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International Journal of Environmental... Jun 2022In children, vasovagal syncope and postural tachycardia syndrome constitute the major types of orthostatic intolerance. The clinical characteristics of postural... (Review)
Review
In children, vasovagal syncope and postural tachycardia syndrome constitute the major types of orthostatic intolerance. The clinical characteristics of postural tachycardia syndrome and vasovagal syncope are similar but their treatments differ. Therefore, their differential diagnosis is important to guide the correct treatment. Therapeutic methods vary in patients with the same diagnosis because of different pathomechanisms. Hence, in patients with vasovagal syncope or postural tachycardia syndrome, routine treatments have an unsatisfactory efficacy. However, biomarkers could increase the therapeutic efficacy significantly, allowing for an accurate and detailed assessment of patients and leading to improved therapeutic effects. In the present review, we aimed to summarize the current state of research into biomarkers for distinguishing the diagnosis of pediatric vasovagal syncope from that of postural tachycardia syndrome. We also discuss the biomarkers that predict treatment outcomes during personalized therapy for each subtype.
Topics: Biomarkers; Child; Hemodynamics; Humans; Postural Orthostatic Tachycardia Syndrome; Syncope, Vasovagal; Tilt-Table Test
PubMed: 35742222
DOI: 10.3390/ijerph19126974 -
Cardiology 2009
Topics: Humans; Pacemaker, Artificial; Syncope, Vasovagal; Vasoconstrictor Agents
PubMed: 19365114
DOI: 10.1159/000212078 -
Heart Rhythm May 2020The role of pacing in vasovagal syncope (VVS) is considered from a physiological basis. Most VVS patients lose consciousness due to hypotension before severe... (Review)
Review
The role of pacing in vasovagal syncope (VVS) is considered from a physiological basis. Most VVS patients lose consciousness due to hypotension before severe bradycardia/asystole occurs. Patients who benefit from dual-chamber pacing typically are older with highly symptomatic, late-onset, frequent and severe syncope with short/no prodrome and documented severe cardioinhibition. Tilt testing is of value in patients with recurrent unexplained syncope to identify important hypotensive susceptibility stemming from reduced venous return and stroke volume (SV). A negative tilt test in vasovagal patients with spontaneous asystole documented by an implantable/insertable loop recorder is associated with lower syncope recurrence rates after pacemaker implantation. Pacing may be more effective if triggered by sensor detection of a parameter changing earlier in the reflex than bradycardia when SV may still be relatively preserved. In this regard, detection of right ventricular impedance offers promise. Conservatism is recommended, limiting pacing in VVS to a small subset of symptomatic older patients with clearly documented cardioinhibition and paying particular attention to the timing of loss of consciousness in relation to asystole/bradycardia. Understanding VVS physiology permits application of well-timed, appropriate pacing that yields benefit for highly symptomatic patients.
Topics: Cardiac Pacing, Artificial; Heart Conduction System; Heart Rate; Humans; Recurrence; Syncope, Vasovagal; Tilt-Table Test
PubMed: 32036025
DOI: 10.1016/j.hrthm.2020.01.029 -
The Journal of International Medical... Sep 2022Vasovagal reaction (VVR) is an adverse reaction to blood donation. Applied muscle tension (AMT) has been reported to reduce the probability of VVR during blood donation;... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Vasovagal reaction (VVR) is an adverse reaction to blood donation. Applied muscle tension (AMT) has been reported to reduce the probability of VVR during blood donation; however, the results have been controversial. We therefore conducted a meta-analysis to systematically evaluate the effect of AMT in reducing VVR.
METHODS
We searched six major databases using "applied muscle tension" and "blood donation-related vasovagal response" as keywords. Relevant articles published in English or Chinese between 1 January 2000 and 30 June 2021 were included in the analysis. The quality of the included articles was evaluated and publication bias was assessed by forest and funnel plots and by Egger's test.
RESULTS
Fifty-one articles were identified, of which six were included according to the pre-defined inclusion and exclusion criteria. A fixed-effects model was adopted for effect size combination and revealed a relative risk of 0.52 (95% confidence interval 0.40 to 0.67). The AMT group was superior to the control in terms of VVR prevention. A funnel plot and Egger's test suggested that the findings were accurate and reliable with low publication bias.
CONCLUSION
AMT could effectively reduce VVR during blood donation. Further multicenter studies with large sample sizes are needed to confirm these results.
Topics: Blood Donors; Humans; Muscle Tonus; Publication Bias; Risk; Syncope, Vasovagal
PubMed: 36127814
DOI: 10.1177/03000605221121958 -
Pacing and Clinical Electrophysiology :... Nov 2017Vasovagal syncope (VVS) or neurocardiogenic syncope is defined by transient loss of consciousness with spontaneous and rapid recovery. Recently, a closed loop... (Review)
Review
Vasovagal syncope (VVS) or neurocardiogenic syncope is defined by transient loss of consciousness with spontaneous and rapid recovery. Recently, a closed loop stimulation (CLS) pacing system has emerged as a new strategy which appears superior to conventional pacing for patients with refractory syncope. However, its efficacy remains of considerable debate and large randomized controlled clinical trials are needed. Between 2002 and 2017, 12 total studies evaluated the use of CLS pacing in patients with refractory VVS, and are summarized in this article.
