The Mystery of Situational Syncope: A Case Series of Three Patients with Uncommon Histories

Syncope, characterized by a transient loss of consciousness, is among the most common reasons for emergency department visits worldwide and can be categorized into reflex syncope, orthostatic hypotension, and cardiac syncope. Situational syncope, a subtype of reflex syncope, is less frequently investigated than other forms. Herein, we describe three patients who presented to the Syncope Unit of Tehran Heart Center with unusual situational syncope triggers, along with the diagnostic methods and treatments used. The first case was a 62-year-old woman who experienced five syncopal episodes over the past 2 years, all of which occurred at an airport during airplane takeoff. Following a prescription for midodrine to be taken before flights, no further syncopal episodes occurred. The second patient was an 18-year-old man with two syncopal episodes, both occurring after smoking marijuana. He was advised to discontinue marijuana use, and no further episodes were reported during a 1-year follow-up period. The final case was a 42-year-old man who was a heavy smoker, presenting with several syncopal episodes following bouts of violent coughing. After cough suppressant medications proved ineffective, he was successfully treated with gabapentin. In conclusion, given the complex nature of diagnosing syncope in some cases, physicians should consider rare triggers when taking the medical history of patients with unexplained syncope.