Huantai County People's Hospital, No. 2198 Huantai Avenue, Suo Town, Huantai County, Zibo City, Shandong Province, China.
The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
BMC Cardiovasc Disord. 2023 Mar 14;23(1):134. doi: 10.1186/s12872-023-03174-2.
A high prevalence of nasopharyngeal carcinoma (NPC) has been found in China, but it rarely occurs with syncope. Studies have demonstrated that syncope due to NPC may be related to carotid sinus syndrome, glossopharyngeal irritation, and parapharyngeal and retropharyngeal space lesions. Such patients require evaluation by nasopharyngoscopy and head magnetic resonance imaging/computed tomography. There is no known single effective treatment for these patients. Various interventions may be considered in an effort to relieve syncope, including vasoconstrictive drugs, cardiac pacemaker implantation, radiotherapy and chemotherapy, and surgical resection.
This case report describes a 56-year-old man who developed recurrent syncope with atrial fibrillation, a long RR interval, and hypotension. A single chamber pacemaker was fitted, but it failed to relieve the symptom. Cranial magnetic resonance imaging and pathological tests led to a final diagnosis of NPC. After six courses of chemotherapy and 35 sessions of radiotherapy, the patient became asymptomatic. However, he died from a massive uncontrolled hemorrhage in the nasopharynx two years later.
This case brings attention to the fact that syncope can be a symptom of NPC. Due to the insidiously malignant nature of this cancer, when a patient presents with syncope, clinicians should bear in mind this connection, albeit a rare one. There are at least two ways of treating NPC-associated syncope, but there is disagreement about which is the most effective.
中国鼻咽癌（NPC）的发病率很高，但很少伴有晕厥。研究表明，NPC 引起的晕厥可能与颈动脉窦综合征、舌咽神经刺激、咽旁和咽后间隙病变有关。这些患者需要通过鼻咽镜和头部磁共振成像/计算机断层扫描进行评估。目前尚没有针对这些患者的单一有效治疗方法。为了缓解晕厥，可以考虑各种干预措施，包括血管收缩药物、心脏起搏器植入、放化疗和手术切除。
本病例报告描述了一名 56 岁男性，反复晕厥，伴有房颤、长 RR 间隔和低血压。植入了单腔起搏器，但未能缓解症状。头颅磁共振成像和病理检查最终诊断为 NPC。经过六轮化疗和 35 次放疗后，患者无症状。然而，两年后他因鼻咽部大量失控性出血而死亡。
本病例提醒人们，晕厥可能是 NPC 的症状之一。由于这种癌症具有隐匿性恶性，当患者出现晕厥时，临床医生应牢记这一关联，尽管这种关联很少见。至少有两种方法可以治疗 NPC 相关的晕厥，但哪种方法最有效存在争议。
