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Cureus Dec 2022Vasovagal syncope (VVS) is a transient, sudden loss of consciousness followed by complete resolution, usually due to a paradoxical autonomic reaction that results in... (Review)
Review
Vasovagal syncope (VVS) is a transient, sudden loss of consciousness followed by complete resolution, usually due to a paradoxical autonomic reaction that results in hypotension and/or bradycardia. In this study, we assessed the correlation between VVS and a patient's psychiatric status, as well as if this association could be a target in the treatment of those patients. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the available literature using the following databases: PubMed, Google Scholar, and ScienceDirect, with last access on July 21, 2022. The search resulted in 1691 articles, and inclusion and exclusion criteria were applied to nine remaining articles, all of which were accepted after using the quality assessment tools, four observational and four randomized controlled trials (RCTs). Four of the included studies assessed the correlation among vasovagal syncope, psychosocial impairment, and quality of life. We found a consistent correlation among VVS, psychosocial impairment, and quality of life (QoL), meaning that VVS patients usually have some degree of psychosocial impairment, especially in the form of anxiety and depression, and a poorer QoL in comparison to their healthy counterparts. The use of psychotherapy and antidepressants was proven to be effective in VVS in RCTs, but further evidence is needed.
PubMed: 36694488
DOI: 10.7759/cureus.32793 -
Frontiers in Cardiovascular Medicine 2022Physical counter pressure maneuvers (CPM) are movements that are recommended to delay or prevent syncope (fainting) by recruiting the skeletal muscle pump to augment... (Review)
Review
Physical counter pressure maneuvers (CPM) are movements that are recommended to delay or prevent syncope (fainting) by recruiting the skeletal muscle pump to augment cardiovascular control. However, these recommendations are largely based on theoretical benefit, with limited data evaluating the efficacy of CPM to prevent syncope in the real-world setting. We conducted a semi-systematic literature review and meta-analysis to assess CPM efficacy, identify literature gaps, and highlight future research needs. Articles were identified through a literature search (PubMed, April 2022) of peer-reviewed publications evaluating the use of counter pressure or other lower body maneuvers to prevent syncope. Two team members independently screened records for inclusion and extracted data. From 476 unique records identified by the search, 45 met inclusion criteria. Articles considered various syncopal conditions (vasovagal = 12, orthostatic hypotension = 8, postural orthostatic tachycardia syndrome = 1, familial dysautonomia = 2, spinal cord injury = 1, blood donation = 10, healthy controls = 11). Maneuvers assessed included hand gripping, leg fidgeting, stepping, tiptoeing, marching, calf raises, postural sway, tensing (upper, lower, whole body), leg crossing, squatting, "crash" position, and bending foreword. CPM were assessed in laboratory-based studies ( = 28), the community setting ( = 4), both laboratory and community settings ( = 3), and during blood donation ( = 10). CPM improved standing systolic blood pressure (+ 14.8 ± 0.6 mmHg, < 0.001) and heart rate (+ 1.4 ± 0.5 bpm, = 0.006), however, responses of total peripheral resistance, stroke volume, or cerebral blood flow were not widely documented. Most patients experienced symptom improvement following CPM use (laboratory: 60 ± 4%, community: 72 ± 9%). The most prominent barrier to employing CPM in daily living was the inability to recognize an impending faint. Patterns of postural sway may also recruit the skeletal muscle pump to enhance cardiovascular control, and its potential as a discrete, proactive CPM needs further evaluation. Physical CPM were successful in improving syncopal symptoms and producing cardiovascular responses that may bolster against syncope; however, practical limitations may restrict applicability for use in daily living.
PubMed: 36312294
DOI: 10.3389/fcvm.2022.1016420 -
Clinical and Applied... 2022Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We... (Meta-Analysis)
Meta-Analysis Review
Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope (: 0.027), chest pain (: 0.006), and obstructive shock (: 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival (: 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06-3.65, : 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20-4.14, : 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086-0.57, : 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137-0.9, : 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.
Topics: Humans; Prevalence; Pulmonary Embolism; Thrombosis; Thrombolytic Therapy; Syncope
PubMed: 36384306
DOI: 10.1177/10760296221140114 -
Annals of Noninvasive Electrocardiology... Mar 2018The total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. However, its prognostic value has been controversial.
