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A patient with recurrent syncope and ST-elevation on the electrocardiogram
N Colman1, W Wieling, A A M Wilde
1Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands. n.colman@amc.uva.nl
Summary
Recurrent syncope in a 56-year-old woman was linked to both vasovagal syncope and coronary artery spasm. Treatment with nifedipine significantly reduced syncopal episodes, suggesting a combined etiology.
Area of Science:
- Cardiology
- Neurology
Background:
- Vasovagal syncope is a common cause of syncope, often diagnosed via head-up tilt testing (HUT).
- Coronary artery spasm can present with chest pain and syncope, mimicking other cardiac conditions.
Observation:
- A 56-year-old woman with a history of over 100 syncopal episodes experienced a typical vasovagal syncope with bradycardia, ST-elevation, and chest pain immediately after an uncomplicated HUT.
- The patient's symptoms during syncope included bradycardia, marked ST-elevation, and chest pain.
Findings:
- The head-up tilt test (HUT) precipitated a syncopal episode, confirming vasovagal syncope.
- The concurrent ST-elevation and chest pain suggested an underlying coronary artery spasm component.
Implications:
- This case highlights a potential combined etiology of vasovagal syncope and coronary artery spasm in patients with recurrent syncope.
- Nifedipine treatment proved effective in managing syncopal episodes, indicating the utility of addressing coronary spasm in such cases.
- Further investigation into concomitant vasovagal and coronary spasm may be warranted for refractory syncope presentations.