Case presentation 15.08.1402

Present illness

A 25-year-old woman complained of

• Weakness
• Reduced physical strength
• Nausea
• Anorexia
• Weight loss 18kg/6months
• Dizziness and syncope
• Heart rate instability
• Arthralgia without arthritis

Began 6 months before admit

For syncope attacks and heart rate instability: ECG holter 7days and BP Holter monitoring

• Office BP monitoring: orthostatic hypotension
• ECG Holter monitoring: no arrhythmia
• Baseline daytime heart rate elevated :110bpm

Echocardiogram: EF 60% and just mitral valve prolaps