A rare cause of cardiac syncope mimicking epilepsy: Left main coronary artery stenosis (original) (raw)
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Polymorphic Catecholaminergic Ventricular Tachycardia as a Cause of Syncope in Pediatric Age
2021
Syncope is one of the most common clinical problem in children characterized by transient, spontaneously self-terminating loss of consciousness with brief duration and complete recovery. The underlying pathophysiological mechanism is a transient and global brain hypoperfusion. In the pediatric population syncope can occur with many different etiologies. Cardiac causes of syncope in children are rare but can be life threatening and have the highest risk of morbidity and mortality. Misdiagnosis of epilepsy is common in patients presenting with syncope; therefore, the differential diagnosis between epileptic seizures and syncope is very important. Here we report the case of a girl with misdiagnosis of epilepsy and a rare arrhythmia as the cause of her recurrent syncopes. Introduction Syncope, classically defined as a transient, self-limited loss of consciousness and postural tone, is a common presenting complaint in the pediatric Emergency Department (ED). By definition, the recovery f...
Diagnostic dilemma of cardiac syncope in pediatric patients
Indian pacing and electrophysiology journal, 2008
Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests. Retrospective study conducted at a tertiary referral arrhythmolology service The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 +/- 3.82(3.5-16) years were reviewed by the investigators. Statistical Package of social science (SPSS) version 9,0 was used for analysis of data. The commonest trigger for syncope in the study population was early following exercise (n=65) and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3%) while 10.7% (n=25) had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2%) were abnormal....
A Rare Cause of Recurrent Syncope in the Pediatric Patient
2017
A previously healthy 4-year-old boy was admitted to hospital for two brief episodes of loss of consciousness. In addition, we note symptoms suggesting a respiratory infection. There was no anemia and no electrolyte imbalance. The child had no neurological symptoms, emergency cerebral CT and EEG were normal. There was however an inappropriate degree of tachycardia, muffled heart sounds and the ECG showed low voltage. Emergency echocardiography showed only mild circumferential pericardial effusion, but also right atrial collapse. NSAID therapy (ibuprofen) was immediately initiated, with no response. It was later replaced with low-dose corticosteroid (prednisone) therapy which resulted in slow, but steady decrease of fluid amount. The patient did not experience recurrent syncope and the pericardial effusion resolved completely during follow-up. Although syncope in children is usually reflex and thus benign, unexplained recurrent syncope should prompt a thorough evaluation including car...
Paroxysmal Ventricular Standstill: A Rare Cardiac Manifestation of Syncope
American Journal of Case Reports, 2020
Rare disease Background: Transient abrupt loss of consciousness due to sudden but pronounced decrease in cardiac output caused by a change in heart rate and rhythm is termed Stokes-Adams disease. Causes of Stokes-Adams syndrome are 1) transition from normal rhythm to high grade block, 2) slowing of idioventricular rhythm in the course of complete heart block, and 3) abnormal ventricular rhythm such as ventricular tachycardia and ventricular fibrillation. Paroxysmal ventricular standstill is one of the rarest causes of Stokes-Adams attack. It is well documented that some patients with a diagnosis of epilepsy actually have a cardiac cause for their convulsions. Brevity of these episodes sometimes makes diagnosis difficult. Case Report: We present a case of 40-year-old builder who was normally fit and healthy who developed paroxysmal ventricular standstill. He presented to the Emergency Department with multiple episodes of seizure-like activity. Blood tests which included antibody screen were normal except for hypophosphatemia. Computed tomography head scan was normal. He was commenced on intravenous phenytoin infusion which did not abort his seizure-like episodes. Eventually, ventricular standstill was recorded on cardiac monitoring. The seizure-like episodes were determined to be Stokes-Adams attacks. He underwent transcutaneous pacing and then transvenous pacing with eventual permanent pacemaker insertion. He did not have further episodes at yearly follow-up. Conclusions: This case serves as a reminder of the diagnostic dilemma between syncope and seizures. Misdiagnosing cardiac dysrhythmia for epilepsy could lead to adverse consequences for the patient. It is incumbent upon the emergency physician to perform cardiac monitoring on all patients who present with syncope or convulsion in order that dysrhythmia is observed during such episode.
