Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Superficial Thrombophlebitis Syncope 1393

complications and prognosis

Complications (of Septic Thrombophlebitis)

■Bacterial endocarditis (often fatal)

■Abscess at site of venipuncture

■Septic emboli to lungs or other organs (splenic abscess, etc.)

Prognosis

■Superficial thrombophlebitis

➣prognosis is excellent

■Septic thrombophlebitis

➣prognosis is related to the timeliness of diagnosis

➣early excision of the septic vein – good prognosis

➣S. aureusendocarditis – poor prognosis

SYNCOPE

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Transient loss of consciousness

■Prodromal malaise, nausea, pallor, diaphoresis, weakness

■Loss of muscle tone is common

■Rapid recovery once pt is recumbent

■Urinary incontinence sometimes occurs during episode

■Episodes may be precipitated by acute or anticipated pain, emo-

tional stress, fluid loss, obstructed venous return, intense activity in

the heat, prolonged standing, postural hypotension, cardiac arrhyth-

mia

■Examination usually normal in vasovagal syncope

■Cardiac arrhythmia or evidence of dysautonomia (eg, postural

hypotension, impaired sweating, pupillary abnormalities) may be

found when syncope is secondary

■With dysautonomias, associated abnormalities may be found in CNS

or PNS

tests

■Normal in vasovagal syncope

■Abnormal autonomic function studies indicate dysautonomia

■Tilt-table testing may reproduce symptoms & indicate cardiac

abnormality