Chest
Volume 106, Issue 5, November 1994, Pages 1601-1603
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Selected Reports
Recurrent Syncope for Over a Decade due to Idiopathic Ventricular Fibrillation

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A 35-year-old man had a history of recurrent syncope for more than a decade. During a witnessed episode, an ambulatory electrocardiographic recording showed ventricular flutter/fibrillation that lasted for 2½ minutes and terminated spontaneously without adverse neurologic sequelae. No structuralheart disease and no possible etiologic factor for the ventricular tachyarrhythmia was found. The patient received an automatic implantable cardioverter defibrillator. Review of the literature suggests that the automatic implantable cardioverter defibrillator is a valid option in idiopathic ventricular fibrillation in young individuals to avoid the potential risk of recurrent cardiac arrest.

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Case Report

A 35-year-old black man was referred to the Brooklyn Veterans Administration Medical Center for syncopal attacks after repeated unrewarding neurologic workup that included multiple electroencephalograms and two head computed tomographic (CT) scans.

For 10 years the patient was treated with phenytoin (Dilantin) in therapeutic dosage that he took regularly except during the period between 1983 to 1986 while serving in the Army in his effort to avoid medical restrictions. The syncopal episodes were

Discussion

Syncope is a symptom caused by a wide variety of diseases ranging from physiologic derangements with few consequences to diseases that may be life-threatening. Causes of syncope include neurocardiogenic syncope, orthostatic hypotension, drug-induced syncope, cerebrovascular diseases, hypersensitive carotid sinus, and cardiac diseases.1 The latter could be classified into mechanical or arrythmogenic causes. Cardiac mechanical causes of syncope include the following: obstruction to left

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Supported by Veterans Administration Medical Research Funds.

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