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The Lancet. Neurology Aug 2022Orthostatic hypotension is an unusually large decrease in blood pressure on standing that increases the risk of adverse outcomes even when asymptomatic. Improvements in... (Review)
Review
Orthostatic hypotension is an unusually large decrease in blood pressure on standing that increases the risk of adverse outcomes even when asymptomatic. Improvements in haemodynamic profiling with continuous blood pressure measurements have uncovered four major subtypes: initial orthostatic hypotension, delayed blood pressure recovery, classic orthostatic hypotension, and delayed orthostatic hypotension. Clinical presentations are varied and range from cognitive slowing with hypotensive unawareness or unexplained falls to classic presyncope and syncope. Establishing whether symptoms are due to orthostatic hypotension requires careful history taking, a thorough physical examination, and supine and upright blood pressure measurements. Management and prognosis vary according to the underlying cause, with the main distinction being whether orthostatic hypotension is neurogenic or non-neurogenic. Neurogenic orthostatic hypotension might be the earliest clinical manifestation of Parkinson's disease or related synucleinopathies, and often coincides with supine hypertension. The emerging variety of clinical presentations advocates a stepwise, individualised, and primarily non-pharmacological approach to the management of orthostatic hypotension. Such an approach could include the cessation of blood pressure lowering drugs, adoption of lifestyle measures (eg, counterpressure manoeuvres), and treatment with pharmacological agents in selected cases.
Topics: Antihypertensive Agents; Blood Pressure; Humans; Hypertension; Hypotension, Orthostatic; Syncope
PubMed: 35841911
DOI: 10.1016/S1474-4422(22)00169-7 -
Minerva Medica Apr 2022To date, there are no doubts about the evaluation of patients with syncope, while differential diagnoses between presyncope and nonspecific symptoms, generically...
To date, there are no doubts about the evaluation of patients with syncope, while differential diagnoses between presyncope and nonspecific symptoms, generically referred to as dizziness, are complex and not clearly standardized. This paper aims to highlight the most frequent vestibular diseases, which can mimic a presyncopal episode in adult and older patients. It should be noted that nonspecific symptoms may be caused by multiple conditions, and they can coexist in the same person, making diagnosis even more difficult. Due to nonspecific symptoms and diagnostic complexity, evaluation of patients with presyncope or dizziness should be multidisciplinary, involving the syncope expert and the audiologist, since the first evaluation of the patient in the Emergency Department.
Topics: Adult; Diagnosis, Differential; Dizziness; Emergency Service, Hospital; Humans; Syncope; Vertigo
PubMed: 34542954
DOI: 10.23736/S0026-4806.21.07808-3 -
Internal Medicine (Tokyo, Japan) Sep 2023Speech-induced atrial tachycardia (AT) with presyncope is extremely rare. A 52-year-old woman employed at a supermarket reported recurrent presyncope while speaking out...
Speech-induced atrial tachycardia (AT) with presyncope is extremely rare. A 52-year-old woman employed at a supermarket reported recurrent presyncope while speaking out loud at her job. Holter electrocardiography revealed AT while swallowing without presyncope. The patient's blood pressure decreased during AT, and she experienced presyncope while saying "IRASSHAIMASE" loudly during a tilt table test. Accordingly, bisoprolol 1.25 mg was prescribed, and the patient did not experience episodes of presyncope with recurrence of AT for 2 years. This case suggests that provocation of arrhythmia in the tilting position may be useful for demonstrating a relationship between arrhythmia and presyncope and/or syncope.
Topics: Female; Humans; Middle Aged; Speech; Syncope; Tachycardia, Supraventricular; Arrhythmias, Cardiac; Tilt-Table Test
PubMed: 36575016
DOI: 10.2169/internalmedicine.1028-22 -
Heart (British Cardiac Society) Dec 2023
Topics: Humans; Diastole; Echocardiography, Doppler; Mitral Valve Insufficiency; Syncope
PubMed: 38101926
DOI: 10.1136/heartjnl-2023-323447 -
Pacing and Clinical Electrophysiology :... Oct 2020Recent studies have described several cardiovascular manifestations of COVID-19 including myocardial ischemia, myocarditis, thromboembolism, and malignant arrhythmias....
INTRODUCTION
Recent studies have described several cardiovascular manifestations of COVID-19 including myocardial ischemia, myocarditis, thromboembolism, and malignant arrhythmias. However, to our knowledge, syncope in COVID-19 patients has not been systematically evaluated. We sought to characterize syncope and/or presyncope in COVID-19.
METHODS
This is a retrospective analysis of consecutive patients hospitalized with laboratory-confirmed COVID-19 with either syncope or presyncope. This "study" group (n = 37) was compared with an age and gender-matched cohort of patients without syncope ("control") (n = 40). Syncope was attributed to various categories. We compared telemetry data, treatments received, and clinical outcomes between the two groups.
