-
Europace : European Pacing,... Aug 2023Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have...
Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have been published in the journal. They undoubtedly improved our understanding of syncope. This symptom is now clearly differentiated from other forms of transient loss of consciousness. The critical role of vasodepression and/or cardioinhibition as final mechanisms of reflex syncope is emphasized. Current diagnostic approach sharply separates between cardiac and autonomic pathways. Physiologic insights have been translated, through rigorously designed clinical trials, into non-pharmacological or pharmacological interventions and interventional therapies. The following manuscript is intended to give the reader the current state of the art of knowledge of syncope by highlighting landmark contributions of the Europace journal.
Topics: Humans; Syncope; Syncope, Vasovagal; Heart
PubMed: 37622579
DOI: 10.1093/europace/euad163 -
Journal of Surgical Education 2016Medical students often feel faint (presyncopal) in the operating room (OR). Despite mandatory surgical rotations in clerkship, there is little formal training and...
OBJECTIVE
Medical students often feel faint (presyncopal) in the operating room (OR). Despite mandatory surgical rotations in clerkship, there is little formal training and acclimatization to the operating suite in the first 2 years of medical school. This study aimed to assess presyncope and syncope in the OR in first, second, third, and fourth year medical students at a large Canadian academic center.
DESIGN
Following an extensive literature review, we developed a mixed methods survey de novo to assess medical students' experience in the OR and determine the frequency of presyncopal and syncopal events.
RESULTS
A total of 180 students (106 females, 59%), evenly distributed among all 4 years of medical school, responded to the survey (response rate 40%, n = 180/454). In total, 75 students (42%) had experienced presyncope, and 10 students (6%) had experienced syncope in the OR. Female medical students were more likely to experience both presyncope (p < 0.001) and syncope (p = 0.011) relative to their male colleagues. They were also more likely to report that these experiences had an effect on their attitude toward the OR (p < 0.001) and their career choice (p < 0.001). Half of respondents believed that the undergraduate medical preclerkship curriculum did not provide adequate exposure to the OR. Students consistently expressed the desire for more preclinical OR exposure and formal instruction concerning OR etiquette. Only 28% of students reported receiving information on how to avoid syncope, and their classmates were the number one source (59%) for this advice. The most commonly employed preventative measures were eating before the OR and staying well hydrated. Presyncope had a negative effect on attitudes toward the OR in 28% of students.
CONCLUSION
Although true loss of consciousness (syncope) among medical students in the OR is uncommon, presyncope is a highly prevalent phenomenon. It is most prevalent in female students, and may have a negative effect on overall student well-being. All students may benefit from normalization of this very common experience by staff surgeons or residents. Formal instruction regarding the common symptoms, triggers, and methods for preventing presyncope and syncope is an essential supplement to the current preclinical medical curriculum.
Topics: Academic Medical Centers; Adult; Canada; Cross-Sectional Studies; Education, Medical, Undergraduate; Female; Humans; Incidence; Male; Operating Rooms; Retrospective Studies; Risk Assessment; Specialties, Surgical; Students, Medical; Syncope; Young Adult
PubMed: 27262593
DOI: 10.1016/j.jsurg.2016.05.003 -
Heart (British Cardiac Society) Apr 2019A 67-year-old man presented to the emergency department with sudden onset of severe presyncope. He reported that he had a permanent pacemaker implanted in 2006 following...
A 67-year-old man presented to the emergency department with sudden onset of severe presyncope. He reported that he had a permanent pacemaker implanted in 2006 following atrioventricular node ablation for persistent atrial fibrillation (AF). After suffering increasing shortness of breath, he underwent upgrade to cardiac resynchronisation therapy (CRT) in 2016. He denied any recent falls, interventions or changes in medication. ECG monitoring showed AF with a broad ventricular escape rhythm at around 25 bpm with pauses of up to 3 s. Placement of a magnet over the device resulted in pacing (figure 1A). The implanted device (Medtronic Syncra C2TR01) was interrogated (figure 1B), and a chest radiograph was obtained (figure 2). heartjnl;105/8/657/F1F1F1Figure 1(A) Twelve-lead ECG demonstrating intrinsic rhythm and pacing after application of magnet. (B) Device interrogation with right ventricular threshold test. heartjnl;105/8/657/F2F2F2Figure 2(C) Anteroposterior chest radiograph demonstrating lead position on admission. QUESTION: What was the cause of this presentation?Noise oversensing on the right ventricular (RV) lead due to lead fracture.The RV septal lead has displaced into the right atrial (RA).RA and RV leads were switched in the can during the CRT upgrade.Increase in threshold of RV and left ventricular (LV) leads resulting in loss of capture.
