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Emergency Medicine Clinics of North... Aug 2016The older adult patient with syncope is one of the most challenging evaluations for the emergency physician. It requires clinical skill, patience, and knowledge of... (Review)
Review
The older adult patient with syncope is one of the most challenging evaluations for the emergency physician. It requires clinical skill, patience, and knowledge of specific older adult issues. It demands care in the identification of necessary resources, such as medication review, and potential linkage with several multidisciplinary follow-up services. Excellent syncope care likely requires reaching out to ensure institutional resources are aligned with emergency department patient needs, thus asking emergency physicians to stretch their administrative talents. This is likely best done as preset protocols prior to individual patient encounters. Emergency physicians evaluate elders with syncope every day and should rise to the challenge to do it well.
Topics: Age Factors; Aged; Emergency Service, Hospital; Humans; Medical History Taking; Risk Assessment; Syncope
PubMed: 27475017
DOI: 10.1016/j.emc.2016.04.010 -
American Journal of Therapeutics 2016Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion followed by spontaneous recovery. Common causes of syncope include vasovagal... (Review)
Review
Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion followed by spontaneous recovery. Common causes of syncope include vasovagal syncope, situational syncope, orthostatic hypotension, carotid sinus hypersensitivity, left- and right-sided obstructive cardiac lesions, and cardiac arrhythmias. History and physical examination often provide valuable clues about the underlying etiology of syncope. Admission decisions in the emergency department can be guided by various risk prediction scores. Evaluation of a patient with syncope involves a large battery of diagnostic tests that include a 12-lead electrocardiogram, Holter monitoring, echocardiogram, tilt table testing, ischemia evaluation, electrophysiologic studies, and other imaging tests. Despite the availability of these advanced diagnostic tests, a significant proportion of patients with syncope remain undiagnosed. Therapy should be tailored based on the underlying etiology of syncope.
Topics: Algorithms; Electrocardiography; Humans; Risk Reduction Behavior; Syncope; Tilt-Table Test
PubMed: 22960849
DOI: 10.1097/MJT.0b013e318256ed0f -
The Annals of Pharmacotherapy Dec 2001To report a case of symptomatic bradycardia and hypotension that resulted from the therapeutic use of citalopram and to review any previous reports in the literature,...
OBJECTIVE
To report a case of symptomatic bradycardia and hypotension that resulted from the therapeutic use of citalopram and to review any previous reports in the literature, from the manufacturer, and the Australian Drug Reaction Advisory Committee (ADRAC).
CASE SUMMARY
A 60-year-old white woman who had been taking citalopram 20 mg/d for two weeks presented to the hospital with a heart rate of 39 beats/min, mild hypotension (systolic BP 105 mm Hg), and a normal electrocardiogram (QTc < 440 msec), following a presyncopal episode. The patient was admitted for cardiac monitoring, and citalopram was discontinued. The bradycardia and hypotension resolved in the 48-hour period following cessation of citalopram. No other medical or pharmacologic cause was found for the adverse drug reaction.
DISCUSSION
Bradycardia has been reported rarely with citalopram in therapeutic doses, but this is the first detailed case with a dose of only 20 mg. The manufacturer reports bradycardia as an infrequent adverse effect (0.1-1%) of citalopram. There have been no reports to ADRAC or to the manufacturer in postmarketing surveillance. There is a case report of asymptomatic bradycardia in a patient whose dose was increased to 40 mg. In the case reported here, there was no QTc prolongation consistent with previous reports. The sinus bradycardia reported more often with therapeutic doses would appear to be distinct to QT abnormalities seen with citalopram overdose.
CONCLUSIONS
Citalopram should be used with care in the elderly and in persons with a history of heart disease. Heart rate and blood pressure should be monitored in the first week of therapy and when doses are modified.
