Psychogenic syncope? A cautionary note.
BACKGROUND
In some patients with recurrent syncope, the etiology may remain unclear despite extensive evaluation. These patients may sometimes be labeled as having a "psychogenic" cause for their syncope.


METHODS
We report on three patients with recurrent unexplained syncope (despite extensive evaluation) who were labeled as having a psychogenic cause for their events. In each patient following placement of an implantable loop recorder, their syncopal events were found to be due to periods of prolonged asystole and/or complete heart block. One patient had prolonged asystole for 44 seconds. In each patient, episodes of syncope were eliminated following permanent pacemaker implantation.


CONCLUSIONS
We conclude that physicians should exercise great caution before labeling any patient's syncope as psychogenic and that prolonged monitoring may be necessary to exclude a potential cardiac rhythm-related etiology.
Kanjwal
Khalil
K
Department of Medicine, Division of Cardiovascular Medicine, Center for Autonomic Disorders, the University of Toledo Medical Center, Toledo, Ohio 43614, USA.
Kanjwal
Yousuf
Y
Karabin
Beverly
B
Grubb
Blair P
BP
D000328:Adult; D002304:Cardiac Pacing, Artificial; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006327:Heart Block / Q000150:complications* / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000150:complications / Q000175:diagnosis; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome