Recurrent Cardiogenic Syncope From Extrinsic Organ Anomaly

Case Presentation A 40-year-old woman presented with recurrent syncope. She reported multiple (>20) episodes of non-prodromal loss consciousness, periodically provoked by physical exertion. One episode resulted in a nasal fracture due to the abrupt nature her The characterization each was inconsistent neurogenic seizure. Other causes syncope (vasovagal, situational, carotid hypersensitivity, and orthostasis) were also deemed unlikely. On examination, low-pitched, brief adventitious sound appreciated after S2 right lower sternal border. remainder examination unremarkable. Initial workup, including complete blood count, comprehensive metabolic panel, cardiac enzymes, ECG yielded normal results. chest radiograph did not show any gross or pulmonary parenchymal pathologic condition ( Fig 1 ). Telemetry demonstrate malignant arrhythmias, video-guided EEG document seizure activity.