Abstract
A 43-year-old man fainted on a train and was transported to our hospital by an ambulance.
No structural heart diseases or neurological abnormalities were observed. Electrocardiogram
on admission demonstrated a junctional escape rhythm with bradycardia at 39 bpm. Sick sinus syndrome was excluded from electrophysiological studies. He had lifelong
episodes of recurrent syncope that occurred due to emotional stress in daily life
and pain associated with medical procedures. Since both the head-up tilt and carotid
sinus massage tests showed a positive response, he was diagnosed with vasovagal syncope
(VVS) and carotid sinus hypersensitivity. He was encouraged to continue the modified
tilt training at home, which included leaning on the wall and squatting if leaning
was intolerant. Thereafter, syncope was not observed in his daily life. This case
highlights the importance of an accurate diagnosis, full education, and home training
for recurrent syncope. This case also suggests that the carotid sinus may be involved
in the neural network that causes VVS.
Learning objective
Reflex syncope includes both vasovagal syncope (VVS) and carotid sinus syndrome (CSS);
however, VVS is discriminated from CSS according to current guidelines. We encountered
a case of VVS associated with carotid sinus hypersensitivity. Recurrent syncope disappeared
with modified tilt training characterized by conventional tilting and subsequent squatting
when tilting was intolerant. This case indicates that the carotid sinus may be involved
in the neural network responsible for VVS.
Keywords
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Article info
Publication history
Accepted:
August 26,
2022
Received in revised form:
August 8,
2022
Received:
April 15,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.