Topics: Blood Pressure; Bradycardia; Citalopram; Female; Heart Rate; Humans; Middle Aged; Selective Serotonin Reuptake Inhibitors; Syncope
PubMed: 11793617
DOI: 10.1345/aph.1A136 -
Journal of the American College of... May 2021Syncope and presyncope lead to well over one million emergency room visits in the United States each year. Elucidating the cause of syncope or presyncope, which are...
Syncope and presyncope lead to well over one million emergency room visits in the United States each year. Elucidating the cause of syncope or presyncope, which are grouped together given similar etiologies and outcomes, can be exceedingly difficult given the diverse etiologies. This becomes more challenging as some causes, such as vasovagal syncope, are relatively innocuous while others, such as cardiac-related syncope, carry a significant increased risk of death. While the mainstay of syncope and presyncope assessment is a detailed history and physical examination, imaging can play a role in certain situations. In patients where a cardiovascular etiology is suspected based on the appropriate history, physical examination, and ECG findings, resting transthoracic echocardiography is usually considered appropriate for the initial imaging. While no imaging studies are considered usually appropriate when there is a low probability of cardiac or neurologic pathology, chest radiography may be appropriate in certain clinical situations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Topics: Echocardiography; Evidence-Based Medicine; Humans; Societies, Medical; Syncope; United States
PubMed: 33958116
DOI: 10.1016/j.jacr.2021.02.021 -
Autonomic Neuroscience : Basic &... Sep 2014An unambiguous definition of syncope is important for care, research and teaching purposes. Unfortunately, many published definitions described 'syncope' as a broad...
An unambiguous definition of syncope is important for care, research and teaching purposes. Unfortunately, many published definitions described 'syncope' as a broad category of transient loss of consciousness (TLOC) but still appeared to use a much narrower concept, creating confusion. The ESC-classification from 2001 and subsequently distinguished between 'transient loss of consciousness', i.e. disorders sharing unconsciousness of short duration with a rapid and spontaneous recovery and syncope, the form of TLOC that is due to cerebral hypoperfusion. Adding the cerebral hypoperfusion element sets syncope apart from other forms of TLOC, mostly epileptic seizures and psychogenic attacks. We provide short descriptions of different forms of syncope and other forms of TLOC.
Topics: Diagnosis, Differential; Humans; Syncope
PubMed: 24881012
DOI: 10.1016/j.autneu.2014.05.007 -
Bailliere's Clinical Neurology Jul 1997Neurogenic syncope is one of the most frequent causes of recurrent syncope in patients with structurally normal heart. The mechanisms leading to neurogenic syncope... (Review)
Review
Neurogenic syncope is one of the most frequent causes of recurrent syncope in patients with structurally normal heart. The mechanisms leading to neurogenic syncope remain poorly understood. Evidence recently obtained from several laboratories suggests that impaired arterial baroreflex adaptation to orthostatic stress, in addition to cessation of vasoconstrictive sympathetic traffic, contributes to the development of hypotension and bradycardia that determine the vasovagal response. Neurogenic syncope encompasses a wide range of reflexogenic syncope that includes the vasovagal type, micturition syncope, carotid sinus hypersensitivity and post-prandial syncope. Head-up tilt testing has become the diagnostic tool of choice for the evaluation of patients with recurrent neurogenic syncope, providing an acceptable sensitivity and high specificity that is largely dependent on the type of tilt protocol used to induce neurogenic syncope. This chapter will review the pathophysiology, diagnosis and therapeutic approach to the patient with neurogenic syncope.
Topics: Animals; Cardiac Pacing, Artificial; Humans; Nervous System Diseases; Syncope; Syncope, Vasovagal
PubMed: 9483298
DOI: No ID Found -
Annals of Emergency Medicine Dec 2014There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in...
STUDY OBJECTIVES
There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of ED-based syncope research.
METHODS
We recruited a multinational panel of syncope experts. A preconference survey identified research priorities, which were refined during and after the conference through an iterative review process.
