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Defecation syncope; digging deep: a case report

Author(s)
Ghulam Kubra Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases (NICVD),Karachi,Pakistan
Fariha Hassan Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases (NICVD),Karachi,Pakistan
Shazia Rasheed Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases (NICVD),Karachi,Pakistan
Muhammad Liaquat Raza Department of Health Management, IoBM,Karachi,Pakistan
Lubna Baqai Department of Cardiology, Tabba Heart Hospital,Karachi,Pakistan
Muhammad Asad Department of Cardiology, Benazir Bhutto Hospital,Rawalpindi,Pakistan
Abstract
Defecation syncope explains the exaggerated vasovagal response while defecating, which may result in unconsciousness and rarely cardiac arrest. It is underreported, mainly because of the patient's hesitation and inability to correlate the two, unless specifically probed by meticulous history taking; the importance of which cannot be over-emphasized. A 28- year old fieldworker with two episodes of syncope, the last of which culminated in a cardiac arrest requiring resuscitation by a bystander. Upon further questioning, it was revealed that both times, the patient had the urge to defecate followed by dizziness and warmth preceding the loss of consciousness. A head-up tilt table test was planned as a means to reenact the symptoms. Upon confirmation of diagnosis, the patient was counselled for lifestyle changes only . Defecation syncope leading to cardiac arrest is a rare entity but with high mortality ratio. Since vagal tone increases during straining effort, reducing physiological response may be helpful to avoid lethal results. Hydration, avoidance of constipation, and squatting position are among the important key risk-reducing factors.
Publication Details
Page(s) 128-130
DOI 10.37184/lnjpc.2707-3521.5.16
Published Journal: Liaquat National Journal of Primary Care, Volume: 5, Issue: 2, Year: 2023

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Keywords
constipation, Defecation, vagal nerve, tone, lifestyle change
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