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.
Vloka ME, Tamis JE, Steinberg JS. Neurally Mediated Syncope in 2 Patients With Extracardiac Disease. Arch Intern Med. 1999;159(6):625-627. doi:10.1001/archinte.159.6.625