A patient with funny spells
A 42 year old nurse presented to her general practitioner with a five year history of intermittent episodes of dizziness, palpitations, and sharp central chest pain. There was no radiation or aggravating or alleviating factors. She complained that the colour of her hands and feet would drain to white, and they would feel cold. Her pulse would become impalpable, progressing to a weak irregular rhythm before returning to normal. All symptoms started at the same time, each episode lasting up to a minute before resolving simultaneously. They were not associated with exercise or posture, and her general condition improved quickly after each episode. She had no associated symptoms of breathlessness, syncope, or fits.
She was diagnosed as having chronic myeloid leukaemia at 32 and treated with bone marrow transplant and irradiation, with no evidence of relapse. She had never smoked and rarely drank alcohol. On examination, her blood pressure was