This is vasovagal syncope with prominent cardioinhibitory component. Not uncommon. Can try conservative management: Salt Hydration Acebutolol or pindolol Norpace Scopolamine patch But at this point, given the # of episodes, including injury, a pacemaker will prevent fainting.
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I was the EP consultant mentioned in the article. Classic prodrome with each syncope. Tilt table with both cardioinhibitory and vadodepressor responses. His worst episodes occurred in the ED while getting IVs placed.
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If trigger avoidance + volume loading +/- medical therapy doesn't dramatically reduce syncope incidence, a pacemaker is likely benefit > risk (including long term risk). When long pauses seen, pacer usually prevents syncope, but not all symptoms. Pacer + acebutolol may work great
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@LisaSandersmd Also it's not clear why this case is presented as a "mystery." This is one of the most common diagnoses i see in young patients who are referred for management. Yes, sometimes it takes a few treatment trials/errors to find what works. But can almost always manage. -
Why this is a mystery case is the true mystery, I agree.
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Matthew I would go to Castle And Connolly Top Doctors in America and find a Great Cardiac Electrophysiologist! Look for the ones that are in the top 1% in the nation! See three or three of them!
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May I suggest you make these articles available to non-subscribers if you really want to crowdsource. Thx
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I’ve seen exactly this in the ER before. Called it sinus arrest and I believe they put in a pacemaker. Couldn’t really say though because I just stabilized and transported to CVICU.
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Something pyschological
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It is a psychological cause.
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It could either be Arrhythmogenic Right Ventricular Dysplasia or Brugada Syndrome. You'd have to get tested to find out though!
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Possible vagal nerve issue.
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We take pride in the technological growth and medical advancement in recent day and age, but still, cases like these make us rethink the need for improvement.
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Yes! I had this happen to me once. My heart stopped after I had an anxiety attack. It lasted for 16 seconds. They called it a vasal vagal syncope
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Bradicardia - pacemaker.
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Perhaps check for vertebral or muscular misalignment in the cervical spine which might be causing pressure on the nerves that regulate the heart walls.https://youtu.be/jTaUswR10t8
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