Abstract
This report presents a case of an 80-year-old Caucasian female with a history of hypertension, deep vein thrombosis (managed with warfarin), and Guillain-Barré syndrome, who experienced a syncopal episode. The diagnostic workup included continuous cardiac monitoring, a transthoracic echocardiogram, and orthostatic vital measurements to identify potential causes of syncope. After ruling out more common etiologies, the syncopal episode was suspected to result from mechanical compression of the left atrium by an untreated hiatal hernia. While surgical correction was considered, the patient declined due to her age and the associated postoperative risks. Consequently, supportive management became the focus of care. This case highlights the importance of comprehensive evaluations for patients with recurrent syncope and the need to provide appropriate lifestyle recommendations when surgical intervention is not pursued.