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Related Experiment Videos

Recurrent syncope--a diagnostic challenge.

Filipa Marques, Cândida Fonseca, Pedro Sarmento

    Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
    |July 28, 2006
    PubMed
    Summary
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    Syncope diagnosis is challenging. A 60-year-old man with recurrent syncope experienced cardiac arrest due to bradyarrhythmia, successfully treated with a pacemaker.

    Area of Science:

    • Cardiology
    • Emergency Medicine

    Background:

    • Syncope diagnosis presents challenges, often mimicking other conditions.
    • European Society of Cardiology guidelines emphasize key questions for initial syncope evaluation.
    • Physicians must identify clinical features suggesting specific diagnoses and evaluation strategies.

    Observation:

    • A 60-year-old man presented with daily, transient loss of consciousness, occurring post-exercise and post-urination.
    • Prodromal symptoms included sweating and a sense of impending death; episodes were witnessed with no abnormal movements.
    • Electrocardiogram revealed sinus rhythm with left bundle branch block; echocardiogram was normal.

    Findings:

    • During 24-hour Holter monitoring, a syncopal event post-urination was recorded, showing a 50-second cardiac arrest with P-wave asystole.

    Related Experiment Videos

  • Cardiac bradyarrhythmia was identified as the cause of the syncopal episodes.
  • Permanent pacemaker implantation resolved the recurrent syncope.

    • Implications:

    • This case highlights the diagnostic difficulty of syncope in the Emergency Department setting.
    • Unusually prolonged cardiac arrest with spontaneous recovery underscores the non-specific nature of syncope symptoms.
    • Accurate diagnosis and timely intervention, such as pacemaker implantation, are crucial for managing cardiac syncope.