Recurrent carotid sinus syncope in a middle-aged woman without any underlying condition: a case report

Syncope is a frequent reason for emergency room visits, often triggering extensive diagnostic evaluations. However, a well-conducted bedside history and physical examination can significantly streamline the process, leading to an accurate diagnosis and reducing unnecessary testing. Carotid sinus syndrome (CSS), though relatively rare, is an important consideration - particularly in middle-aged and older adults.

We report the case of a 53-year-old woman who had been experiencing recurrent episodes of syncope for 13 years. Despite undergoing multiple investigations, no definitive diagnosis had been established. However, a thorough clinical examination, combined with carotid sinus massage (CSM), ultimately identified CSS with a vasodepressor response. She was advised to adopt lifestyle modifications, including avoiding known triggers, increasing fluid intake, and taking Fludrocortisone 0.1 mg daily. A 1-year follow-up revealed complete resolution of her syncopal episodes.

CSS is often an overlooked cause of recurrent syncope, requiring specific diagnostic techniques such as CSM for identification. The vasodepressor variant, in particular, is best managed with conservative strategies, patient education, and volume expansion. While randomized controlled trials are lacking, anecdotal evidence supports the use of Fludrocortisone and midodrine in selected cases. This case underscores the critical role of history-taking and bedside assessment in the accurate diagnosis and effective management of reflex syncope.

A meticulous clinical history and targeted physical examination remain essential in identifying rare causes of syncope, such as CSS. This approach not only ensures appropriate management but also helps prevent misdiagnosis, optimizes the use of healthcare resources, and ultimately improves patient outcomes.