Topics: Cardiac Pacing, Artificial; Humans; Pacemaker, Artificial; Syncope, Vasovagal
PubMed: 28895151
DOI: 10.1111/pace.13194 -
Internal Medicine Journal Aug 2010Vasovagal syncope (VVS) is the commonest cause of recurrent syncope and has a high level of morbidity in both young and elderly patients. Diagnosis and treatment are... (Review)
Review
Vasovagal syncope (VVS) is the commonest cause of recurrent syncope and has a high level of morbidity in both young and elderly patients. Diagnosis and treatment are often unsatisfactory despite the fact that syncope has a lifetime cumulative incidence of 35%. A detailed history can often yield an accurate diagnosis in most young patients. Older patients are more likely to present in an atypical manner and although the yield is low, a more comprehensive diagnostic assessment may be needed. It is important to identify patients with low supine systolic blood pressure who are prone to recurrent VVS. These patients represent a distinct subtype of VVS and may respond to a tailored therapeutic approach. Treatment options for VVS are limited because of a paucity of randomized trials. The backbone of therapy is educating the patient, avoiding precipitating factors, maintaining hydration and the application of physical counter-pressure manoeuvres. Drug therapy is rarely warranted; however, fludrocortisone, alpha-agonists, such as midodrine and dihydroergotamine, and selective serotonin reuptake inhibitors may be helpful in some patients. Permanent cardiac pacing is rarely needed and randomized trials do not support its use.
Topics: Animals; Disease Management; Fludrocortisone; Humans; Patient Education as Topic; Secondary Prevention; Selective Serotonin Reuptake Inhibitors; Syncope, Vasovagal
PubMed: 20718882
DOI: 10.1111/j.1445-5994.2010.02295.x -
Magnetic Resonance Imaging Clinics of... Nov 2017Adverse reactions to iodinated and gadolinium-based contrast agents occur at an incidence of less than 1%. Although the exact pathophysiologic mechanisms are not... (Review)
Review
Adverse reactions to iodinated and gadolinium-based contrast agents occur at an incidence of less than 1%. Although the exact pathophysiologic mechanisms are not completely understood, the treatment regimens are well accepted. Skin testing may be helpful in patients with a history of severe allergiclike reaction to aid in the selection of alternative contrast agents. Premedication should only be used for a history of allergiclike reaction. Imaging team members should be familiar with signs and symptoms of contrast reactions to allow for prompt assessment and treatment. A plan of action should be in place for contrast reactions and rehearsed regularly.
Topics: Adrenal Cortex Hormones; Antihypertensive Agents; Contrast Media; Diuretics; Drug Hypersensitivity; Fluid Therapy; Histamine Antagonists; Humans; Hypertension; Nitroglycerin; Oxygen Inhalation Therapy; Pulmonary Edema; Risk Factors; Syncope, Vasovagal; Vasodilator Agents
PubMed: 28964463
DOI: 10.1016/j.mric.2017.06.008 -
Herzschrittmachertherapie &... Sep 2021This review discusses important aspects of pathophysiology, diagnosis and therapy of reflex syncope. The autonomic nervous system plays a crucial role in the origin of... (Review)
Review
This review discusses important aspects of pathophysiology, diagnosis and therapy of reflex syncope. The autonomic nervous system plays a crucial role in the origin of this frequently observed form of syncope. In most cases, reflex syncopes occur under specific circumstances. Thus, a detailed history is essential. Besides a physical exam und a normal 12-lead ECG, dedicated tests like tilt-table-testing, carotid massage and the implantation of a loop recorder often assist in making the correct diagnosis. The basis of therapy for all patients is reassurance about the benign course of the disease as well as education about adequate measures. Pharmacotherapy is reserved to a minority of patients. In older patients with repeat or severe syncopes and documented asystoles, pacemaker therapy is a valuable option.
Topics: Aged; Autonomic Nervous System; Humans; Pacemaker, Artificial; Reflex; Syncope; Syncope, Vasovagal
PubMed: 34189616
DOI: 10.1007/s00399-021-00775-2 -
Lost in translation: Knowledge, attitudes and practices in donors experiencing a vasovagal reaction.Transfusion and Apheresis Science :... Jun 2016Vasovagal symptoms have implications for donor safety and retention. This study explored knowledge, attitudes and practices in donors experiencing a vasovagal reaction.
BACKGROUND
Vasovagal symptoms have implications for donor safety and retention. This study explored knowledge, attitudes and practices in donors experiencing a vasovagal reaction.
MATERIALS AND METHODS
Semi-structured interviews were conducted with donors (n = 30) who experienced a donation-related vasovagal reaction.
RESULTS
Donors were unaware of applied muscle tension or fluid loading techniques despite availability of information. Some donors engaged in excessive pre-donation hydration. Procedural knowledge was limited for first-time plasma donors.
DISCUSSION
Future interventions should focus on adherence to pre-donation fluid loading and muscle tensing exercises during key donation time-points. Education for new plasma donors also appears important.
Topics: Adolescent; Adult; Attitude to Health; Blood Donors; Female; Humans; Knowledge; Male; Middle Aged; Syncope, Vasovagal
PubMed: 26704301
DOI: 10.1016/j.transci.2015.11.016 -
BMJ (Clinical Research Ed.) Aug 2004
Review
Topics: Cardiac Pacing, Artificial; Cardiovascular Agents; Humans; Syncope, Vasovagal
PubMed: 15297344
DOI: 10.1136/bmj.329.7461.336