The Mystery of Situational Syncope: A Case Series of Three Patients with Uncommon Histories
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Amir Hossein Behnoush
,
Amirmohammad Khalaji
,
Arya Aminorroaya
,
Hamed Tavolinejad
,
Somayeh Yadangi
,
Masih Tajdini
Abstract
Syncope, characterized by a transient loss of consciousness, is among the most common reasons for emergency department visits worldwide and can be categorized into reflex syncope, orthostatic hypotension, and cardiac syncope. Situational syncope, a subtype of reflex syncope, is less frequently investigated than other forms. Herein, we describe three patients who presented to the Syncope Unit of Tehran Heart Center with unusual situational syncope triggers, along with the diagnostic methods and treatments used.
The first case was a 62-year-old woman who experienced five syncopal episodes over the past 2 years, all of which occurred at an airport during airplane takeoff. Following a prescription for midodrine to be taken before flights, no further syncopal episodes occurred. The second patient was an 18-year-old man with two syncopal episodes, both occurring after smoking marijuana. He was advised to discontinue marijuana use, and no further episodes were reported during a 1-year follow-up period. The final case was a 42-year-old man who was a heavy smoker, presenting with several syncopal episodes following bouts of violent coughing. After cough suppressant medications proved ineffective, he was successfully treated with gabapentin.
In conclusion, given the complex nature of diagnosing syncope in some cases, physicians should consider rare triggers when taking the medical history of patients with unexplained syncope.
2. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883–948.
3. Adkisson WO, Benditt DG. Pathophysiology of reflex syncope: a review. J Cardiovasc Electrophysiol. 2017;28(9):1088–97.
4. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72.
5. Zou R, Wang S, Lin P, Hu C, Wang Y, Li F, et al. The clinical characteristics of situational syncope in children and adults undergoing head-up tilt testing. Am J Emerg Med. 2020;38(7):1419–23.
6. Sadeghian S, Aminorroaya A, Tajdini M. The Syncope Unit of Tehran Heart Center. Eur Heart J. 2020;42(2):148–50.
7. Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, et al. 2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017;136(5):e60–122.
8. Algahtani H, Shirah B. Cough syncope induced by post nasal drip successfully managed by gabapentin. Respir Med Case Rep. 2017;22:47–50.
9. da Silva RM. Syncope: epidemiology, etiology, and prognosis. Front Physiol. 2014;5:471.
10. de Caprariis PJ, de Caprariis-Salerno A, Lyon C. Healthcare professionals and in-flight medical emergencies: resources, responsibilities, goals, and legalities as a Good Samaritan. South Med J. 2019;112(1):60–5.
11. Lei LY, Raj SR, Sheldon RS. Midodrine for the prevention of vasovagal syncope: a systematic review and meta-analysis. Europace. 2022.
12. Richards JR, Blohm E, Toles KA, Jarman AF, Ely DF, Elder JW. The association of cannabis use and cardiac dysrhythmias: a systematic review. Clin Toxicol (Phila). 2020;58(9):861–9.
13. Van Keer JM. Cannabis-induced third-degree AV block. Case Rep Emerg Med. 2019;2019:5037356.
14. Ohlsson A, Lindgren JE, Wahlen A, Agurell S, Hollister LE, Gillespie HK. Plasma delta-9 tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking. Clin Pharmacol Ther. 1980;28(3):409–16.
15. Heckle MR, Nayyar M, Sinclair SE, Weber KT. Cannabinoids and symptomatic bradycardia. Am J Med Sci. 2018;355(1):3–5.
16. Stuart R, Richards JR. Cannabinoid hyperemesis syndrome: an unexpected problem in an unusual setting—a case report. Mil Med. 2020;185(9–10):e1894–6.
17. McIntosh HD, Estes EH, Warren JV. The mechanism of cough syncope. Am Heart J. 1956;52(1):70–82.
18. Krediet CT, Wieling W. Edward P. Sharpey-Schafer was right: evidence for systemic vasodilatation as a mechanism of hypotension in cough syncope. Europace. 2008;10(4):486–8.
19. Sharpey-Schafer EP. The mechanism of syncope after coughing. Br Med J. 1953;2(4841):860–3.
20. Benditt DG, Samniah N, Pham S, Sakaguchi S, Lu F, Lurie KG, et al. Effect of cough on heart rate and blood pressure in patients with "cough syncope". Heart Rhythm. 2005;2(8):807–13.
21. Dicpinigaitis PV, Lim L, Farmakidis C. Cough syncope. Respir Med. 2014;108(2):244–51.
22. Chung KF, McGarvey L, Mazzone SB. Chronic cough as a neuropathic disorder. Lancet Respir Med. 2013;1(5):414–22.
23. Shi G, Shen Q, Zhang C, Ma J, Mohammed A, Zhao H. Efficacy and safety of gabapentin in the treatment of chronic cough: a systematic review. Tuberc Respir Dis (Seoul). 2018;81(3):167–74.
24. Brignole M. Diagnosis and treatment of syncope. Heart. 2007;93(1):130–6.
25. Kenny RA, McNicholas T. The management of vasovagal syncope. QJM. 2016;109(12):767–73.
26. Aydin MA, Salukhe TV, Wilke I, Willems S. Management and therapy of vasovagal syncope: a review. World J Cardiol. 2010;2(10):308–15.
27. Bhalla R, Soobhanath C, Celebi S, Chhabra M, Narula P. Unusual cases of syncope in the pediatric age group. Case Rep Pediatr. 2021;2021:8849766.
| Files | ||
| Issue | Vol 20 No 1 (2025) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/jthc.v20i1.19224 | |
| Keywords | ||
| Syncope Situational Syncope Marijuana Cough Case Report | ||
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