OBJECTIVE
This systematic review and meta-analysis evaluated the significance of TRCT in predicting arrhythmic and/or mortality endpoints.
METHODS
PubMed and Embase databases were searched through December 31, 2016.
RESULTS
Of the 890 studies identified initially, 13 observational studies were included in our meta-analysis. A total of 11,528 patients, mean age 47 years old, 72% male, were followed for 43 ± 6 months. Data from five studies demonstrated lower TCRT values in myocardial infarction patients with adverse events (syncope, ventricular arrhythmias, or sudden cardiac death) compared to those without these events (mean difference = -0.36 ± 0.05, p < .001; I = 48%). By contrast, only two studies analyzed outcomes in heart failure, and pooled meta-analysis did not demonstrate significant difference in TCRT between event-positive and event-negative patients (mean difference = -0.01 ± 0.10, p > .05; I = 80%).
CONCLUSION
TCRT is lower in MI patients at high risk of adverse events when compared to those free from such events. It can provide additional risk stratification beyond the use of clinical parameters and traditional electrocardiogram markers. Its value in other diseases such as heart failure requires further studies.
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Female; Humans; Male; Predictive Value of Tests; Prognosis; Risk Assessment; Survival Analysis; Tachycardia, Ventricular; Vectorcardiography; Ventricular Fibrillation
PubMed: 28901628
DOI: 10.1111/anec.12495 -
Clinical Autonomic Research : Official... Jun 2022Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing... (Review)
Review
BACKGROUND
Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing fatigue, sometimes with "brain fog", which may further impact their quality of life, but the incidence and severity of fatigue in patients with syncope remain unclear. In this systematic review, we report evidence on the associations between fatigue and conditions of orthostatic syncope.
METHODS
We performed a comprehensive literature search of four academic databases to identify articles that evaluated the association between orthostatic syncope [postural orthostatic tachycardia syndrome (POTS), vasovagal syncope (VVS), orthostatic hypotension (OH)] and fatigue. Studies were independently screened using a multi-stage approach by two researchers to maintain consistency and limit bias.
RESULTS
Our initial search identified 2797 articles, of which 13 met our inclusion criteria (POTS n = 10; VVS n = 1; OH n = 1; VVS and POTS n = 1). Fatigue scores were significantly higher in patients with orthostatic syncope than healthy controls, and were particularly severe in those with POTS. Fatigue associated with orthostatic syncope disorders spanned multiple domains, with each dimension contributing equally to increased fatigue. "Brain fog" was an important symptom of POTS, negatively affecting productivity and cognition. Finally, fatigue was negatively associated with mental health in patients with POTS.
CONCLUSION
In conditions of orthostatic syncope, fatigue is prevalent and debilitating, especially in patients with POTS. The consideration of fatigue in patients with orthostatic disorders is essential to improve diagnosis and management of symptoms, thus improving quality of life for affected individuals.
Topics: Fatigue; Humans; Hypotension, Orthostatic; Postural Orthostatic Tachycardia Syndrome; Quality of Life; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 35689118
DOI: 10.1007/s10286-022-00868-z -
Global Epidemiology Jun 2024Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal... (Review)
Review
BACKGROUND
Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal syncope using a systematic review and meta-analysis.Methods: In this systematic review and meta-analysis study, the global prevalence of vasovagal syncope using the keywords Prevalence, Epidemiology, Vasovagal syncope, and Reflex syncope in PubMed, WoS, Scopus, ScienceDirect databases, and Google scholar search engine without time limit until July 20, 2022, was extracted and transferred to the information management software (EndNote). Then the repeated studies were excluded, and researchers evaluated the remaining studies during three stages (i.e., screening, eligibility, and qualitative assessment). The heterogeneity of studies was investigated using the I index, and the analysis of eligible studies was performed using the random effects model.
RESULTS
In the review of 12 studies with a sample size of 36,156 people, the global prevalence of vasovagal syncope was reported as 16.4 (95%CI: 6-37.5), and the study of publication bias in the studies through the Egger test shows the absence of publication bias in the studies.
CONCLUSION
The prevalence reported in the studies shows a high prevalence of vasovagal syncope, which requires serious intervention and preventive, diagnostic, and therapeutic measures. It is necessary for health policymakers to take effective measures in this field.
