Things come in Twos

So ive been covering medical wards this week

Had a call on monday about a lovely syncopal lady who untill the last week was still doing, Scottish highland dancing, Aquarobics, and Spin classes. Apparently she had an AS murmur but such good function so had never been investigated.

So she came to me with an episode of syncope. Walking up a slight incline, stopped twice as lightheaded and the final time after attempting to continue collapsed. Firstly i sorted out her face, stiched her up and had a good look at her.

She really was an awesome 85 Y/O lady. I was really not that convinced she had a slow rising pulse but she had an awesome ESM murmur Grade 5.5. (when you believe you can hear it from the end of the bed!)

Plan was to keep her for the night as was 10pm and get USS ect organised for the morning. 

I went down for the USS and had a play (attached photo is not mine) i wish i could get the perfect view but as just learning its not that pretty.


I thought this was pretty impressive, peak of >100mmHg and mean >60mmHg.

Discussed with cardiology and shes off to our teritary centre for work up to a percutaneous valve replacement.

Then yesterday afternoon got a call about a nice bloke with CHF and fast AF, ESM murmur.

Arrives to me pretty wet. had 80 IV frusemide and responded well. Bumped up his digoxin which was subtheraputic week before and his rate settled nicely.

Whilst having a look at him and his old records hes on the waitlist for a TAVI…due to happen in feb 2012. AS with peak 95mmHg and mean >60…

Cool CT recon from his work up


So that was my Duo of tight AS with clear symptoms. Also first time I have seen Exhertional syncope secondary to AS.

So questions for anyone/everyone. What have you had come in twos or threes?