Cardioinhibitory syncope due to bloodphobia associated asystole

Neurocardiogenic syncope is not an uncommon occurrence in the general population and affects people across a wide range of age groups. Several sub-specialties are involved in the management of this phenomenon and quite often a multidisciplinary approach is needed for arriving at the final diagnosis and deciding on the optimal treatment for this condition. Often, a thorough history and physical examination will aid in narrowing the differential of syncope and, in the right setting, both passive and provocative testing can be complementary. Neurocardiogenic syncope with a malignant course is a serious entity and usually needs prompt identification of its underlying etiology. It has been generally attributed to a severe cardioinhibitory or vasodepressor mechanism and most cases required tailored therapy. We describe a case which has many of the elements described above - a multidisciplinary approach, malignant neurocardiogenic syncope with profound asystole from a cardioinhibitory response, simplistic bed-side provocative testing, and tailored therapy.