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Transfusion Mar 2008
Topics: Adolescent; Blood Donors; Female; Humans; Male; Phlebotomy; Sex Factors; Syncope, Vasovagal; Time Factors
PubMed: 18302666
DOI: 10.1111/j.1537-2995.2007.01638.x -
Therapeutische Umschau. Revue... Mar 1997Vasovagal syncope, also called neurocardiogenic syncope, is common with younger people. It results from an inappropriate, excessive autonomic reflex activity. In the... (Review)
Review
Vasovagal syncope, also called neurocardiogenic syncope, is common with younger people. It results from an inappropriate, excessive autonomic reflex activity. In the elderly patient the syncope may be provoked by massage of the carotid bodies and is then known as carotid sinus syndrome. The pathogenesis of neurocardiogenic syncope is debated. Sudden vasodilation and/or bradycardia have been attributed to the activation of ventricular mechanoreceptors. The use of betablockers is based on this hypothesis. Head-up tilting at 60 degrees is helpful in the evaluation of syncope. In the therapy of recurrent vasovagal syncope, a thorough information of the patient and an adaptation of behaviour are often successful. Some authors have reported goods results with betablockade, etilefrin or mineralocorticoids. The patient with repeated severe syncopal attacks and asystole may benefit from an implantable DDD pacemaker.
Topics: Adolescent; Adult; Aged; Autonomic Nervous System; Bradycardia; Carotid Body; Child; Humans; Middle Aged; Syncope, Vasovagal; Tilt-Table Test
PubMed: 9333976
DOI: No ID Found -
Journal of Cardiovascular Medicine... Feb 2021It is commonly reported that vasovagal syncope (VVS) is more frequent in women. Presently, this issue has never been investigated. The purpose of this review was to... (Review)
Review
It is commonly reported that vasovagal syncope (VVS) is more frequent in women. Presently, this issue has never been investigated. The purpose of this review was to evaluate, through an extensive review of the literature, whether women are really more affected by VVS than men. The gender distribution was investigated in individuals with classical and nonclassical VVS. The database PubMed was searched using the terms 'syncope', 'vasovagal syncope', 'neurally mediated syncope' and 'tilt testing'. Twelve studies dealing with classical and 75 with nonclassical VVS were eligible. In the individuals with classical (N = 1861) and nonclassical VVS (N = 9696), a trend towards a greater percentage of women emerged (P = 0.14 and 0.07, respectively). In the total population with VVS (N = 11 557), the percentage of women was significantly higher than that of men (58 versus 42%, P = 0.03). Most of the individuals were young or middle-aged. In 84% of the studies, the percentage of women was greater than that of men. A separate analysis was carried out in older VVS patients (≥60 years) and only two studies were eligible to be evaluated. Considering that almost all the studies were carried out in the western nations, where the number of men and women is almost superimposable until the age of 65 years and a bias by gender has never been reported in the management of VVS, these data strongly suggest that young and middle-aged women are more affected by VVS than their male counterparts. At present, data are too scant to draw a definitive conclusion in older VVS patients.
Topics: Female; Global Health; Humans; Male; Prevalence; Sex Distribution; Sex Factors; Syncope, Vasovagal; Tilt-Table Test
PubMed: 32925389
DOI: 10.2459/JCM.0000000000001009 -
Clinical Autonomic Research : Official... Aug 2008Major lines of evidence suggest that classical (emotional and orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological... (Review)
Review
Major lines of evidence suggest that classical (emotional and orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological trait. It is, therefore, reasonable to investigate the possible factors that may explain its origin and evolution. We reviewed the data available in the literature on the vasovagal reaction in humans and animals in order to identify possible similarities that might provide insight into the evolution of VVS. We found two processes which appear relevant to the investigation of VVS evolution: fear and threat bradycardia in animals, and the vasovagal reflex during hemorrhagic shock in humans and animals. We suggest that VVS in humans involves physiological mechanisms similar to those found in other vertebrates, and that this may indicate a common evolutionary root. The available data seem to suggest that VVS evolved as an advantageous response to inescapable predators or to stressful and possibly dangerous heart conditions. The inhibition of the sympathetic system, together with activation of the vagal system, characterizes VVS. The consequent slowing of the heart rate induced by VVS may constitute a beneficial break of the cardiac pump, thereby reducing myocardial oxygen consumption. We suggest that classical VVS did not evolve recently in the modern human lineage; rather, it should be regarded as a selected response, which probably evolved in the ancient past as a "defense mechanism" of the organism within some ancestral group(s) of vertebrates.
Topics: Animals; Biological Evolution; Blood Pressure; Bradycardia; Fear; Heart Rate; Humans; Reflex; Shock, Hemorrhagic; Syncope, Vasovagal
PubMed: 18592129
DOI: 10.1007/s10286-008-0479-7 -
Handbook of Clinical Neurology 2014Sudden cardiac death can occur after exposure to extreme stress and sometimes as a complication of acute neurologic disease. Excessive adrenergic stimulation of the... (Review)
Review
Sudden cardiac death can occur after exposure to extreme stress and sometimes as a complication of acute neurologic disease. Excessive adrenergic stimulation of the heart is most likely the responsible mechanism for the majority of cases of sudden cardiac death. The neurocardiogenic injury induced by sympathetic overstimulation can affect the myocardium and the electrical conduction system, leading to heart failure and arrhythmias. The characteristic features of stress cardiomyopathy (also known as takotsubo cardiomyopathy or apical ballooning syndrome) can be diagnosed by echocardiography and cardiovascular magnetic resonance imaging. This chapter reviews the history, definition, pathophysiology, triggers, and clinical manifestations of neurocardiogenic injury. It also discusses specific neurologic conditions associated with sudden death: epilepsy (sudden unexplained death in epilepsy, SUDEP) and stroke.
