Title : Deciphering the mind-heart mystery : A case report on 16-year-old’s struggle with unexplained dizziness and non-exertion syncope
Abstract:
This 16-year-old male presented by recurrent dizziness, escalating to blank spells resulting in sudden, non-exertion-related syncope. Despite extensive medical evaluations including normal clinical examination, blood pressure readings (lying and standing), EEG, resting ECG, echocardiogram and routine blood tests, no cause could be established. A 24-hour Holter monitor demonstrated 68 pauses in sinus rhythm, with the longest pause lasting 6.9 seconds. These pauses coincided with the patient's dizzy spells suggesting a rare cardiac pathology in 16 year old, ventricular standstill (VS). This case explores the implications of high-degree atrioventricular (AV) block in young individuals. Potential causes include coronary artery disease, inflammatory and autoimmune disorders to genetic anomalies and congenital heart defects. Ventricular standstill is particularly hazardous, considered ten times more lethal than ventricular fibrillation (VFib), often leading to cardiac arrest and sudden death if not promptly addressed. Remarkably, this case adds to only 105 published instances of VS. This figure was corroborated through evaluation of the medical evidence notably drawing on contributions from Parkinson et al, Daniel Adewale Adegoke and Andrew Sagalov et al separately, whose reviews have chronicled VS cases from 1921 onwards. Our patient’s case marks the 5th youngest individual ever diagnosed with VS. This narrative underscores the need for rapid intervention. Implanting a pacemaker is often the only safeguard against life-threatening bradycardia or asystole, even if the patient shows no symptoms. Such preemptive action is crucial for preventing fatal outcomes and ensuring long-term health. Further investigations were unremarkable, including negative results for cardiac myocardial viability MRI, autoimmune and genetic studies, the root cause of VS in our patient remains unknown. Unlike other young VS sufferers who had conditions like myocarditis, Short QT syndrome, septic shock from respiratory infection, or ventricular septal defect (VSD). In conclusion, this case highlights the indispensable role of early detection and advanced medical intervention in managing rare cardiac abnormalities. Ventricular standstill is rare in this age group and there are only few cases reported in the medical literature. This case is the fifth youngest ever reported.
