0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
Hyperphosphatemia Hypersensitive Carotid Syndrome and Syncope 759aluminum hydroxide is osteomalacia, and CNS disturbances with long-
term use.
follow-up
■Serial assessments are required. If due to acute renal failure, patients
may become hypophosphatemic with post-obstructive or resolving
ATN diuresis.complications and prognosis
■The primary complication of hyperphosphatemia is extraskeletal
calcification, including coronary artery and other vascular calcifica-
tion with resultant hemodynamic changes. In addition, recent data
indicate that hyperphosphatemia (>5.5 mg/dl) is associated with
increased mortality in dialysis patients.Hypersensitive Carotid Syndrome and Syncope..............
EDMUND C. KEUNG, MD
history & physical
History
■More commonly in men and in elderly.
■Syncope or presyncope caused by a hypersensitive reflex response
to carotid sinus stimulation.
■Tight collar, shaving and sudden head turning.
■Often associated with neck pathology, sinus and AV node dysfunction
and coronary artery disease.Signs & Symptoms
■Near or frank syncope with carotid stimulation.
■Three types of response:
➣cardioinhibitory, 34 to 78% (ventricular asystole from sinus arrest
of block)
➣vasodepressor with hypotension, 5–10%
➣mixed type.
tests
■Basic Tests
➣12-lead ECG during carotid sinus massage:
➣Defined as > 3 s asystole for abnormal cardioinhibitory response
and a decrease in 30 (with symptoms) or 50 mm Hg (without