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Title: High spinal cord injury precipitating syncope: a rare indication for pacemaker insertion.
Austin Authors: Khan, Isa;Scully, Timothy G;Teh, Andrew W ;Wong, Geoffrey R
Affiliation: Cardiology
Issue Date: 10-Oct-2023
Date: 2023
Publication information: BMJ Case Reports 2023-10-10; 16(10)
Abstract: The current evidence for vasovagal syncope management is that cardiac pacing is only indicated in a highly select group of patients where symptoms can be linked to bradycardic episodes. High spinal cord injury can lead to autonomic dysfunction and sympathetic nervous system hypoactivity. A high spinal cord injury can theoretically precipitate profound bradycardia leading to haemodynamic instability and syncope. A patient in his 50s with a history of C2 spinal injury was admitted to our tertiary centre for management of what was initially thought to be septic shock causing hypotension and syncope. With evidence to suggest this patient's presentation may be profound reflex syncope in the context of unopposed parasympathetic signalling, consensus was reached to implant a permanent pacemaker. Remarkably, the patient's haemodynamics stabilised and there were no further episodes of syncope.
DOI: 10.1136/bcr-2023-255020
ORCID: 0000-0002-1104-3511
Journal: BMJ Case Reports
PubMed URL: 37816572
ISSN: 1757-790X
Type: Journal Article
Subjects: Adult intensive care
Spinal cord
Cardiac Pacing, Artificial/adverse effects
Pacemaker, Artificial/adverse effects
Spinal Cord Injuries/complications
Syncope, Vasovagal/etiology
Syncope, Vasovagal/therapy
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