RESULTS
Among 1000 COVID-19 patients admitted to the Mount Sinai Hospital, the incidence of syncope/presyncope was 3.7%. The median age of the entire cohort was 69 years (range 26-89+ years) and 55% were men. Major comorbidities included hypertension, diabetes, and coronary artery disease. Syncopal episodes were categorized as (a) unspecified in 59.4% patients, (b) neurocardiogenic in 15.6% patients, (c) hypotensive in 12.5% patients, and (d) cardiopulmonary in 3.1% patients with fall versus syncope and seizure versus syncope in 2 of 32 (6.3%) and 1 of 33 (3.1%) patients, respectively. Compared with the "control" group, there were no significant differences in both admission and peak blood levels of d-dimer, troponin-I, and CRP in the "study" group. Additionally, there were no differences in arrhythmias or death between both groups.
CONCLUSIONS
Syncope/presyncope in patients hospitalized with COVID-19 is uncommon and is infrequently associated with a cardiac etiology or associated with adverse outcomes compared to those who do not present with these symptoms.
Topics: Adult; Aged; Aged, 80 and over; Betacoronavirus; COVID-19; Comorbidity; Coronavirus Infections; Female; Hospitalization; Humans; Incidence; Male; Middle Aged; New York City; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Syncope; Telemetry
PubMed: 32840325
DOI: 10.1111/pace.14047 -
Mayo Clinic Proceedings Oct 2022
Topics: Exanthema; Humans; Male; Syncope
PubMed: 36202500
DOI: 10.1016/j.mayocp.2022.03.028 -
Postgraduate Medicine Aug 1989Presyncope and syncope are relatively common in the primary care population, but episodes may signal serious metabolic, neurologic, or cardiovascular disease. Accurate... (Review)
Review
Presyncope and syncope are relatively common in the primary care population, but episodes may signal serious metabolic, neurologic, or cardiovascular disease. Accurate diagnosis is important, because treatment must be directed to the underlying cause. The cost of a full evaluation can be staggering; therefore, a goal-oriented approach to diagnosis is most productive and cost-effective.
Topics: Age Factors; Arrhythmias, Cardiac; Coronary Disease; Electrocardiography; Epilepsy; Heart; Hemodynamics; Humans; Monitoring, Physiologic; Syncope
PubMed: 2666973
DOI: No ID Found -
American Family Physician Mar 2017Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high...
Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and orthostatic hypotension. Neurally mediated syncope is the most common type and has a benign course, whereas cardiac syncope is associated with increased morbidity and mortality. Patients with presyncope have similar prognoses to those with syncope and should undergo a similar evaluation. A standardized approach to syncope evaluation reduces hospital admissions and medical costs, and increases diagnostic accuracy. The initial assessment for all patients presenting with syncope includes a detailed history, physical examination, and electrocardiography. The initial evaluation may diagnose up to 50% of patients and allows immediate short-term risk stratification. Laboratory testing and neuroimaging have a low diagnostic yield and should be ordered only if clinically indicated. Several comparable clinical decision rules can be used to assess the short-term risk of death and the need for hospital admission. Low-risk patients with a single episode of syncope can often be reassured with no further investigation. High-risk patients with cardiovascular or structural heart disease, history concerning for arrhythmia, abnormal electrocardiographic findings, or severe comorbidities should be admitted to the hospital for further evaluation. In cases of unexplained syncope, provocative testing and prolonged electrocardiographic monitoring strategies can be diagnostic. The treatment of neurally mediated and orthostatic hypotension syncope is largely supportive, although severe cases may require pharmacotherapy. Cardiac syncope may require cardiac device placement or ablation.
Topics: Diagnosis, Differential; Education, Medical, Continuing; Electrocardiography; Humans; Syncope
PubMed: 28290647
DOI: No ID Found -
The Western Journal of Emergency... Apr 2020Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without...
INTRODUCTION
Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.
METHODS
This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013-April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).
RESULTS
Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.
CONCLUSION
Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making.
Topics: Emergency Service, Hospital; Female; Hospitalization; Humans; Intensive Care Units; Male; Middle Aged; Patient Selection; Prognosis; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Syncope
PubMed: 32421523
DOI: 10.5811/westjem.2020.2.45028 -
Dysphagia Dec 2018There have been over 80 documented cases of swallow syncope-a rare form of reflex or neurally mediated syncope-with most cases associated with an underlying esophageal...
There have been over 80 documented cases of swallow syncope-a rare form of reflex or neurally mediated syncope-with most cases associated with an underlying esophageal disorder. Here, we describe the first reported case of swallow syncope or presyncope caused by an infectious esophagitis. Our 65-year-old patient initially developed dysphagia, odynophagia, and presyncope with swallowing. This lead to nutrition and medication avoidance behavior, which was followed by the development of diabetic ketoacidosis. The diagnosis of swallow presyncope was confirmed with a provocative swallow study demonstrating 8 s sinus arrest, and an underlying cause of Candida esophagitis was found by upper endoscopy. Symptoms completely resolved after treatment with micafungin.
Topics: Aged; Antifungal Agents; Candida; Candidiasis; Deglutition Disorders; Diabetic Ketoacidosis; Esophagitis; Female; Humans; Micafungin; Syncope
PubMed: 30062546
DOI: 10.1007/s00455-018-9932-5