clin Electrophysiol 2001;24:122-124. . We thank Blackwell Publishing for permitting this reproduction | ||
#Hellstrom pmid=8741718 | |||
#Krediet pmid=12270863 | |||
#Sra pmid=8455666 | |||
#Hainsworth Hainsworth R. Syncope and fainting: classification and pathopsychological basis. In: Bannister R, Mathias CJ, eds. Autonomic failure. A textbook of clinical disorders of the autonomic nervous system. 4th ed. New York: Oxford University Press; 1999:428-36. | |||
#Connolly pmid=12734133 | |||
#Deal pmid=9249828 | |||
#Marks pmid= | |||
<biblio> | <biblio> | ||