Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

17 June 2020 : Case report  United Kingdom

Paroxysmal Ventricular Standstill: A Rare Cardiac Manifestation of Syncope

Challenging differential diagnosis, Management of emergency care, Rare disease

Daniel Adewale Adegoke1AEF*

DOI: 10.12659/AJCR.924381

Am J Case Rep 2020; 21:e924381


BACKGROUND: Transient abrupt loss of consciousness due to sudden but pronounced decrease in cardiac output caused by a change in heart rate and rhythm is termed Stokes-Adams disease. Causes of Stokes-Adams syndrome are 1) transition from normal rhythm to high grade block, 2) slowing of idioventricular rhythm in the course of complete heart block, and 3) abnormal ventricular rhythm such as ventricular tachycardia and ventricular fibrillation. Paroxysmal ventricular standstill is one of the rarest causes of Stokes-Adams attack. It is well documented that some patients with a diagnosis of epilepsy actually have a cardiac cause for their convulsions. Brevity of these episodes sometimes makes diagnosis difficult.

CASE REPORT: We present a case of 40-year-old builder who was normally fit and healthy who developed paroxysmal ventricular standstill. He presented to the Emergency Department with multiple episodes of seizure-like activity. Blood tests which included antibody screen were normal except for hypophosphatemia. Computed tomography head scan was normal. He was commenced on intravenous phenytoin infusion which did not abort his seizure-like episodes. Eventually, ventricular standstill was recorded on cardiac monitoring. The seizure-like episodes were determined to be Stokes-Adams attacks. He underwent transcutaneous pacing and then transvenous pacing with eventual permanent pacemaker insertion. He did not have further episodes at yearly follow-up.

CONCLUSIONS: This case serves as a reminder of the diagnostic dilemma between syncope and seizures. Misdiagnosing cardiac dysrhythmia for epilepsy could lead to adverse consequences for the patient. It is incumbent upon the emergency physician to perform cardiac monitoring on all patients who present with syncope or convulsion in order that dysrhythmia is observed during such episode.

Keywords: Arrhythmias, Cardiac, Electrocardiography, Syncope, Adams-Stokes Syndrome, Diagnostic Errors, Seizures

Add Comment 0 Comments

In Press

Case report  Portugal

Bartter Syndrome Presenting as Arginine-Vasopressin Resistance: A Report of 2 Cases

Am J Case Rep In Press; DOI: 10.12659/AJCR.942872  

Case report  China (mainland)

Extended Left Hemihapatectomy with Right Hepatic Artery Reconstruction for Primary Hepatic Neuroendocrine N...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943721  

Case report  Austria

Smoking-Associated Endotracheal Hair Growth: A Case Report on Tracheal Complications

Am J Case Rep In Press; DOI: 10.12659/AJCR.943909  

Case report  Japan

Virtual Reality-Guided Simulation for Percutaneous Coronary Intervention in a Patient with Anatomical Anoma...

Am J Case Rep In Press; DOI: 10.12659/AJCR.944485  

Most Viewed Current Articles

07 Mar 2024 : Case report  USA 38,124

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133


10 Jan 2022 : Case report  Germany 31,073

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...

DOI :10.12659/AJCR.935263

Am J Case Rep 2022; 23:e935263

19 Jul 2022 : Case report  Saudi Arabia 17,693

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

DOI :10.12659/AJCR.936128

Am J Case Rep 2022; 23:e936128

23 Feb 2022 : Case report  USA 17,607

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923