Atypical presentation of cardiac syncope in the elderly: a case report

Abstract

Syncope is defined as a transient, self-limited, loss of consciousness with an1. inability to maintain postural tone, which is followed by spontaneous recoverySyncope can be cardiac or non cardiac in origin. In elderly, cardiac syncope hasworse prognosis and can present atypically. We report the case of a 75 year oldpatient who presented with history of syncope at home after developing anallergic reaction to diclofenac and colchicine. He had non-ST elevationmyocardial infarction (NSTEMI) and angiogram revealed severe atheromatouscoronary disease with culprit right coronary artery (RCA) lesion. Transient sinusnode dysfunction secondary to ischemia was thought to cause his syncope. Hehad coronary artery bypass grafting and was discharged home a few days later.CONCLUSION: Significant coronary artery disease was unmasked in our patientby an initial allergic reaction. In elderly patients, a thorough work- up to rule outcardiac syncope is indicated.INTRODUCTIONCASE REPORTSyncope is defined as a transient, self-limited, loss of consciousness with an1 inability to maintain postural tone, which is followed by spontaneous recovery.Syncope is a common clinical problem accounting for 1-3% of all emergency2 department (ED) visits and 6% acute admissions. Assessment of syncope inpatients presenting to the emergency department is challenging because of theheterogeneity of underlying pathophysiologic processes and diseases. Althoughmany underlying causes of syncope are benign, others are associated withsubstantial morbidity or mortality, including cardiac arrhythmia, myocardial3,4 infarction, pulmonary embolism and occult hemorrhage.