Abstract
The authors present a case of a man with recurrent syncopal episodes. The patient had been hospitalized twice before reaching a correct diagnosis. The syncope was originally ascribed to a sick sinus syndrome, which led to pacemaker implantation. Nonetheless, the patient relapsed with no evidence of pacemaker dysfunction, and was readmitted to the hospital where the likely cause for his symptoms was identified: an adenocarcinoma of the lung infiltrating the vagus and recurrent laryngeal nerves. No further syncopal episodes occurred after thoracic surgery. This syncope led to an early diagnosis of lung cancer leading to appropriate and life extending treatment.
References
Task Force for the Diagnosis and Management of Syncope, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA, Heart Rhythm Society (HRS), Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, Deharo JC, Gajek J, Gjesdal K, Krahn A, Massin M, Pepi M, Pezawas T, Ruiz Granell R, Sarasin F, Ungar A, van Dijk JG, Walma EP, Wieling W (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30(21):2631–2671
Brignole M, Ungar A, Bartoletti A, Ponassi I, Lagi A, Mussi C, Ribani MA, Tava G, Disertori M, Quartieri F, Alboni P, Raviele A, Ammirati F, Scivales A, De Santo T (2006) Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals. Evaluation of Guidelines in Syncope Study 2 (EGSYS-2) GROUP. Europace 8(8):644–650
Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M (2008) Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 94(12):1620–1626
Parry SW, Matthews IG (2013) Update on the role of pacemaker therapy in vasovagal syncope and carotid sinus syndrome. Prog Cardiovasc Dis 55(4):434–442
Kronborg MB, Nielsen JC (2012) Pacing in sinus node disease to prevent atrial fibrillation. Expert Rev Cardiovasc Ther 10(7):851–858. doi:10.1586/erc.12.79
Semelka M, Gera J, Usman S (2013) Sick sinus syndrome: a review. Am Fam Physician 87(10):691–696
Dicpinigaitis PV, Lim L, Farmakidis C (2014) Cough syncope. Respir Med 108(2):244–251. doi:10.1016/j.rmed.20113.10.020
Salo LM, Woods RL, Anderson CR, McAllen RM (2007) Nonuniformity in the von Bezold–Jarisch reflex. Am J Physiol Regul Integr Comp Physiol 293(2):R714–R720
Madden KM, Lockhart C (2009) Arterial baroreflex function in older adults with neurocardiogenic syncope. Clin Invest Med 32(3):E191–E198
International Association for the study of lung cancer (2009) Staging manual in thoracic oncology. Editorial Rx Press, Orange Park
Darnell RB, Posner JB (2011) Paraneoplastic syndromes. Oxford University Press, New York
Patel AK, Yap VU, Fields J, Thomsen JH (1979) Carotid sinus syncope induced by malignant tumors in the neck: emergence of vasodepressor manifestations following pacemaker therapy. Arch Intern Med 139(11):1281–1284
Macdonald DR, Strong E, Nielsen S, Posner JB (1983) Syncope from head and neck cancer. J Neurooncol 1(3):257–267
Chen HY (2012) Recurrent syncope as initial symptom in apical intrathoracic tumor. J Clin Med Res 4(1):77–80
Dubrava J, Drgona L, Kadlecik R (2005) An unusual cause of recurrent syncope: mediastinal lymphoma diagnosed with transesophageal echocardiography. Eur J Intern Med 16(3):204–206
Koga T, Kaseda S, Miyazaki N, Kawazoe N, Abe I, Sadoshima S, Onoyama K (2000) Neurally mediated syncope induced by lung cancer: a case report. Angiology 51(3):263–267
Vloka ME, Tamis JE, Steinberg JS (1999) Neurally mediated syncope in 2 patients with extracardiac disease. Arch Intern Med 159(6):625–627
Bassetti CL (2014) Transient loss of consciousness and syncope. Handb Clin Neurol 119:169–191
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Campagna, D., Amaradio, M.D., Battaglia, E. et al. An uncommon cause of syncope. Intern Emerg Med 11, 425–429 (2016). https://doi.org/10.1007/s11739-015-1317-2
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DOI: https://doi.org/10.1007/s11739-015-1317-2