A 69‐year old man with a history of congestive heart failure was admitted for recurrent syncope. He initially presented with 4 months of progressive dyspnea on exertion and facial swelling. Subsequently, he developed at least 20 episodes of syncope precipitated by leaning forward or rapid positional changes. Tilt table testing and orthostatic vital signs were normal. A venogram performed at an outside facility revealed occlusion of the superior vena cava (SVC). He received intravenous tissue plasminogen activator for 3 days with no improvement in symptoms. He presented to our institution with persistent syncope precipitated by positional changes. Medical history was notable for congestive heart failure, with an ejection fraction of 25%, coronary artery disease, colon cancer status post resection, and diabetes mellitus. An implantable cardiac defibrillator (ICD) had been placed 3 years prior to admission for primary prevention. Physical examination revealed facial plethora, left upper‐extremity edema, and bilateral pulmonary rales. The remainder of the physical examination was unremarkable. Interrogation of his pacemaker showed no evidence of arrhythmia and telemetry revealed normal sinus rhythm. Echocardiogram showed impaired right ventricular filling and a left ventricular ejection fraction of 10%. He underwent extraction of his ICD and recanalization with stenting of his SVC. His syncope completely resolved, and the patient was discharged home.
Syncope is one of the most common reasons for hospital admission. Although most cases are secondary to neurocar‐diogenic syncope, cardiac arrhythmia, or seizure, the differential is broad. Our patient presented with syncope in the setting of occlusion of his superior vena cava. We hypothesize that his positional changes led to transient occlusion of venous collaterals, leading to impaired venous return and directly resulting in impaired cardiac output. Only a handful of cases of syncope secondary to superior vena cava occlusion have been reported in the literature.
Superior vena cava syndrome is a rare but important cause of syncope in hospitalized patients.
A. Odden ‐ none; A. Berg ‐ none
To cite this abstract:Odden A, Berg A. Recurrent Syncope: A Plethora of Causes. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 355. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/recurrent-syncope-a-plethora-of-causes/. Accessed April 4, 2020.