Lifestyle Effects on an Unusual Presentation of Syncope: A Case Report

We present a 53-year-old Hispanic male with a history of palpitations and chronic marijuana use coming to the emergency department (ED) with three episodes of sudden loss of consciousness that occurred after starting his job as a night shift worker, which led to severe chronic sleep deprivation. These episodes lacked prodromal (chest pain, shortness of breath, palpitations, diaphoresis) and postictal (drowsiness, nausea, confusion, headache) symptoms. Electrocardiograms (EKGs) performed in the ED revealed sinus bradycardia with a heart rate of 54 beats per minute (bpm), which dropped to 37 bpm during admission. Overnight telemetry exhibited sinus pauses, characterized by a delay in atrial activity for at least three seconds. A repeat EKG showed an incomplete right bundle branch block (RBBB). The patient received a final diagnosis of recurrent syncope and was given an implantable loop recorder (ILR). The ILR revealed several sinus pauses over the span of three months with no syncopal episodes. The patient was educated on dietary and lifestyle modifications to reduce the risk of experiencing syncopal episodes. This case study explores a unique presentation of syncope with a multifactorial etiology and discusses the impact of lifestyle behaviors on syncope exacerbation.