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Internal Medicine (Tokyo, Japan) Dec 2023
Topics: Humans; Speech; Tachycardia; Syncope; Tilt-Table Test
PubMed: 37062741
DOI: 10.2169/internalmedicine.1737-23 -
Respiratory Research Jul 2018Adenosine 5'-triphiosphate (ATP) is released from cells under physiologic and pathophysiologic conditions. Extracellular ATP acts as an autocrine and paracrine agent... (Review)
Review
Adenosine 5'-triphiosphate (ATP) is released from cells under physiologic and pathophysiologic conditions. Extracellular ATP acts as an autocrine and paracrine agent affecting various cell types by activating cell surface P2 receptors (P2R), which include trans-cell membrane cationic channels, P2XR, and G protein coupled receptors, P2YR. We have previously shown that ATP stimulates vagal afferent nerve terminals in the lungs by activating P2X2/3R. This action could lead to bronchoconstriction, cough and the local release of pro-inflammatory neuropeptides. In addition, ATP markedly enhances the IgE-dependent histamine release from human lung mast cells. Thus, we have proposed for the first time that extracellular ATP plays a mechanistic role in pulmonary pathophysiology in general and chronic obstructive pulmonary disease (COPD), and acute bronchoconstriction in asthma in particular. The present review examines whether ATP could also play a role in bradycardia and syncope in a subset of patients with pulmonary embolism.
Topics: Adenosine Triphosphate; Animals; Bradycardia; Humans; Platelet Activation; Pulmonary Embolism; Syncope
PubMed: 30055609
DOI: 10.1186/s12931-018-0848-2 -
Cleveland Clinic Journal of Medicine Dec 2014
Topics: Humans; Syncope; Tilt-Table Test
PubMed: 25452355
DOI: 10.3949/ccjm.81pe.12001 -
Cardiology Journal 2018The aim of this study was to evaluate implantable loop recorders (ILRs) in an unselected cohort in order to determine diagnostic yield, time to pacemaker/implantable...
BACKGROUND
The aim of this study was to evaluate implantable loop recorders (ILRs) in an unselected cohort in order to determine diagnostic yield, time to pacemaker/implantable cardioverter-defibrillator (ICD) implantation, predictors thereof, safety issues, and syncope management including usage of preceding diagnostic tools.
METHODS
Patients who underwent ILR evaluation in any of three centers in Region Gävleborg, Swe-den, between April 2007 and April 2013 were included and their medical records retrieved. Logistic regression was used to evaluate predictors of pacemaker/ICD outcome expressed as odds ratios (ORs) and Kaplan-Meier estimates for time-dependent analysis.
RESULTS
A total of 173 patients (52.6% females) with a mean age of 56.2 years received an ILR dur-ing a mean follow-up of 605 days. In the 146 patients evaluated for syncope/presyncope, 28.1% received a pacemaker (n = 39) or ICD (n = 2). The cumulative incidence at 6, 12, and 18 months were 8.8%, 21.3%, and 26.7%, respectively. Age > 75 years was the only significant predictor for outcome (p = 0.010) and the following variables showed a tendency toward significance: abnormal elevation of the biomarker B-type natriuretic peptide (OR 2.05, p = 0.100), a history of trauma (OR 1.71, p = 0.179), and patho-logic electrocardiogram (OR 1.68, p = 0.231). A computerized tomography of the skull was performed in 52.1% of the syncope cases.
CONCLUSIONS
In syncope evaluation in an unselected cohort, 28.1% were diagnosed with an arrhyth-mia necessitating a pacemaker/ICD. The only significant predictor was advanced age. Time to diag-nosis is unpredictable and prolonged ILR monitoring is warranted in addition to optimal use of other diagnostic tools.
Topics: Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Conduction System; Humans; Male; Middle Aged; Pacemaker, Artificial; Retrospective Studies; Syncope; Time Factors; Treatment Outcome
PubMed: 28840588
DOI: 10.5603/CJ.a2017.0101 -
Medicina (Kaunas, Lithuania) Jun 2021Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope... (Review)
Review
Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders' inputs. We then co-designed with patients and frontline teams, and developed and tested specific strategies. A total of 114 clinicians completed surveys and 32 clinicians and stakeholders participated in interviews. Results from the surveys and interviews indicated low awareness of syncope guidelines, communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change as major barriers to CPG implementation. Thirty-one patients and their family caregivers participated in interviews and expressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. Identifying change methods to address the clinician barriers and patients and family caregivers expectations informed development of the multilevel, multicomponent implementation strategy, MISSION, which includes patient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and a corresponding mobile app, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Effective multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.
Topics: Delivery of Health Care; Emergency Service, Hospital; Humans; Mobile Applications; Practice Guidelines as Topic; Surveys and Questionnaires; Syncope
PubMed: 34204986
DOI: 10.3390/medicina57060570 -
The Permanente Journal 2015A cough, then breathlessness; laughter then breathlessness. Is the cause the tubes or the gut?
A cough, then breathlessness; laughter then breathlessness. Is the cause the tubes or the gut?
Topics: Adult; Humans; Laryngismus; Laughter; Male; Syncope
PubMed: 25663214
DOI: 10.7812/TPP/14-128 -
Medicina (Kaunas, Lithuania) May 2021Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12-86% of patients. There is often a low diagnostic yield, with up to... (Review)
Review
Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12-86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.
Topics: Emergency Service, Hospital; Hospitalization; Humans; Patient Discharge; Risk; Syncope
PubMed: 34064050
DOI: 10.3390/medicina57060514 -
Annals of Emergency Medicine May 2023
Topics: Humans; Male; Syncope
PubMed: 37085210
DOI: 10.1016/j.annemergmed.2022.10.031 -
JACC. Cardiovascular Interventions Oct 2022
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Syncope; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 36202567
DOI: 10.1016/j.jcin.2022.07.030 -
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