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

Summary

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