View source for Vasovagal syncope interrupting sleep

''CT Paul Krediet, David L Jardine‡, Pietro Cortelli§, AGR Visman ||and Wouter Wieling*;  &#42; Department of Internal Medicine, Academic Medical Center, University of Amsterdam (The Netherlands); ‡ Department of General Medicine, Christchurch Hospital, Christchurch (New Zealand); § Neurological Section, University of Modena and Reggio Emilia, Bologna (Italy); ||Department of Cardiology, Beatrix Ziekenhuis, Gorinchem (The Netherlands)''<br /><br />

{{case_present|
[[File:NocturnalSyncope_Fig1.png | thumb | 500px | left | Figure 1. Simultaneous EEG and ECG recordings preceding and during typical nocturnal episode. The montage consists of four sets of channels running anterior to posterior recorded from the right parasagittal, left parasagittal, right temporal, and left temporal areas respectively. <br/><br/>

Panel A: 	time 5:49 AM, normal sleep EEG, heart rate 90 bpm. <br/>
Panel B: 	time 5:50 AM, EEG unchanged, heart rate 126 bpm. <br/>
Panel C: 	time 5:52 AM (after calling for nurse), patient lying supine in bed unable to move, EEG unchanged, heart rate 36 bpm. Patient is pale and sweating profusely. 
]]

A female patient had her first nocturnal syncopal episode at the age of 40. She woke up at night after sleeping for some hours, aware of nausea, abdominal discomfort and an urge to defecate. She lost consciousness while supine. She sweated profusely but did not bite her tongue. Her husband observed transient myoclonic jerking. After this, similar episodes occurred regularly (at least one per month) and only at night. The syncopal episodes never exceeded one minute and were atraumatic. She was incontinent of urine and faeces once. A tilt test provoked a vasovagal reaction followed by 7 seconds of asystole and reproduced her nocturnal symptoms. Because of ongoing symptoms she underwent neurological investigations and a typical nocturnal episode was recorded during permanent EEG and ECG monitoring.}}

The EEG was judged normal by two independent neurologists. The ECG however showed a pronounced bradycardia (36 bpm) during the episode, with an atrioventricular node escape rhythm. At the age of 44 a permanent dual chamber pacemaker was implanted and the patient reported less syncope but ongoing episodes of nocturnal pre-syncope with abdominal discomfort <cite>Krediet</cite>.

{{clr}}