Cardioinhibitory vasovagal syncope in a cancer patient

Abstract

The progress in cancer knowledge and treatment has led to a new frontier: cardio-oncology [1–27]. Cancer patients can benefit from an open dialogue between both cardiologists and oncologists [1] for the optimal effective patient care [1,12,17]. We present a case of a 57year-old Italian man complaining about episodes of cardioinhibitory vasovagal syncope [28–30]. He reported a history of atrial fibrillation, diabetes mellitus, smoking, a sotalol treatment, a chemotherapy treatment and a laryngeal tracheostomy for laryngeal cancer. Echocardiographic evaluation revealed a biatrial dilatation, a fibrocalcification of a three-leaflet aortic valve with a severe aortic stenosis [AVA = 0.8 cm, transvalvular mean gradient = 51 mm Hg] [Fig. 1] and a moderate aortic regurgitation [PHT= 415ms], and amildmitral regurgitation. Results of a 24-hour Holter monitoring showed several pauses of at least 1.5 s and up to 2.5 s, and 68 pauses of longer than 2.5 s (max pause of 3360 ms). Computer tomography imaging showed progressive stenosis of the left internal carotid artery and the total occlusion of the left jugular vein due to neck neoplastic mass [Fig. 2]. A pacemaker implantation was successfully performed.