RESULTS
There were 31 participants from 7 countries who represented 10 clinical and methodological specialties. High-priority research recommendations were organized around a conceptual model of ED decisionmaking for syncope, and they address definition, cohort selection, risk stratification, and management.
CONCLUSION
We convened a multispecialty group of syncope experts to identify the most pressing knowledge gaps and defined a high-priority research agenda to improve the care of patients with syncope in the ED.
Topics: Biomedical Research; Emergency Medical Services; Humans; Syncope
PubMed: 24882667
DOI: 10.1016/j.annemergmed.2014.04.014 -
Heart (British Cardiac Society) Nov 2023
Topics: Humans; Syncope; Electrocardiography; Reflex
PubMed: 37137676
DOI: 10.1136/heartjnl-2022-322031 -
The Canadian Journal of Cardiology Jun 1998To determine electroencephalographic (EEG) changes occurring during syncope induced by headup tilt table testing.
OBJECTIVE
To determine electroencephalographic (EEG) changes occurring during syncope induced by headup tilt table testing.
DESIGN
Prospective observational study.
SETTING
Calgary General Hospital Syncope Clinic, Calgary, Alberta.
PATIENTS
Eighteen patients with a history of recurrent syncope who developed syncope while undergoing diagnostic isoproterenol tilt table testing.
INTERVENTIONS
Continuous EEGs were recorded in 18 sequentially consenting patients while they underwent diagnostic headup tilt table testing.
MAIN RESULTS
Patients developed presyncope after 2.6 +/- 2.4 mins and syncope after 3.7 +/- 2.5 minutes. Systolic blood pressure dropped from 117 +/- 17 mmHg to 65 +/- 9 mmHg, and heart rate dropped from 124 +/- 26 beats/min to 65 +/- 27 beats/min. Fourteen patients developed presyncope, while five developed syncope without appreciable presyncope. Abnormal EEGs were recorded in 13 of 14 patients during presyncope and in 18 of 18 patients during syncope. No patients developed EEG abnormalities before the onset of presyncope, and the proportion of patients with EEG abnormalities gradually increased throughout presyncope. During presyncope, theta and delta wave slowing, and background suppression were noted in eight of 14, nine of 14 and one of 14 patients, respectively. During syncope, theta and delta wave slowing, and background suppression were noted in nine of 18, 11 of 18 and six of 18 patients, respectively (not significant versus presyncope). There were strikingly abrupt changes in the EEG rhythm within 15 s of the transition to syncope in 14 of 18 patients. Six patients developed new theta wave slowing, 11 developed new delta wave slowing, and seven developed background suppression. No epileptiform activity was recorded.
CONCLUSIONS
Both presyncope and syncope induced by tilt testing are associated with EEG abnormalities, and no single EEG pattern is pathognomonic of either. The transition from presyncope to syncope is marked by abrupt EEG changes.
Topics: Adult; Electroencephalography; Female; Humans; Male; Middle Aged; Syncope; Tilt-Table Test
PubMed: 9676166
DOI: No ID Found -
Brain and Nerve = Shinkei Kenkyu No... Aug 2022Syncope is defined as the transient loss of consciousness due to cerebral hypoperfusion. Reflex syncope (neurally mediated syncope) is among all syncope, vasovagal...
Syncope is defined as the transient loss of consciousness due to cerebral hypoperfusion. Reflex syncope (neurally mediated syncope) is among all syncope, vasovagal syncope is among reflex syncope in addition. We frequently treated several patients with vasovagal syncope in our clinical situation. We report here the mechanisms and treatments of vasovagal syncope. Although this syncope has a low risk, the diagnosis and the treatments are complicated. Therefore, invasive treatments are necessary in selected patients. This article discusses the management procedures of syncope according to the guidelines and our clinical experience.
Topics: Consciousness; Humans; Syncope; Syncope, Vasovagal
PubMed: 35941792
DOI: 10.11477/mf.1416202162