Comprehensive cardiovascular evaluation of a 67-year-old woman presenting with syncope during blood sampling revealed significant stenosis of the right internal carotid and vertebral arteries.
Case Report (n=1)
This case highlights that seemingly typical vasovagal syncope can mask significant underlying cerebrovascular disease, warranting thorough evaluation in patients with vascular risk factors.
Objective: This case report describes a patient who experienced syncope during blood sampling. While vasovagal reactions are common and typically self-limiting, this case illustrates that apparently typical syncope may occasionally indicate significant underlying cardiovascular pathology, particularly in patients with atherosclerotic risk factors. Design and method: Case report of a patient admitted to the Emergency Department due to syncope accompanied by nausea and vomiting during blood sampling. The analysis includes symptom assessment, diagnostic work-up, and treatment course. Results: A 67-year-old woman with a history of hypertension and COPD presented with syncope during blood sampling and was referred to the Department of Hypertensiology, Gastroenterology and Internal Medicine. Initial head computed tomography (CT) revealed no intracranial bleeding or traumatic lesions. Physical examination showed no abnormalities. Further diagnostic work-up was performed. Laboratory tests and Holter ECG monitoring were unremarkable. Echocardiography revealed mild left ventricular dysfunction (EF 48%) with hypokinesis of the inferior wall. Carotid Doppler ultrasound showed diffuse atherosclerotic changes, borderline stenosis of the right internal carotid artery (RICA) and features of grade III subclavian steal syndrome of the left vertebral artery. Based on these findings, the patient was referred to the Invasive Cardiology Department. Subsequent imaging, including coronary angiography and carotid artery angiography, revealed significant stenosis at the origin of the right internal carotid artery (80–90%) stenosis at the origin of the right vertebral artery (50–60%) and no relevant changes in the coronary vessels. Follow-up echocardiography showed normalization of myocardial contractility (EF 58%). The patient was subsequently referred to the Vascular Surgery Clinic where she was qualified for carotid endarterectomy RICA. Conclusions: This case demonstrates that even seemingly minor events, such as fainting during blood sampling, can reveal serious underlying cardiovascular disease. Syncope should not automatically be attributed to fear or vasovagal reactions, especially in patients with vascular risk factors, and warrants thorough evaluation to identify potentially life-threatening conditions. The patient's case exemplifies complications that can arise in the early stages of atherosclerosis, emphasizing the importance of comprehensive cardiovascular diagnostics.
Bondaruk et al. (Fri,) conducted a case report in Syncope (n=1). Comprehensive cardiovascular diagnostics was evaluated on Identification of underlying cardiovascular pathology. Comprehensive cardiovascular evaluation of a 67-year-old woman presenting with syncope during blood sampling revealed significant stenosis of the right internal carotid and vertebral arteries.