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Revue Medicale de Liege Jul 2016Syncope accounts for nearly 5 % of the emergency intake causes. Swallow syncope is a rare form of cardio-neurogenic syncope. Less than a hundred cases were reported... (Review)
Review
Syncope accounts for nearly 5 % of the emergency intake causes. Swallow syncope is a rare form of cardio-neurogenic syncope. Less than a hundred cases were reported since its first description in the mid-18th century. We present the case of an 83-year-old patient with recurrent syncope occurring during meals. Telemetry monitoring revealed a severe bradycardia with complete AV block and a pause of 8 seconds. A dual chamber pacemaker was implanted and the syncopal episodes were abolished. We shall briefly review the diagnostic methods, mechanisms, and therapy of swallow syncope.
Topics: Aged, 80 and over; Carotid Stenosis; Deglutition; Deglutition Disorders; Electrocardiography; Humans; Male; Pacemaker, Artificial; Syncope
PubMed: 28383846
DOI: No ID Found -
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 -
The Journal of Evidence-based Dental... Sep 2021This systematic review aimed to give an overview of the current evidence surrounding the aetiology and management in terms of treatment and prevention of syncope in... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review aimed to give an overview of the current evidence surrounding the aetiology and management in terms of treatment and prevention of syncope in dental practices. Alongside the occurrence, the practitioner's competence, and the association between syncope and local anaesthetics were discussed.
METHODS
An electronic search in EMBASE, Web of Science, PubMed, Cochrane databases and a hand search were performed by 2 independent reviewers to identify studies up to November 2019. Eligibility criteria were applied and relevant data was extracted. Inclusion criteria covered all types of dental treatment under local anaesthesia or conscious sedation performed by a wide range of oral health care workers in their practices. Risk of bias of the included studies was assessed using the methodological tools recommend by Zeng et al. No restrictions were made to exclude papers from qualitive analysis based on risk of bias assessment.
RESULTS
The search yielded a total of 18 studies for qualitative analysis. With the exception of one prospective cohort study, all articles were considered having a high risk of bias. Meta-analysis showed that dentists encountered on average 1.2 cases of syncope per year. The male gender (RR = 2.69 [1.03, 7.02]), dental fear (RR = 3.55 [2.22, 5.70]), refusal of local anaesthesia in non-acute situations (OR = 12.9) and the use of premedication (RR = 4.70, [1.30, 16.90]) increased the risk for syncope. Treatment and prevention were underreported as both were solely discussed in one study. The supine recovery position with raised legs and oxygen administration (15l/min) was presented as an effective treatment. The Medical Risk-Related History (MRRH) system was proposed as prevention protocol, yet this protocol was ineffective in reducing incidence rates (p = 0.27). The majority of dentists (79.2%) were able to diagnose syncope, yet most (86%) lacked the skills for appropriate treatment. Only 57,6% of dental practices were equipped with an oxygen cylinder.
CONCLUSIONS
Syncope is the most common emergency in dental practices. Nonetheless, the vast majority of dentists do not seem competent nor prepared to manage this emergency. Psychogenic factors seem to play an important role in provoking syncope. Placing the patient in a supine reclined position with raised legs in combination with the administration of oxygen seems effective for regaining consciousness. Although valuable in many aspects, risk assessment by medical history taking is not proven to result in fewer episodes. The strength of these conclusions is low based on GRADE guidelines..
Topics: Anesthesia, Local; Anesthetics, Local; Conscious Sedation; Humans; Male; Prospective Studies; Syncope
PubMed: 34479666
DOI: 10.1016/j.jebdp.2021.101581 -
Autonomic Neuroscience : Basic &... Mar 2021Transient cardiovascular and cerebrovascular responses within the first minute of active standing provide the means to assess autonomic, cardiovascular and... (Review)
Review
Transient cardiovascular and cerebrovascular responses within the first minute of active standing provide the means to assess autonomic, cardiovascular and cerebrovascular regulation using a real-world everyday stimulus. Traditionally, these responses have been used to detect autonomic dysfunction, and to identify the hemodynamic correlates of patient symptoms and attributable causes of (pre)syncope and falls. This review addresses the physiology of systemic and cerebrovascular adjustment within the first 60 s after active standing. Mechanical factors induced by standing up cause a temporal mismatch between cardiac output and vascular conductance which leads to an initial blood pressure drops with a nadir around 10 s. The arterial baroreflex counteracts these initial blood pressure drops, but needs 2-3 s to be initiated with a maximal effect occurring at 10 s after standing while, in parallel, cerebral autoregulation buffers these changes within 10 s to maintain adequate cerebral perfusion. Interestingly, both the magnitude of the initial drop and these compensatory mechanisms are thought to be quite well-preserved in healthy aging. It is hoped that the present review serves as a reference for future pathophysiological investigations and epidemiological studies. Further experimental research is needed to unravel the causal mechanisms underlying the emergence of symptoms and relationship with aging and adverse outcomes in variants of orthostatic hypotension.