Topics: Aged; Atrial Fibrillation; Atrioventricular Node; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Equipment Failure Analysis; Humans; Male; Prosthesis Failure; Radiography, Thoracic; Syncope
PubMed: 30514728
DOI: 10.1136/heartjnl-2018-314118 -
Revista Espanola de Cardiologia Jul 2004
Topics: Heart Diseases; Humans; Prognosis; Risk Assessment; Syncope
PubMed: 15274845
DOI: No ID Found -
Current Problems in Cardiology Apr 2004Syncope is a syndrome consisting of a relatively short period of temporary and self-limited loss of consciousness caused by transient diminution of blood flow to the... (Review)
Review
Syncope is a syndrome consisting of a relatively short period of temporary and self-limited loss of consciousness caused by transient diminution of blood flow to the brain (most often the result of systemic hypotension). Syncope comprises part of a subset of clinical conditions in which loss of consciousness is transient. Other conditions in this group, which are not syncope and should be clearly distinguished from syncope, include, for example, seizure disorders, posttraumatic loss of consciousness, and cataplexy. Recent surveys indicate that syncope accounts for approximately 1% of emergency department visits in Europe, although older reports from the United States placed this number closer to 3%. The reported prevalence of syncope in the population varies: 15% of children before the age of 18 years; 25% of a military population aged 17 to 26 years; 16% and 19%, respectively, in men and women aged 40 to 59 years; and up to 23% in a nursing home population older than 70 years. The highest frequency of syncope occurs in patients with cardiovascular comorbidity and older patients in institutional care settings. The causes of syncope are numerous and, not infrequently, multiple factors may contribute. The diagnostic evaluation is benefited by availability of a detailed medical history and reports of eyewitnesses. In this context, the physician must consider the classification of the causes of syncope, and address the most likely causes first. The principal groups of causes may be summarized as: (1) neurally mediated reflex syncope (eg, vasovagal faint, carotid sinus syndrome); (2) orthostatic (postural) syncope; (3) cardiac arrhythmias; (4) structural cardiac and pulmonary causes; and (5) cerebrovascular disorders (rare). In addition, conditions that may mimic syncope but are not true syncope (eg, psychogenic pseudosyncope) must be considered. Only after a definitive cause is established can appropriate treatment be initiated. In this regard, the syncope evaluation is facilitated by maintaining an organized diagnostic approach. The practitioner should avoid wasteful use of short-term ambulatory electrocardiographic recordings (eg, Holter monitors) and rarely positive neurologic tests (eg, electroencephelography, head magnetic resonance imaging/computed tomography) in the absence of head trauma or evident neurologic signs. In many medical centers the evaluation of patients with syncope is haphazard, and may be substantially enhanced by establishment of a multidisciplinary syncope evaluation unit or team.
Topics: Diagnosis, Differential; Humans; Syncope
PubMed: 15107784
DOI: 10.1016/j.cpcardiol.2003.12.002 -
The Journal of Invasive Cardiology Oct 2023A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued,...
A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued, forceful pulsations in his abdomen followed by presyncope.
Topics: Male; Humans; Aged; Pacemaker, Artificial; Abdomen; Syncope; Equipment Design
PubMed: 37984332
DOI: 10.25270/jic/23.00210 -
Acta Clinica Belgica Dec 2018Introduction Swallow syncope is a neurally mediated syncope. Multiple causes have been described in literature. A rare cause is arrhythmias. Only a limited amount of...
Introduction Swallow syncope is a neurally mediated syncope. Multiple causes have been described in literature. A rare cause is arrhythmias. Only a limited amount of cases present the association of swallow syncope and third degree AV-block. Case presentation A 39-year-old man presented with episodes of presyncope while eating. Further medical history, physical examination, resting 12-lead ECG, cyclo-ergometry, transthoracic echocardiography and MRI of the heart were normal. 24 h Holter monitoring demonstrated high-grade third-degree atrioventricular (AV) block. The patient was scheduled for pacemaker implantation. Discussion Arrhythmia is a rare cause of swallow syncope. Reported arrhythmic causes are sinus bradycardia, sinoatrial block, atrioventricular block and complete atrial and ventricular asystole. Essential to the diagnosis is that (pre)syncope is preceded by swallowing and documentation of AV block on 24 h Holter monitoring. Treatment is guided by ESC guidelines which state that reflex syncope has a grade IIa recommendation for pacing, while current evidence suggests that asymptomatic vagally mediated AV block should not be treated until symptomatic.
