A man with recurrent syncope

Case presentation A 68-year-old man had been suffering from recurrent syncopal episodes for the previous 3 years. These episodes usually lasted about 1 or 2 min, were associated with diaphoresis, and sometimes with chest and epigastric discomfort; they were related to neither exertion nor orthostatic position, and they resolved with a rapid and spontaneous recovery. The frequency of these occurrences had progressively increased, from a few occurrences per year to monthly and sometimes even weekly presentations. The patient had several cardiovascular risk factors: a positive family history for coronary artery disease and stroke; hypercholesterolemia; previous smoking; BMI 29.6 kg/m 2 . His past medical history was remarkable for Helicobacter pylori positive gastroduodenitis, unresponsive to eradication therapy, and a recently diagnosed arterial hypertension. His only medication was simvastatin 20 mg OD.