Topics: Baroreflex; Blood Pressure; Cerebrovascular Circulation; Hemodynamics; Humans; Hypotension, Orthostatic; Syncope
PubMed: 33385733
DOI: 10.1016/j.autneu.2020.102756 -
Brazilian Journal of Medical and... Mar 2018We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their...
We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.
Topics: Aged; Brazil; Cardiomyopathies; Cohort Studies; Disease-Free Survival; Emergency Medical Services; Female; Heart Diseases; Humans; Male; Proportional Hazards Models; Risk Factors; Survival Analysis; Syncope
PubMed: 29513795
DOI: 10.1590/1414-431X20176989 -
Internal Medicine (Tokyo, Japan) May 2024A 74-year-old woman presented to our hospital with syncope after a coronavirus disease 2019 (COVID-19) infection. Upon admission, she passed out, and an 8 second sinus...
A 74-year-old woman presented to our hospital with syncope after a coronavirus disease 2019 (COVID-19) infection. Upon admission, she passed out, and an 8 second sinus arrest was detected during telemetry monitoring. During the next syncope episode, telemetry monitoring showed that her heart rate decreased from 80 to 36 bpm, accompanied by a 2.4 second pause. A permanent pacemaker was implanted; however, the patient still experienced syncope. The head-up tilt test revealed a vasodepressor reflex syncope. The need for permanent pacemakers in patients with syncope following COVID-19 therefore remains controversial.
Topics: Humans; COVID-19; Aged; Female; Syncope; Pacemaker, Artificial; SARS-CoV-2; Tilt-Table Test; Telemetry; Syncope, Vasovagal
PubMed: 38432984
DOI: 10.2169/internalmedicine.3324-23 -
PloS One 2023Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice.
BACKGROUND
Physicians are often asked to counsel patients about driving safety after syncope, yet little empirical data guides such advice.
METHODS
We identified a population-based retrospective cohort of 9,507 individuals with a driver license who were discharged from any of six urban emergency departments (EDs) with a diagnosis of 'syncope and collapse'. We examined all police-reported crashes that involved a cohort member as a driver and occurred between 1 January 2010 and 31 December 2016. We categorized crash-involved drivers as 'responsible' or 'non-responsible' for their crash using detailed police-reported crash data and a validated responsibility scoring tool. We then used logistic regression to test the hypothesis that recent syncope was associated with driver responsibility for crash.
RESULTS
Over the 7-year study interval, cohort members were involved in 475 police-reported crashes: 210 drivers were deemed responsible and 133 drivers were deemed non-responsible for their crash; the 132 drivers deemed to have indeterminate responsibility were excluded from further analysis. An ED visit for syncope occurred in the three months leading up to crash in 11 crash-responsible drivers and in 5 crash-non-responsible drivers, suggesting that recent syncope was not associated with driver responsibility for crash (adjusted odds ratio, 1.31; 95%CI, 0.40-4.74; p = 0.67). However, all drivers with cardiac syncope were deemed responsible, precluding calculation of an odds ratio for this important subgroup.
CONCLUSIONS
Recent syncope was not significantly associated with driver responsibility for traffic crash. Clinicians and policymakers should consider these results when making fitness-to-drive recommendations after syncope.
Topics: Humans; Accidents, Traffic; Retrospective Studies; Automobile Driving; Police; Logistic Models; Syncope
PubMed: 36656813
DOI: 10.1371/journal.pone.0279710 -
The Cochrane Database of Systematic... Apr 2016The most recent syncope guideline recommends that implantable loop recorders (ILRs) are implanted in the early phase of evaluation of people with recurrent syncope of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The most recent syncope guideline recommends that implantable loop recorders (ILRs) are implanted in the early phase of evaluation of people with recurrent syncope of uncertain origin in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. Observational and case-control studies have shown that loop recorders lead to earlier diagnosis and reduce the rate of unexplained syncopes, justifying their use in clinical practice. However, only randomised clinical trials with an emphasis on a primary outcome of specific ILR-guided diagnosis and therapy, rather than simply electrocardiogram (ECG) diagnosis, might change clinical practice.
