Severe hypotension requiring resuscitation in tumour-related carotid sinus syndrome: a case report

Background: An uncommon cause of reflex syncope is carotid sinus syndrome (CSS). In rare cases, this can be caused by compression of the carotid sinus by a progressive or invasive tumour.

Case summary: A 57-year-old female was presented at the emergency department with recurrent syncope in the morning. After initial observation, no heart rhythm abnormalities or syncope were observed. The day after discharge, she was presented again with a syncope. Hypotension and bradycardia were observed this time. Furthermore, a mass in the neck area was found near the carotid artery. She was admitted to the cardiology department with suspected carotid sinus syndrome for telemetric observation. Diagnostics by biopsy and PET-CT showed a metastasized squamous cell carcinoma of the tongue. Initial treatment of dexamethasone was started after which the recurrence of the syncope decreased. However, during admission, an in-hospital cardiac arrest occurred due to persistent vagal stimulation. As a result, the patient was started on neoadjuvant chemotherapy and midodrine, after which she experienced multiple complications and died.

Discussion: To the best of our knowledge, this is the first case report that shows an IHCA due to severe hypotension related to a carotid sinus syndrome.