MLA Domain 5 · Presentation

Blackouts and faints

19 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 6

Aortic stenosis

Onset of symptoms (syncope/angina/dyspnoea) in severe AS → urgent referral for valve replacement (poor prognosis untreat

Autonomic neuropathy

Symptomatic postural hypotension with falls; severe gastroparesis; coexisting cardiac autonomic involvement

Bradyarrhythmias & AV block

Adverse features (shock, syncope, myocardial ischaemia, heart failure) or risk of asystole (Mobitz II, complete block, r

Enteric fever (typhoid & paratyphoid)

Intestinal perforation/GI bleeding (third week) → surgical emergency

Hypertrophic cardiomyopathy (HCM)

Exertional syncope, family history of sudden death, massive LVH, non-sustained VT or abnormal BP response → high sudden-

Syncope (vasovagal & cardiac)

Syncope on EXERTION, while supine, or with palpitations; abnormal ECG; family history of sudden death; structural heart

recognised feature · 10

Aortic dissection

Type A dissection (ascending aorta) → emergency cardiothoracic surgery

Extradural haemorrhage

Deteriorating GCS after a lucid interval, fixed dilated pupil, Cushing reflex → herniation; neurosurgical emergency

Long QT syndrome & channelopathies

Documented torsades/VF or aborted sudden death → ICD

Myocarditis

Fulminant myocarditis (cardiogenic shock, ventricular arrhythmia, high-grade block) → ICU/mechanical support

Phobias (including agoraphobia)

Severe avoidance causing housebound state or functional collapse

Postural (orthostatic) hypotension

Recurrent falls/injury in the elderly → address as a falls risk (cross-ref acute_care falls framework)

Pulmonary embolism

Haemodynamic instability (massive PE) → consider thrombolysis; pregnancy (alters imaging choice)

Pulmonary hypertension

Right heart failure/syncope → specialist pulmonary hypertension centre

Restrictive cardiomyopathy & ARVC

ARVC with syncope/arrhythmia/family history of sudden death → ICD and exercise restriction

Ventricular tachycardia & fibrillation

Pulseless VT or VF → immediate defibrillation + ALS (shockable arm)

differential of the above · 3

Hypoglycaemia

Reduced consciousness/seizure; sulfonylurea-induced hypoglycaemia is prolonged → admit/observe

Malaria

Severe/complicated falciparum malaria (cerebral, hypoglycaemia, acidosis, AKI, high parasitaemia) → medical EMERGENCY →

Mitral regurgitation

Acute severe MR from papillary muscle rupture (days after an inferior MI) → cardiogenic shock → emergency surgery