OBJECTIVES
To assess the incidence of mortality, quality of life, adverse events and costs of ILRs versus conventional diagnostic workup in people with unexplained syncope.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2015), MEDLINE, EMBASE, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) Search Portal in April 2015. No language restriction was applied.
SELECTION CRITERIA
We included all randomised controlled trials of adult participants (i.e. ≥ 18 years old) with a diagnosis of unexplained syncope comparing ILR with standard diagnostic workup.
DATA COLLECTION AND ANALYSIS
Two independent review authors screened titles and abstracts of all potential studies we identified as a result of the literature search, extracted study characteristics and outcome data from included studies and assessed risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We contacted authors of trials for missing data. We analysed dichotomous data (all-cause mortality and aetiologic diagnosis) as risk ratios (RR) with 95% confidence intervals (CI). We used the Chi(2) test to assess statistical heterogeneity (with P < 0.1) and the I² statistic to measure heterogeneity among the trials. We created a 'Summary of findings' table using the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness and publication bias) to assess the quality of a body of evidence as it relates to the studies which contribute data to the meta-analyses for the prespecified outcomes.
MAIN RESULTS
We included four trials involving a total of 579 participants. With the limitation that only two studies reported data on mortality and none of them had considered death as a primary endpoint, the meta-analysis showed no evidence of a difference in the risk of long-term mortality between participants who received ILR and those who were managed conventionally at follow-up (RR 0.97, 95% CI 0.41 to 2.30; participants = 255; studies = 2; very low quality evidence) with no evidence of heterogeneity. No data on short term mortality were available. Two studies reported data on adverse events after ILR implant. Due to the lack of data on adverse events in one of the studies' arms, a formal meta-analysis was not performed for this outcome.Data from two trials seemed to show no difference in quality of life, although this finding was not supported by a formal analysis due to the differences in both the scores used and the way the data were reported. Data from two studies seemed to show a trend towards a reduction in syncope relapses after diagnosis in participants implanted with ILR. Cost analyses from two studies showed higher overall mean costs in the ILR group, if the costs incurred by the ILR implant were counted. The mean cost per diagnosis and the mean cost per arrhythmic diagnosis were lower for participants randomised to ILR implant.Participants who underwent ILR implantation experienced higher rates of diagnosis (RR (in favour of ILR) 0.61, 95% CI 0.54 to 0.68; participants = 579; studies = 4; moderate quality evidence), as compared to participants in the standard assessment group, with no evidence of heterogeneity.
AUTHORS' CONCLUSIONS
Our systematic review shows that there is no evidence that an ILR-based diagnostic strategy reduces long-term mortality as compared to a standard diagnostic assessment (very low quality evidence). No data were available for short-term all-cause mortality. Moderate quality evidence shows that an ILR-based diagnostic strategy increases the rate of aetiologic diagnosis as compared to a standard diagnostic pathway. No conclusive data were available on the other end-points analysed.Further trials evaluating the effect of ILRs in the diagnostic strategy of people with recurrent unexplained syncope are warranted. Future research should focus on the assessment of the ability of ILRs to change clinically relevant outcomes, such as quality of life, syncope relapse and costs.
Topics: Adult; Electrocardiography; Electrodes, Implanted; Humans; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Syncope
PubMed: 27092427
DOI: 10.1002/14651858.CD011637.pub2 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jan 2019
Topics: Humans; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 30628895
DOI: 10.5543/tkda.2018.96898 -
International Journal of Environmental... Apr 2023Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work,... (Review)
Review
Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work, especially for high-risk tasks. To date, it is impossible to quantify the exact impact of syncope on work and public safety since it is highly improbable to identify loss of consciousness as the fundamental cause of work or driving-related accidents, especially fatal injuries. Working at high-risk jobs such as public transport operators, in high elevations, or with exposure to moving parts, construction equipment, fireworks, or explosives demand attention and total awareness. Currently, no validated criteria or indicators are available for occupational risk stratification of a patient with reflex syncope to return to work. By drawing inspiration from the updated literature, this narrative review intends to summarise the leading knowledge required regarding the return to work for subjects affected by syncope. According to the available data, the authors highlighted some key findings, summarised in macro-items, such as defined risk stratification for vasovagal accidents, return to work after a critical event, and a focus on pacemaker (PM) implementation. Lastly, the authors proposed a flowchart for occupational physicians to help them manage the cases of workers affected by syncope and exposed to levels of risk that could represent a danger to the workers' health.
Topics: Humans; Syncope, Vasovagal; Syncope; Pacemaker, Artificial; Occupational Health; Transportation
PubMed: 37107742
DOI: 10.3390/ijerph20085460