Topics: Death, Sudden, Cardiac; History, 19th Century; History, 20th Century; Humans; Syncope, Vasovagal
PubMed: 24365285
DOI: 10.1016/B978-0-7020-4086-3.00002-3 -
Orvosi Hetilap Jun 2003The diagnosis of epilepsy is complicated by various conditions that can mimic an epileptic seizure. Many patients with abnormal seizure activity during loss of... (Review)
Review
The diagnosis of epilepsy is complicated by various conditions that can mimic an epileptic seizure. Many patients with abnormal seizure activity during loss of consciousness may have cardiovascular syncope with global cerebral hypoxia (convulsive syncope), which may be difficult to differentiate from epilepsy on clinical grounds. The differentiation is, however, important because they need quite different treatment modalities. In addition, long-term anticonvulsant therapy is expensive and can cause serious morbidity. The authors present a case of a patient thought to have treatment-resistant epilepsy for years with recurrent seizure-attacks, who were subsequently found to have a malignant vasovagal reaction of 24s-asystole as a cause for the so called convulsive syncope. A simple, non-invasive evaluation of circulatory responses to acute orthostasis, the head-up tilt table test, can identify cardiovascular reflex abnormalities in patients with recurrent idiopathic seizure-like episodes. The authors could also reproduce the symptoms of the spontaneous attacks in their patient by this way, to confirm an alternative diagnosis of malignant vasovagal reaction and convulsive syncope in this patient with "refractory epilepsy". This rare cardioinhibition can be safely treated by dual-chamber pacemaker implantation, alleviating for the convulsive attacks, this therapeutic option was advised to this patient as well. Orthostatic stress tests should be considered early in the diagnostic workup of patients with convulsive blackouts. Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy, atypical premonitory symptoms, non-diagnostic electroencephalograms and failure to respond to anticonvulsant therapy.
Topics: Adult; Blood Pressure; Diagnosis, Differential; Epilepsy; Heart Rate; Humans; Male; Pacemaker, Artificial; Syncope, Vasovagal; Tilt-Table Test
PubMed: 12901179
DOI: No ID Found -
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 -
General Dentistry 2008Vasovagal syncope is not an uncommon event in children and adolescents; however, this fact is not widely known among the dental community. Although there is little... (Review)
Review
Vasovagal syncope is not an uncommon event in children and adolescents; however, this fact is not widely known among the dental community. Although there is little information about the incidence of vasovagal syncope occurring among children and adolescents in the dental setting, dentists should always take care to eliminate factors that can predispose a patient to a vasovagal reaction. The dental team should be familiar with the emergency protocols for a vasovagal syncope episode. For this study, the author conducted a MEDLINE search using the key terms "vasovagal syncope", "syncope in children", "syncope treatments", and "syncope and dentistry" to define the pathophysiology, incidence, treatment options, and dental implications of vasovagal syncope. The articles included those published in English and in peer-reviewed journals, in addition to the most recent medical and dental textbooks as they related to syncope.
Topics: Adolescent; Child; Child, Preschool; Dental Anxiety; Dental Care for Children; Humans; Pediatric Dentistry; Syncope, Vasovagal
PubMed: 19284194
DOI: No ID Found -
Clinical Pediatrics Oct 2014
Topics: Child; Electrocardiography; Female; Humans; Recurrence; Syncope, Vasovagal
PubMed: 24951556
DOI: 10.1177/0009922814540044 -
Current Opinion in Cardiology Jan 2002Patients with frequent vasovagal syncope have a poor quality of life and often resist treatment with standard pharmacologic approaches. Although the evidence is weak,... (Review)
Review
Patients with frequent vasovagal syncope have a poor quality of life and often resist treatment with standard pharmacologic approaches. Although the evidence is weak, clinical vasovagal syncope is probably associated with some degree of bradycardia. Studies of temporary pacing during tilt table tests showed that pacing prevented syncope in a little over half of patients who developed a vasovagal response. Six open-label studies of permanent pacing show that permanent pacemaker therapy is associated with substantial improvement over medical therapy. The roles of specific pacemaker modes have not been determined, although there is some evidence that rate-drop responsiveness helps. The second Vasovagal Pacemaker Study will quantify the true benefits of pacing for vasovagal syncope and assess the role of rate-drop response algorithms.
Topics: Bradycardia; Cardiac Pacing, Artificial; Heart Rate; Humans; North America; Patient Selection; Randomized Controlled Trials as Topic; Sensory Thresholds; Syncope, Vasovagal
PubMed: 11790939
DOI: 10.1097/00001573-200201000-00013