85-year old Beatrice Hicks has been seeing your family medicine clinic since her MI four years ago. Her post-MI heart failure with preserved ejection fraction symptoms are being held in check by propanolol, ramipril, and furosemide. She is seeing you today because of pre-syncope and syncope and worsening orthopnea/paroxysmal nocturnal dyspnea.
PE: Temp 38.5C, BP 112/86 (no change on standing), HR 85 regular, heart sounds normal, JVP 4cm above sternal angle, slight crackles at lung base. Neurologic exam normal.
What are the main classes of syncope? What questions would you like to ask to differentiate?
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