Clinical Observation
March 22, 1999

Neurally Mediated Syncope in 2 Patients With Extracardiac Disease

Author Affiliations

From the Arrhythmia Service, Division of Cardiology, Department of Medicine, St Luke's–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.


Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

Arch Intern Med. 1999;159(6):625-627. doi:10.1001/archinte.159.6.625

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.