title: Neurocardiogenic Syncope and Supraventricular Tachycardia in Association with a Rare Congenital Aortic Valve Abnormality.
abstract: We report a case of a 26-year-old woman who presented with multiple episodes of syncope over a five-months period of time. Transthoracic echocardiogram had shown a normal functioning quadricuspid aortic valve (QAV) which was also confirmed on a transesophageal echocardiogram. Computed tomographic angiography of heart and coronary arteries showed the QAV with equal size of all aortic cusps and normal coronary arteries. Intermittent chest pain and palpitations warranted an exercise stress test. The stress test revealed normal aerobic exertion, with achievement of 101% of maximal peak heart rate. However, during peak stress, we noted a drop in her blood pressure significantly resulting in dizziness. No arrhythmias were noted during the stress test. With recurrent syncope episodes and palpitations, Holter monitoring was done, revealing supraventricular tachycardia (SVT). We discuss current available literature and coassociations with QAV. New association of QAV with SVT needs further analysis.
authors.affiliation: Department of Internal Medicine/Pediatrics, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI, USA.
authors.forename: Yashwant
authors.identifier: 0000-0002-1352-583X
authors.initials: Y
authors.lastname: Agrawal
authors.affiliation: Department of Cardiology, Michigan State University/Borgess Medical Center, Kalamazoo, MI, USA.
authors.forename: Jagadeesh K
authors.identifier: 0000-0003-4635-4616
authors.initials: JK
authors.lastname: Kalavakunta
authors.affiliation: Department of Cardiology, Michigan State University/Borgess Medical Center, Kalamazoo, MI, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Cardiology, Michigan State University/Borgess Medical Center, Kalamazoo, MI, USA.
authors.forename: William
authors.initials: W
authors.lastname: Lapenna