The mystery of situational syncope: a case series of three patients with uncommon histories

Situational syncope triggers

Abstract

Syncope, characterized by transient loss of consciousness, is among the most common reasons for emergency department visits worldwide and can be categorized into reflex syncope, orthostatic hypotension, and cardiac syncope. Situational syncope as one of the subtypes of reflex syncope is much less investigated than other types. Herein, we report three patients presented to the syncope unit of Tehran Heart Center with unusual situational syncope triggers, in addition to their diagnosis tools and treatment of them. The first case was a 62-year-old woman with five syncopal episodes in the last two years, all of which were at the airport and during the airplane take-off. With the prescription of midodrine before the flights, no further syncope occurred. The second was an 18-year-old man with two syncope episodes, both of which were after marijuana smoking. He was advised to quit smoking marijuana and no syncope episode was recorded in the one-year follow-up. The last case was a 42-year-old heavy-smoker man with a complaint of several syncopal episodes after bursting coughs. After the failure of cough suppressor medications, he was cured with gabapentin. In conclusion, due to the complicated nature of syncope diagnosis in some cases, rare syncope triggers should always be taken into consideration by physicians in the history taking of patients with unexplained syncope.