A 50-year-old female patient, presented with repeated syncope for more than 2 years. Prior assessments were conducted at different hospitals, but no definite abnormalities were found. The patient's fear and anxiety about possible future attacks were escalating. Through a Head-up tilt test, the cause was finally identified as vasovagal syncope. Following a 5-min administration of nitroglycerin, the patient reported palpitations, nausea, and deep, rapid breathing. The electrocardiogram initially showed a first-degree atrioventricular block, progressing swiftly to a second-degree type I atrioventricular block—high atrioventricular block. Immediate intervention was undertaken, but blood pressure was not instantly ascertainable, coinciding with an abrupt loss of consciousness. Subsequent electrocardiographic findings included paroxysmal third-degree atrioventricular block, sinus arrest, and complete cardiac arrest, prompting the initiation of external cardiac compressions. The longest recorded ventricular arrest approximated 15 s, with sinus rhythm resuming post 10 s of cardiac compressions and the patient regaining consciousness. The patient underwent vagal ablation and no longer experienced syncope.

中文翻译：

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中年女性反复晕厥的诊治

患者女，50岁，反复晕厥2年余。此前曾在不同医院进行过评估，但没有发现明确的异常情况。患者对未来可能发作的恐惧和焦虑不断升级。通过平视倾斜试验，最终确定病因为血管迷走性晕厥。给予硝酸甘油 5 分钟后，患者报告出现心悸、恶心和深呼吸急促。心电图最初显示一度房室传导阻滞，迅速进展为二度I型房室传导阻滞——高度房室传导阻滞。立即进行了干预，但血压无法立即确定，同时意识突然丧失。随后的心电图检查结果包括阵发性三度房室传导阻滞、窦性停搏和完全心脏骤停，促使开始心脏外按压。记录的最长心室停搏时间约为 15 秒，心脏按压 10 秒后窦性心律恢复，患者恢复意识。患者接受了迷走神经消融术，不再出现晕厥。