Unexplained transient loss of consciousness in a 58 year old male after a Legionella pneumonia: Difference between revisions

Legionella pneumonia. He also complained of light-headedness during prolonged standing and near-syncope during toilet visits at night. A few months prior to the visit to our unit he lost consciousness on a very hot day shortly after standing up from a chair. He fell into a swimming pool and almost drowned. After this episode cardiological assessment was performed An EKG and echocardiogram both were normal. During tilt-table testing a large drop in blood pressure was observed after administration of nitroglycerin (from 150/80 mm Hg prior to the tilt test to 60 mmHg systolic during the test), but the patient did not faint and the test result was interpreted as negative. During bicycle exercise testing  the patient had to stop at a load of 120 Watt only, because of fatigue and light-headedness. Blood pressure dropped from 150/60  mmHg sitting on the bicycle to 60/40 mmHg directly post-exercise. No EKG-changes were noted. Because the fall in blood pressure during exercise was unexplained, cardiac catheterisation including ventricular and coronary angiography was performed to exclude cardiac disease. No abnormalities could be found.   

On examination in our syncope unit he was in good general health. His finger arterial pressure was 190/93 mmHg supine with an asymptomatic fall to 175/93 after 3 min standing. During an exercise test (step-test) blood pressure decreased in 1 minute from values around 175/95 mmHg to levels of 114/64 (Figure 1).  

[[File:TransientLossCons58yoMale_Fig2.jpg | thumb | right | 300px | Figure 2: Blood pressure and heart rate response during the Valsalva manoeuvre. Note the fall in pressure during straining and the lack of blood pressure overshoot after release of the strain.]]

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