Why the study?
Does treatment of underlying extracardiac disease resolve neurally mediated syncope in patients with severe bradycardia and hypotension?
Does treatment of underlying extracardiac disease resolve neurally mediated syncope in patients with severe bradycardia and hypotension?
Neurally mediated syncope with severe bradycardia and hypotension can be triggered by serious underlying extracardiac pathologic processes, emphasizing the need for broad differential diagnoses.
Supports evaluating extracardiac triggers in refractory neurally mediated syncope; hypothesis-generating and requires prospective confirmation.
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.
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Vloka et al. (1999) studied this question.
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