Syncope is a sudden but reversible brief loss of consciousness secondary to an acute reduction of cerebral perfusion. Reflex syncope denotes neurologically mediated syncope, which includes vasovagal, carotid sinus syndrome, and other situational syncope. The most frequent form of syncope is vasovagal, which is triggered by emotional stress or prolonged standing, and may be diagnosed with the tilt table test. A thorough investigation of syncope is necessary as serious cardiovascular disorders may also be a cause. A tilt table test is a widely used tool utilized by clinicians to diagnose vasovagal syncope and is sometimes augmented with isoproterenol, a β-sympathomimetic that acts on the heart. This report seeks to explain a case of a 48-year-old previously healthy woman who experienced inferior wall ST elevations during tilt table test supplemented with isoproterenol. There is reason to believe that the results of this patient’s tilt table test were due to vasovagal syncope in conjunction with right coronary artery vasospasm.
In systemic lupus erythematosus (SLE), cardiac manifestations are known to be present in up to 50% of patients. However, it is rare for acute pericarditis to be the leading symptom at the time of diagnosis of SLE occurring in up to 1% of patients. We present a case series in which 3 patients with no prior history of SLE presented with acute pericarditis. This was found to be the leading manifestation of their disease, which ultimately led to the diagnosis of SLE. These patients were initially treated with nonsteroidal anti-inflammatory drugs and colchicines; however, steroids and disease-modifying anti-rheumatologic agents were ultimately added to their medical therapy.
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