Situational Syncope — EECC MCQ

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EasyGeneral CardiologySituational SyncopeEECC

A 45-year-old man with hypertension and obesity presents with recurrent syncope exclusively during micturition at night. He has no structural heart disease. His ECG and echocardiography are normal. What is the most likely type of syncope?

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Correct answer: A — Situational (reflex) syncope — a subtype of neurally mediated syncope triggered by micturition

Situational syncope is a subtype of reflex (neurally mediated) syncope triggered by specific situations: micturition, defecation, coughing, swallowing, or laughing. Micturition syncope typically occurs in males during or immediately after urination, especially at night (when transitioning from lying to standing, combined with vagal activation during bladder emptying and relative volume depletion). The ESC Syncope Guidelines (2018) classify it under reflex syncope. Management includes: sitting to urinate (especially at night), adequate hydration, avoiding alcohol before bedtime, and standing up slowly. No further cardiac investigation is typically needed if the history is classic and there is no structural heart disease.

Reference: ESC (2018): Guidelines on Syncope