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A Complete Workup of Recurrent Syncope Caused by Significant Left Main Coronary Artery Stenosis

Seyed Zaidi1, Rafsan Ahmed2, Ahmad Jallad1

  • 1Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA.

Cureus
|July 18, 2022
PubMed

Insights

Syncope, often caused by reduced blood flow to the brain, can rarely stem from ischemic cardiomyopathy. This case highlights the importance of considering coronary artery disease in syncope evaluations.

Area of Science:

  • Cardiology
  • Neurology
  • Internal Medicine

Background:

  • Syncope, characterized by transient cerebral hypoperfusion, has a broad differential diagnosis.
  • Common causes include vasovagal responses, orthostatic hypotension, drug effects, arrhythmias, and structural heart disease.
  • Ischemic cardiomyopathy is a less common, yet critical, consideration in syncope workup.

Observation:

  • An 81-year-old male presented with recurrent witnessed syncopal episodes and newly diagnosed heart failure.
  • Extensive cardiac investigations were performed, including electrocardiograms (EKG), echocardiogram, Holter monitoring, electrophysiology (EP) study, and coronary angiography.
  • The diagnostic workup identified significant coronary artery disease (CAD) with 80% distal left main disease, leading to ischemic ventricular tachycardia.

Findings:

  • The patient underwent successful coronary artery bypass grafting (CABG).
  • Post-procedure, syncopal events completely resolved.
  • The patient was discharged on guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) and CAD.

Implications:

  • This case underscores the rare but significant association between extensive myocardial ischemia and syncope via ventricular arrhythmias.
  • It emphasizes the necessity of including ischemic heart disease in the differential diagnosis for patients presenting with syncope.
  • Prompt identification and management of CAD can resolve syncopal episodes and improve outcomes in heart failure patients.

Keywords:
atrial tachycardiacoronary angiogramcoronary artery diseaseischemic cardiomyopathyleft main coronary artery stenosispercutaneous coronary interventionrecurrent syncopeventricular tachycardia

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