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After pleural drainage and chest tube removal, he had no recurrence and was discharged after completing intravenous antibiotics.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/a-rare-case-of-asystole-due-to-exaggerated-vagal-tone-following-chest-tube-placement-case-report/455332/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/a-rare-case-of-asystole-due-to-exaggerated-vagal-tone-following-chest-tube-placement-case-report/455332.png","ImageObject",300,407,{"name":42,"@type":43},"LangkahRina","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What condition required the chest tube in this case?","Question",{"text":63,"@type":64},"Empyema arising as a complication of pneumonia required left-sided chest tube placement in addition to antibiotics.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What happened immediately after chest tube placement?",{"text":68,"@type":64},"After the first drainage of thick pleural fluid, the patient developed syncope with telemetry showing bradycardia, a sinus pause, and asystole lasting 16 seconds, followed by spontaneous return to sinus rhythm.",{"name":70,"@type":61,"acceptedAnswer":71},"Were reversible causes such as ischemia or lab abnormalities identified?",{"text":72,"@type":64},"Electrolytes and high-sensitivity troponin were within normal limits, and the ECG showed no signs of ischemia; follow-up evaluation did not indicate pneumothorax or tube displacement.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},455332,1790765134,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":97,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962090893776,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/14/2025  \nReview ended 11/28/2025  \nPublished 12/06/2025  \n© Copyright 2025  \nAsif et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98599  \nOpen Access Case Report  \nA Rare Case ofAsystole Due to Exaggerated Vagal Tone Following Chest Tube Placement  \nMuhammad Asif 1, Sukhila Reddy 1, Jurgen Shtembari 1, Talha Shamshad 2, Muhammad U. Rana 1, Randolph Martin 1  \n1. Cardiology, Carle Foundation Hospital, Urbana, USA 2. Internal Medicine, Carle Foundation Hospital, Urbana, USA Corresponding author: Muhammad Asif, [dr.asifmd81@gmail.com](dr.asifmd81@gmail.com)  \nAbstract  \nExcessive vagal tone can lead to unstable bradyarrhythmias. We present the case of a 39-year-old otherwise healthy man who failed outpatient treatment for community-acquired pneumonia with oral antibiotics and underwent left-sided chest tube placement for empyema. After chest tube placement, the patient had a firstever episode of syncope, which on telemetry coincided with a 16-second pause and asystole followed by the spontaneous recovery of sinus rhythm. Electrolytes and high-sensitivity troponin were within normal limits. The electrocardiogram (EKG) did not reveal any signs of ischemia. Eventually, the chest tube was removed after the drainage of pleural fluid, and the patient did not have any recurrence of arrhythmia or symptoms. He was discharged home after the completion of intravenous antibiotics.  \nCategories: Cardiology, Internal Medicine, Cardiac/Thoracic/Vascular Surgery  \nKeywords: chest tube complication, chest tube management, increased vagal tone, reflex asystolic syncope, reversible bradycardia, transient asystole  \nIntroduction  \nEmpyema is a well-known complication of pneumonia (PNA) . The treatment of empyema requires the placement of a chest tube in addition to appropriate antibiotics. Chest tube placement is usually a safe procedure. However, it can rarely cause severe brady-or tachyarrhythmias [1] . Appropriate management requires clinicians ' awareness of this rare complication to assist in prompt identification and guide treatment. Symptomatic sinus pauses secondary to chest tube insertion have been reported previously in the literature [2] . We report a rare case in which the sinus pause was unusually prolonged, lasting 16 seconds, leading to asystole recorded on telemetry and clinical syncope before the spontaneous return of sinus rhythm.  \nCase Presentation  \nA 39-year-old man without any previous cardiac disease history presented with a non-productive cough, fever, and chills for 10 days. A review of systems was significant for pleuritic chest pain. Prior to arrival atthe emergency room (ER), he was diagnosed with community-acquired pneumonia (CAP) as an outpatient for which he received five days of oral levofloxacin and two days of intravenous ceftriaxone without relief of symptoms. The patient then presented to the ER for further evaluation. In the ER, his vital signs were within normal limits, and his physical exam was consistent with decreased breath sounds at the left mid to lower lung field with rhonchi. Labs were significant for normal hemoglobin and neutrophilic leukocytosis with a white blood cell (WBC) count of 17×103/uL (4-11×103/uL) and a platelet count of 594×103/uL (140- 400×103/uL) . High-sensitivity troponin, lactic acid, and baseline electrocardiogram (EKG) were within normal limits. A computed tomography (CT) scan of the chest with contrast showed mixed airspace and interstitial infiltrate in the left lower lobe with a moderate-sized loculated pleural fluid collection suggestive of empyema (Figure 1) .  \nHow to cite this article  \nAsif M , Reddy S , Shtembari J , et al. (December 06 , 2025) A Rare Case of Asystole Due to Exaggerated Vagal Tone Following Chest Tube Placement. ","cbCaiftfHSEyi3HS","https://ap.wps.com/l/cbCaiftfHSEyi3HS","pdf",1958409,"English","# Introduction\n## Case Presentation","[{\"question\":\"What condition required the chest tube in this case?\",\"answer\":\"Empyema arising as a complication of pneumonia required left-sided chest tube placement in addition to antibiotics.\"},{\"question\":\"What happened immediately after chest tube placement?\",\"answer\":\"After the first drainage of thick pleural fluid, the patient developed syncope with telemetry showing bradycardia, a sinus pause, and asystole lasting 16 seconds, followed by spontaneous return to sinus rhythm.\"},{\"question\":\"Were reversible causes such as ischemia or lab abnormalities identified?\",\"answer\":\"Electrolytes and high-sensitivity troponin were within normal limits, and the ECG showed no signs of ischemia; follow-up evaluation did not indicate pneumothorax or tube displacement.\"}]","A Rare Case of Asystole Due to Exaggerated Vagal Tone Following Chest Tube Placement - Case Report | PDF",1790742634,13]