Syncope of multifactorial etiology or several symptoms of the same disease? - competition case report


Authors: MUDr. Hana Moravcová 1;  MUDr. Pavla Balcárková 2;  MUDr. Ivo Dvořák 1;  MUDr. Michal Rezek 2;  doc. MUDr. Miroslav Novák;  CSc. 2;  doc. MUDr. Tomáš Kára, Ph.D. 2
Authors‘ workplace: I. interní kardioangiologická klinika FN u sv. Anny v Brně 1;  I. interní kardioangiologická klinika FN u sv. Anny v Brně, Mezinárodní centrum klinického výzkumu 2
Published in: Kardiol Rev Int Med 2013, 15(4): 247-251
Category:

Overview

This case report describes a young woman who was examined for recurrent presyncopal and syncopal states. She had atypical symptoms difficult to classify to one of known categories of syncopes. Using numerous diagnostic methods we gradually eliminated all possible causes. She received the Reveal recording system subsequently followed by an implantation of a DDD pacemaker, because of detection of bradycardia. After 18 months from the beginning of our investigation the disease culminated in a serious deterioration of her state with recurrent need of cardio-pulmonary resuscitation, which led to diagnosis of Brugada syndrome based on the detection of ventricular tachycardia and typical ECG changes. This was followed by successful ICD implantation. The case was further complicated by ongoing presyncopes, with sinus tachycardia and marked changes of her blood pressure. Because of this, the differential diagnosis was even more difficult. After exclusion of other possible causes, severe autonomic dysfunction augmented by long-term hospitalization was finally diagnosed. Therapeutically the patient is now successfully controlled by a relatively high dose of beta-blocker.

Keywords:
syncope – Brugada syndrome – autonomic dysfunction


Sources

1. Kautzner J et al. Synkopa: diagnostika a léčba. Cor Vasa 2007; 49: 63–73.

2. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical praktice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial – the OESIL 2 study. Eur Heart J 2000; 21: 935–940.

3. Morita H, Kusano-Fukushima K, Nagase S et al. Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome. J Am Coll Cardiol 2002; 40: 1437–1444.

4. Kapoor WN. Current evaluation and management of syncope. Circulation 2002; 106: 1606–1609.

5. Antzelevitch C, Brugada P, Borggrefe M et al. Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111: 659–670.

6. Morita H, Fukushima-Kusano K, Nagase S et al. Sinus node function in patients with Brugada-type ECG. Circ J 2004; 68: 473–476.

Labels
Paediatric cardiology Cardiac surgery Cardiology
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