Unusual Cause of Recurrent Syncope in a Child
Pacing and Clinical Electrophysiology, 2009
A 5-year-old boy with an unremarkable past medical and family history presented with recurrent syncope precipitated by physical activity. Electrocardiogram performed in the emergency room after one of his episodes revealed atrial flutter. He had a structurally normal heart. Exercise stress test revealed atrial fibrillation with rapid ventricular response immediately on commencement of running. Atrial fibrillation subsequently organized into atrial flutter with variable ventricular response followed by spontaneous conversion to sinus rhythm. This case highlights the use of exercise stress test in a preschool child to elicit an unusual cause of syncope. (PACE 2009; 32:416-418)
Pediatrics International, 2002
Background : Arrhythmias are among the malignant causes of syncope. This study has been undertaken to determine the relative incidence and significance of dysrhythmia in the pathogenesis of syncope among patients referred to a pediatric cardiology unit. Methods : Between March 1997 and March 1999, 105 consecutive patients (59 female, 46 male) aged 11.5 ± 3.6 years without neurologic or cardiac morphologic causes were evaluated for at least one episode of syncope. A pediatric cardiologist and a pediatric neurologist evaluated all the patients. Routine chest X-ray, 12-lead electrocardiogram (ECG), electroencephalography (EEG), 24-h Holter monitoring and echocardiography were carried out. When deemed necessary, further tests were undertaken for the cases of syncope which were unexplained by routine tests. Results : The cause of syncope was identified as vasovagal in 25.7% ( n = 27) and related to dysrhythmia in 30.5% ( n = 32). The cause was migraine-associated syncope in two children, psychogenic syncope in three children and orthostatic hypotension in one patient. The cause was unknown in 36.2% ( n = 38). Conclusion : We conclude that dysrhythmia is a significant and frequent cause in children referred to pediatric cardiology units. The combination of ECG, Holter monitoring, electrophysiologic study, transtelephonic ECG and head-up tilt test can identify the underlying cause of syncope in as many as 58% of these patients that present with syncope.
Cardioinhibition can be the unique manifestation of epilepsy-like syncope
Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, 2015
Sudden death and syncope remain frequently unexplained despite numerous investigations. Here, we report the case of a pacemaker-implanted patient who presented during video-polysomnography recording a complete atrioventricular block simultaneously with an electrical seizure. Remarkably, the patient was completely asymptomatic. He had a history of recurrent syncope previously diagnosed as convulsive vasovagal syncope with cardioinhibition. This observation challenges the current belief that epilepsy-like syncope is a partial complex seizure systematically characterized by a stereotypical clinical course and ending suddenly with syncope. Physicians should know that syncope, followed by jerking movements, of cardiac origin is frequent and often misdiagnosed as epilepsy. Conversely, and although this is a rare condition, they should also be aware of the possibility of epilepsy-like syncope, even in the absence of any other principle symptoms evocative of epilepsy.
Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy, 2001
The natural history of pediatric patients with severely symptomatic neurocardiogenic syncope is poorly defined respect to the likelihood of remission or symptomatic recurrence along time. We undertook this study to investigate the likelihood of clinical relapse, and to assess the effect of prophylactic pharmacological treatment in the most symptomatic patients. Twenty-nine patients with neurocardiogenic syncope were studied at our Institution: 14 (12 +/- 3.6 years) highly symptomatic received prophylactic therapy with beta-blockers guided by head up tilt (HUT), whereas 15 (12.2 +/- 2.7 years) moderately symptomatic received only education to avoid triggering of the vasovagal reflex and to abort forthcoming syncope. Patients were then followed respectively for 33.7 +/- 9.0 and 33.3 +/- 8.7 months (p = NS). The average duration of symptoms before HUT was 9.0 +/- 4.3 months (range 3-17) for treated patients, and 6.2 +/- 2.5 months (range 2-11) for those untreated (p < 0.05). Treated...