PubMed: 38283939
DOI: 10.1016/j.gloepi.2024.100136 -
Vaccine Jan 2018Clusters of anxiety-related adverse events following immunization (AEFI) have been observed in several countries and have disrupted country immunization programs. We... (Review)
Review
BACKGROUND
Clusters of anxiety-related adverse events following immunization (AEFI) have been observed in several countries and have disrupted country immunization programs. We conducted a systematic literature review to characterize these clusters, to generate prevention and management guidance for countries.
METHODS
We searched seven peer-reviewed databases for English language reports of anxiety-related AEFI clusters (≥2 persons) with pre-specified keywords across 4 categories: symptom term, cluster term, vaccine term, and cluster AEFI phenomenon term/phrase. All relevant reports were included regardless of publication date, case-patient age, or vaccine. Two investigators independently reviewed abstracts and identified articles for full review. Data on epidemiologic/clinical information were extracted from full text review including setting, vaccine implicated, predominant case-patient symptoms, clinical management, community and media response, and outcome/impact on the vaccination program.
RESULTS
Of 1472 abstracts reviewed, we identified eight published clusters, from all six World Health Organization (WHO) regions except the African Region. Seven clusters occurred among children in school settings, and one was among adult military reservists. The size and nature of these clusters ranged from 7 patients in one school to 806 patients in multiple schools. Patients' symptoms included dizziness, headache, and fainting with rapid onset after vaccination. Implicated vaccines included tetanus (2), tetanus-diphtheria (1), hepatitis B (1), oral cholera (1), human papillomavirus (1), and influenza A (H1N1)pdm09 (2). In each report, all affected individuals recovered rapidly; however, vaccination program disruption was noted in some instances, sometimes for up to one year.
CONCLUSIONS
Anxiety-related AEFI clusters can be disruptive to vaccination programs, reducing public trust in immunizations and impacting vaccination coverage; response efforts to restore public confidence can be resource intensive. Health care providers should have training on recognition and clinical management of anxiety-related AEFI; public health authorities should have plans to prevent and effectively manage anxiety-related AEFI clusters. Prompt management of these occurrences can be even more important in an era of social media, in which information is rapidly spread.
Topics: Anxiety; Dizziness; Global Health; Headache; Humans; Immunization; Immunization Programs; Syncope; Vaccines
PubMed: 29198916
DOI: 10.1016/j.vaccine.2017.11.017 -
JAMA Internal Medicine Nov 2016Overuse of medical care is an increasingly recognized problem in clinical medicine. (Review)
Review
IMPORTANCE
Overuse of medical care is an increasingly recognized problem in clinical medicine.
OBJECTIVE
To identify and highlight original research articles published in 2015 that are most likely to reduce overuse of medical care, organized into 3 categories: overuse of testing, overtreatment, and questionable use of services. The articles were reviewed and interpreted for their importance to clinical medicine.
EVIDENCE REVIEW
A structured review of English-language articles on PubMed published in 2015 and review of tables of contents of relevant journals to identify potential articles that related to medical overuse in adults.
FINDINGS
Between January 1, 2015, and December 31, 2015, we reviewed 1445 articles, of which 821 addressed overuse of medical care. Of these, 112 were deemed most relevant based on their originality, methodologic quality, and number of patients potentially affected. The 10 most influential articles were selected by consensus using the same criteria. Findings included a doubling of specialty referrals and advanced imaging for simple headache (from 6.7% in 2000 to 13.9% in 2010); unnecessary hospital admission for low-risk syncope, often leading to adverse events; and overly frequent colonoscopy screening for 34% of patients. Overtreatment was common in the following areas: 1 in 4 patients with atrial fibrillation at low risk for thromboembolism received anticoagulation; 94% of testosterone replacement therapy was administered off guideline recommendations; 91% of patients resumed taking opioids after overdose; and 61% of patients with diabetes were treated to potentially harmfully low hemoglobin A1c levels (<7%). Findings also identified medical practices to question, including questionable use of treatment of acute low-back pain with cyclobenzaprine and oxycodone/acetaminophen; of testing for Clostridium difficile with molecular assays; and serial follow-up of benign thyroid nodules.
CONCLUSIONS AND RELEVANCE
The number of articles on overuse of medical care nearly doubled from 2014 to 2015. The present review promotes reflection on the top 10 articles and may lead to questioning other non-evidence-based practices.
