Annals of Case Reports and Clinical Studies (ISSN: 2834-5673) | Volume 5, Issue 4 | Case Report | Open Access
Shaun Nevil*
Athira Manoj1, Gautam Prasanth2, Ayoon Fatima3, Kanishka Verma4, Shaun Nevil5*, S Anton Charles6 and Chaitra C.S7
1Kasturba Medical College, Mangalore, India
2Kasturba Medical College, Mangalore, India
3University College of Medicine and Dentistry, Pakistan
4Sri Guru Ram Das Institute of Medical Sciences and Research, India
5Department of Internal Medicine, ESIC Medical College & PGIMSR, Karnataka, India
6Department of Internal Medicine, ESIC Medical College & PGIMSR, Karnataka, India
7Assistant Professor, Department of Internal Medicine, ESIC Medical College & PGIMSR, Karnataka, India
*Correspondence to: Shaun Nevil
Fulltext PDFSyncope and altered sensorium in elderly patients often arise from overlapping cardiac, metabolic, and neurological etiologies, making accurate diagnosis challenging. A 71-year-old male presented with giddiness, excessive daytime sleepiness, and new-onset Generalized Tonic-Clonic Seizure (GTCS). Evaluation revealed symptomatic sinus bradycardia with ventricular bigeminy, significant hyponatremia, and type 1 respiratory failure in the background of chronic obstructive pulmonary disease. Continuous cardiac monitoring demonstrated intermittent severe bradycardia, while laboratory investigations confirmed electrolyte imbalance and elevated cardiac biomarkers. The coexistence of these conditions created a diagnostic dilemma, as each could independently explain the clinical presentation. Hyponatremia and hypoxia likely lowered the seizure threshold, while severe bradycardia may have contributed to convulsive syncope due to cerebral hypoperfusion. Additionally, seizure-related autonomic disturbances may have exacerbated cardiac arrhythmias, highlighting a complex bidirectional interaction.
Syncope; Hyponatremia; Ventricular bigeminy; Bradycardia; Seizure
Athira Manoj, Gautam Prasanth, Ayoon Fatima, Kanishka Verma, Shaun Nevil5, S Anton Charles, et al. Ventricular Bigeminy Presenting as Syncope and Seizure in the Setting of Hyponatremia: A Diagnostic Dilemma. Ann Case Rep Clin Stud. 2026;5(4):1-4.