Recurrent Cardiogenic Syncope From Extrinsic Organ Anomaly

Area of Science:

• Cardiology
• Neurology

Background:

• Recurrent syncope, particularly exertional syncope, necessitates a thorough differential diagnosis.
• Excluding common causes like vasovagal syncope, seizures, and orthostatic intolerance is crucial.

Observation:

• A 40-year-old woman experienced frequent, non-prodromal syncope episodes, often triggered by exertion.
• A distinct low-pitched adventitious sound was noted after the second heart sound (S2) on the right lower sternal border.
• Initial investigations including ECG, cardiac enzymes, chest X-ray, telemetry, and EEG were unremarkable.

Findings:

• The physical examination finding of an adventitious sound post-S2 was the key diagnostic clue.
• This finding suggested an underlying cardiac etiology for the exertional syncope.
• The syncope episodes were inconsistent with neurogenic seizures and other common vasodepressor causes.

Implications:

• This case underscores the diagnostic value of cardiac auscultation in unexplained syncope.
• It highlights the need to consider cardiac causes, even with normal initial workup.
• Further investigation into the cardiac sound is warranted to identify the specific pathology causing exertional syncope.