Topics: Delivery of Health Care; Evidence-Based Medicine; Guidelines as Topic; Health Services Misuse; Humans; Mass Screening; Medical Overuse; Patient Readmission; Prescription Drug Overuse; Quality of Health Care; Randomized Controlled Trials as Topic; United States; Unnecessary Procedures
PubMed: 27654002
DOI: 10.1001/jamainternmed.2016.5381 -
The Egyptian Heart Journal : (EHJ) :... Dec 2018Idiopathic short-coupled ventricular tachyarrhythmias make up a considerable proportion of ventricular tachyarrhythmias in structurally normal hearts and are the cause... (Review)
Review
INTRODUCTION
Idiopathic short-coupled ventricular tachyarrhythmias make up a considerable proportion of ventricular tachyarrhythmias in structurally normal hearts and are the cause of 5-10% of unexpected sudden cardiac deaths. There is disparity in the literature regarding their description and a lack of formal diagnostic criteria to define them.
OBJECTIVE
To validate ECG indices for the diagnosis of these ventricular tachyarrythmias and to subsequently unify their differing descriptions in the literature under a new terminology: .
METHODS
We conducted a systematic review of all published studies describing short-coupled torsades de pointes, idiopathic ventricular fibrillation and polymorphic ventricular tachycardia. Published tracings were analysed using a standard set of criteria to define the different ECG intervals. Previously proposed diagnostic indices were validated using a control group of previously published long-coupled torsades de pointes cases.
RESULTS
Validation of the ECG indices revealed that a coupling interval < 400 ms was the most reliable measurement (sensitivity 100%, specificity 97%), followed by a coupling interval/QT < 1 (sensitivity 96%, specificity 100%).
CONCLUSION
Idiopathic short-coupled ventricular tachyarrhythmias encompass all previous descriptions of this tachyarrhythmia including idiopathic ventricular fibrillation, short-coupled torsades de pointes, Purkinje-related torsades de pointes and idiopathic polymorphic ventricular tachycardia. This arrhythmia can be diagnosed by newly proposed criteria with high sensitivity and specificity.
PubMed: 30591747
DOI: 10.1016/j.ehj.2018.06.003 -
Circulation Feb 2016The role of programmed ventricular stimulation in identifying patients with Brugada syndrome at the highest risk for sudden death is uncertain. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The role of programmed ventricular stimulation in identifying patients with Brugada syndrome at the highest risk for sudden death is uncertain.
METHODS AND RESULTS
We performed a systematic review and pooled analysis of prospective, observational studies of patients with Brugada syndrome without a history of sudden cardiac arrest who underwent programmed ventricular stimulation. We estimated incidence rates and relative hazards of cardiac arrest or implantable cardioverter-defibrillator shock. We analyzed individual-level data from 8 studies comprising 1312 patients who experienced 65 cardiac events (median follow-up, 38.3 months). A total of 527 patients were induced into arrhythmias with up to triple extrastimuli. Induction was associated with cardiac events during follow-up (hazard ratio, 2.66; 95% confidence interval [CI], 1.44-4.92, P<0.001), with the greatest risk observed among those induced with single or double extrastimuli. Annual event rates varied substantially by syncope history, presence of spontaneous type 1 ECG pattern, and arrhythmia induction. The lowest risk occurred in individuals without syncope and with drug-induced type 1 patterns (0.23%, 95% CI, 0.05-0.68 for no induced arrhythmia with up to double extrastimuli; 0.45%, 95% CI, 0.01-2.49 for induced arrhythmia), and the highest risk occurred in individuals with syncope and spontaneous type 1 patterns (2.55%, 95% CI, 1.58-3.89 for no induced arrhythmia; 5.60%, 95% CI, 2.98-9.58 for induced arrhythmia).
CONCLUSIONS
In patients with Brugada syndrome, arrhythmias induced with programmed ventricular stimulation are associated with future ventricular arrhythmia risk. Induction with fewer extrastimuli is associated with higher risk. However, clinical risk factors are important determinants of arrhythmia risk, and lack of induction does not necessarily portend low ventricular arrhythmia risk, particularly in patients with high-risk clinical features.
Topics: Brugada Syndrome; Defibrillators, Implantable; Humans; Observational Studies as Topic; Prospective Studies; Risk Assessment; Tachycardia, Ventricular; Ventricular Fibrillation
PubMed: 26797467
DOI: 10.1161/CIRCULATIONAHA.115.017885