SOC Geriatric Unit, Pugliese-Ciaccio Hospital, via Madonna dei Cieli, I-88100 Catanzaro, Italy.
Arch Gerontol Geriatr. 2012 Nov-Dec;55(3):706-8. doi: 10.1016/j.archger.2011.10.018. Epub 2011 Nov 23.
A 66 year-old man was brought to the emergency room (ER) for syncope and sphincter incontinence; syncope duration was about 15 min. Similar short duration episodes had been referred by his relatives during the last months, following small traumas; no seizures had been registered. Patient told he was affected with BS, having already been diagnosed 5 years before, after performing an electrocardiogram (ECG) highly suggestive for it. He had performed an electrophysiologic study, which had not shown any sustained ventricular arrhythmias after scheduled stimulation. This finding together to the lack of symptoms had suggested a conservative treatment, notwithstanding that familiar history documented his father's sudden death. Patient was also affected with hypertension and gastroesophageal reflux disease. Clinical examination did not suggest any significant findings. Laboratory tests, supra aortic Doppler ultrasound, electroencephalogram (EEG) and brain CT were normal. ECG showed sinus rhythm with a heart frequency of 82 bpm, QRS axis was normal, as well as atrioventricular conduction. ST coved-type elevation with right bundle branch block pattern and repolarization abnormalities were found. Holter ECG and Doppler echocardiography were also performed. The onset of syncope in presence of BS suggested the evaluation of this case report together with electrophysiolgists and neurologists. Therefore, an implantable cardioverter defibrillator (ICD) was implanted through left subclavian vein. He was discharged eight days after hospitalization, diagnosis was "Syncope in patient affected with BS, hypertension". Arrhythmogenic risk stratification is necessary; the indication for implanting this device is obvious in symptomatic patients, whereas it is controversial in patients presenting only ECG patterns of BS. In conclusion, the above mentioned case report rises remarkable diagnostic and therapeutic issues. The finding of BS in a patient with syncope indicates the opportunity of implanting a defibrillator and only clinical experience and common opinions may help doctors in taking the most appropriated, often difficult, decisions.
一位 66 岁男性因晕厥和括约肌失禁被送往急诊室（ER）；晕厥持续时间约 15 分钟。在过去的几个月里，他的亲戚曾因类似的短暂发作（发作后有小创伤）向他报告过类似的短暂发作，但没有记录到癫痫发作。患者自述患有 BS，5 年前曾因心电图（ECG）高度提示该病而被诊断。他曾进行过电生理研究，但在预定刺激后没有发现任何持续性室性心律失常。这一发现以及缺乏症状表明应进行保守治疗，尽管家族病史记录了他父亲的猝死。患者还患有高血压和胃食管反流病。临床检查未提示有任何明显的发现。实验室检查、升主动脉多普勒超声、脑电图（EEG）和脑 CT 均正常。心电图显示窦性心律，心率为 82 次/分，QRS 轴正常，房室传导正常。发现 ST 弓背型抬高伴右束支传导阻滞模式和复极异常。还进行了动态心电图和多普勒超声心动图检查。BS 患者晕厥发作提示与电生理学家和神经科医生一起评估该病例报告。因此，通过左锁骨下静脉植入了植入式心脏复律除颤器（ICD）。他在住院八天后出院，诊断为“BS 患者晕厥，高血压”。心律失常风险分层是必要的；在有症状的患者中，植入该设备的指征是明确的，而在仅出现 BS 心电图模式的患者中，该指征存在争议。总之，上述病例报告提出了显著的诊断和治疗问题。晕厥患者出现 BS 表明有植入除颤器的机会，只有临床经验和普遍意见才能帮助医生做出最合适的、往往是困难的决策。