Topics: Adult; Athletes; Atrioventricular Block; Deglutition; Electrocardiography, Ambulatory; Humans; Male; Syncope
PubMed: 29202647
DOI: 10.1080/17843286.2017.1410601 -
International Journal of Environmental... Nov 2021Syncope and presyncope episodes that occur during work could affect one's safety and impair occupational performance. Few data are available regarding the prevalence of...
Syncope and presyncope episodes that occur during work could affect one's safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress, and metabolic disorders in promoting syncope, presyncope, and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47 ± 11 years), employed at different companies, underwent clinical evaluation and blood tests, and completed questionnaires to assess sleep quality, occupational distress, and mental disorders. The occurrence of syncope, presyncope, and unexplained falls during working life was assessed via an ad hoc interview. The prevalence of syncope, presyncope, and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted odds ratio aOR: 1.62, confidence intervals at 95%: 1.05-2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16-2.77), and poor mental health (aOR: 2.43 CI 95%: 1.52-3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25-2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08-4.18), and poor mental health (aOR: 2.61 CI 95%: 1.78-3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors, and increasing worker resilience might reduce syncope and presyncope events in the working population.
Topics: Adult; Humans; Male; Middle Aged; Occupational Health; Odds Ratio; Prevalence; Sleep Quality; Syncope
PubMed: 34886008
DOI: 10.3390/ijerph182312283 -
The Canadian Journal of Cardiology Dec 2017Emergency department (ED) visits for syncope are common. Validation of ED administrative diagnostic coding for syncope is required before these codes can be used for...
Emergency department (ED) visits for syncope are common. Validation of ED administrative diagnostic coding for syncope is required before these codes can be used for health services research. We performed a retrospective multicentre chart review using a regional ED database in British Columbia. We identified adults who visited 1 of 3 high-volume urban EDs between 2010 and 2015. Cohort 1 included 350 ED visits for patients with a presenting complaint (PC) of syncope/presyncope, a discharge diagnosis (DD) of syncope and collapse, or both. Cohort 2 included 100 patients with ED visits with neither a PC of syncope/presyncope nor a DD of syncope and collapse. The reference standard was abstractor conclusion regarding syncope and presyncope ("definite/very likely" vs "possible" vs "unlikely" vs "absent") after structured review of ED medical records. We found that in cohort 1, syncope or presyncope were definite/very likely or possible in 96% of visits with a PC of syncope/presyncope and a DD of syncope and collapse. Syncope alone was definite/very likely in only 56% of visits. In cohort 2, syncope was definitely absent for 94% of patients. The reference standard showed excellent face validity and abstractor inter-rater agreement (Cohen κ > 0.80). Vital signs and orthostatic vital signs were not documented for 8% and 84% of visits, respectively. Our results suggest that a PC of syncope/presyncope combined with a DD of syncope and collapse is highly predictive of syncope or presyncope. These findings will inform design and interpretation of syncope health services research.
Topics: Diagnostic Techniques, Cardiovascular; Emergency Service, Hospital; Female; Hospital Records; Humans; Male; Middle Aged; Patient Discharge; Retrospective Studies; Syncope
PubMed: 29102452
DOI: 10.1016/j.cjca.2017.08.026 -
Revista Espanola de Cardiologia Feb 1999We describe the rare association of angina at effort and presyncope in a young patient with an anomalous origin of left coronary artery and associated coronary spasm in... (Review)
Review
We describe the rare association of angina at effort and presyncope in a young patient with an anomalous origin of left coronary artery and associated coronary spasm in the normal right coronary artery. The patient did well under calcium channel blocker therapy after seven years of follow-up, which is in contrast with the usual recommended management of these patients.
Topics: Adult; Angina Pectoris; Calcium Channel Blockers; Coronary Vasospasm; Coronary Vessel Anomalies; Drug Therapy, Combination; Humans; Male; Nifedipine; Physical Exertion; Prognosis; Sinus of Valsalva; Syncope; Verapamil
PubMed: 10073098
DOI: 10.1016/s0300-8932(99)74883-9