Neurally Mediated Syncope in 2 Patients With Extracardiac Disease

Abstract

We describe the cases of 2 patients with repetitive episodes of syncope with profound bradycardia and hypotension. In both patients, the symptoms were initially thought to be neurally mediated and idiopathic but were ultimately determined to be triggered by serious underlying pathologic processes: a massive and locally invasive tumor of the hypopharynx in 1 patient and a gangrenous gallbladder in the other. Appropriate treatment resulted in a resolution of this syndrome in both patients. These cases emphasize the importance of an appropriate evaluation and broad differential diagnoses for patients with severe bradycardia and hypotension.

Complete atrioventricular block in a patient with acute cholecystitis: a case of cardio-biliary reflex?

“…There is only one case report describing a neurally mediated syncope and complete AV block due to chronic cholecystitis [5]. Analogous to our patient, the arrhythmia completely resolved after removal of the gallbladder.…”

“…Analogous to our patient, the arrhythmia completely resolved after removal of the gallbladder. But, the patient died on the first postoperative day due to massive upper gastrointestinal bleeding [5]. Our patient completely recovered and is in good health 12 months postoperatively without recurrence of syncope.…”

Recurrent syncope in systemic lupus erythematosus: a hidden cause in abdomen

“…GB is richly supplied with sympathetic and parasympathetic innervation. It has been postulated that GB distension secondary to inflammation may result in increased reflex sympathetic discharge in the spinothalamic tract, which in turn stimulates the baroreceptor pathway and reflex increase in vagal tone, leading to bradycardia and syncope 6. In this case, the episodic syncope was also associated with recent history of significant weight loss, anorexia and severe abdominal pain, which further reiterates our hypothesis of GB-related syncope.…”

Symptomatic Sinus Bradycardia in a Patient With Acute Calculous Cholecystitis Due to the Cardio-Biliary Reflex (Cope’s Sign): A Case Report

“…In 1971, O'Reilly and Krauthamer [5] described the development of reflex sinus bradycardia and other various electrocardiogram changes in the setting of acute cholecystitis or biliary colic, also known as Cope's sign or the cardio-biliary reflex [4,9]. Although most pathologies relating to the gallbladder rely heavily on the clinical presentation for diagnosis, some patients may present with symptoms mimicking acute coronary syndrome (ACS) along with dynamic ECG changes suggestive of ACS [5,6].…”