The management of interdisciplinary consults of the geriatric patient with co-morbidities

Abstract

Introduction: The geriatric patient must be approached differently due to the association of comorbidities, the difficult anamnesis and the possible cognitive degradation. Therefore, determining the etiology of an acute episode requires a multidisciplinary approach and a competent differential diagnosis. Material and methods: We present G.A. patient, a 77-year-old female, who was consulted in the Emergency Department and admitted to the Internal Medicine-Geriatrics Department because of syncope associated with dyspnea with orthopnea, atypical chest pain and coughing with mucous expectoration. These symptoms could be due to a number of underlying conditions, such as: Cardiovascular causes - the patient suffered a DDD pacemaker implantation 2 months ago after atrial tachycardia with first degree atrioventricular block, second degree atrioventricular block type I and type II, associated with left ventricular dysfunction - we need to consider: a pacemaker malfunction, congestive heart failure or an acute coronary syndrome (cardiology consult); Neurological causes - a possible transient ischemic attack (neurological consult); Orthostatic hypotension as a complication of type 2 diabetes mellitus and/or possibly the effect of antihypertensive medication - the patient is suffering from grade 3 hypertension) (diabetology consult); vertebrobasilar insufficiency secondary to spondyloarthropathy (rheumatology consult); Treatment and lifestyle modification non-compliance, frequent at the geriatric patient (a thorough anamnesis). Results: The clinical exam, paraclinical tests and interdisciplinary consults established that the treatment and lifestyle modification non-compliance led to an acute decompensated heart failure. Discussions: The particularity of this case resides in the extensive investigations needed to establish the cause of a syncopal episode in a geriatric patient with multiple comorbid conditions. Medical advice and supervision should be the hallmark of her future life. This case presentation wishes to emphasize the need to open doctor-patient relationships, efficient and complete anamnesis, and also the importance of therapy adhesion.