Article Text

Reminder of important clinical lesson
An unusual cause of syncope
  1. Priya Nair,
  2. Alan Robertson,
  3. Ronald MacWalter
  1. Ninewells Hospital, Department of Stroke Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
  1. Priya Nair, priya.nair{at}nhs.net

Summary

We present an unusual cause of recurrent syncope in a man in his 50s. He worked as a metallurgist and suffered syncopal events in his poorly ventilated workshop. A detailed history revealed that he used several solvents and chemicals at work and often kept workplace windows closed; he also smoked cannabis in his workshop. Physical examination was unremarkable. Investigations for prior haematemesis had shown oesophageal varices, cirrhosis and portal hypertension. An electrocardiogram (ECG), 24 hour ECG and an echocardiogram were normal. Liver biopsy showed steatohepatitis and cirrhosis consistent with toxic metabolic injury. He was advised to improve ventilation in his work environment following which he had no further episodes. The episodes of syncope were diagnosed to be secondary to effects of solvent inhalation compounded by effects of cannabis in a poorly ventilated workshop. This report illustrates the importance of eliciting an accurate social and occupational history in unusual cases.

View Full Text

Statistics from Altmetric.com

Footnotes

  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.