A 45-year old man with recurrent syncope: an unusual presentation of coronary artery disease

Abstract

A 45-year old normotensive, euglycaemic, non-smoker was referred from a peripheral hospital to the Cardiology unit of the University College Hospital, Nigeria for evaluation of recurrent exercise induced syncope. Initial 12-lead electrocardiogram (ECG), 24-hr ambulatory ECG, trans-thoracic echocardiogram and electroencephalogram (EEG) were normal. A repeat episode of syncope warranted further investigation. Immediate post syncope ECG showed deeply inverted symmetrical T waves in the anterior leads. He underwent coronary angiogram which revealed distal left main disease and 70-80% stenosis of the proximal Left Anterior Descending Artery (LAD). The Circumflex artery was non dominant with normal Right Coronary artery. He subsequently had Percutaneous Transluminal Coronary Angioplasty (PTCA) of the LAD. Post-revascularisation course has been satisfactory with no recurrence of syncope. In view of the rising trend of cardiac death in the country, there is the need for high index of suspicion in making diagnosis of coronary artery disease in patients with syncope.

Ambulatory postural blood pressure changes and history allow a better selection of patients that should undergo a head-up tilt test

“…On the other hand, the subjects that have an exercise-related syncope represent a high risk subset of patients that must be studied to detect structural heart disease and lethal arrhythmias [1,4,[18][19][20]. Thus, sudden cardiac death risk stratification is mandatory and the HUTT is not a test designed to identify the mentioned high risk conditions.…”