Recurrent Syncope Due to Carotid Sinus Hypersensitivity and Sick Sinus Syndrome

Abstract

Syncope is a sudden and brief loss of consciousness with postural tone. Its recovery is usually spontaneous. There are various causes of syncope including cardiac, vascular, neurologic, metabolic and miscellaneous origins. The tracing is usually time-consuming and costly. The diagnosis of carotid sinus syncope may sometimes be difficult since the symptoms are nonspecific, especially in older persons. Here, we report the case of a 72-year-old woman who sought medical attention at our hospital due to repeated syncope episodes over the previous 5 years. Neurologic examinations showed negative results (including brain computed tomography). Twenty-four-hour ambulatory electrocardiogram monitoring showed atrial and ventricular premature contractions only. Electrophysiologic study disclosed prolonged corrected sinus node recovery time (1,737 ms) with poor atrioventricular conduction. Drop of blood pressure together with sinus bradycardia developed after left side carotid sinus massage. Both carotid sinus hypersensitivity with sick sinus syndrome contributed to this patient's syncope, and after pacemaker placement together with selective serotonin reuptake inhibitor treatment, she was free from syncope thereafter.

Carotid sinus hypersensitivity, as a cause of syncope, in a patient with coronary artery disease: A case report

“…The cardioinhibitory type is a common variant of CSH as compared to vasodepressor and mixed type. The vasodepressor type is a least common type of CSH [ 7 ]. It is important to distinguish between cardioinhibitory and vasodepressor type of CSH.…”

“…The symptoms that patient can present with CSH include syncope or dizziness based on the perfusion to brain [ 7 ]. Carotid sinus massage is a simple and reliable test to diagnose CSH.…”

Syncope due to sinus node dysfunction after surgical patch closure of atrial septal defect: A case report

“…Therefore, syncope is defined as a transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. Various causes are well described in the literature and include cardiac, vascular, neurological, metabolic and miscellaneous origins [1]. Sometimes it is difficult to determine the real cause of syncope, so numerous analyses need to be performed.…”