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Journal of the American Heart... Aug 2022Background We assessed the reliability and feasibility of blood pressure (BP) measurements by means of a new wearable watch-type BP monitor (HeartGuide) in detecting...
Background We assessed the reliability and feasibility of blood pressure (BP) measurements by means of a new wearable watch-type BP monitor (HeartGuide) in detecting episodes of hypotensive (pre)syncope induced by tilt table test. Methods and Results An intrapatient comparison between systolic BP (SBP) measured by means of the HeartGuide device and noninvasive finger beat-to-beat BP monitoring was undertaken both at baseline in supine position and repeatedly during tilt table test in patients evaluated for reflex syncope. Intrapatient fall of systolic BP from baseline was measured. Eighty-one patients (mean age, 61±19 years; 46 women) were included. Overall, HeartGuide was able to yield BP values at the time of BP nadir in 58 (72%) patients (average HeartGuide SBP 102±18 mm Hg, versus finger SBP 101±19 mm Hg). Compared with baseline, the maximum SBP decrease was on average -28.5±27.8 and -30.3±33.9 mm Hg respectively (Lin's concordance correlation coefficient=0.78, =0.79, =0.001). In the subgroup of 38 patients with tilt table test induced (pre)syncope, the average HeartGuide SBP during symptoms was 97±16 mm Hg, and the finger SBP was 94±18 mm Hg. Compared with baseline, the maximum SBP decrease was on average -35.2±29.3 and -43.3±31.8 mm Hg, respectively (Lin's concordance correlation coefficient=0.83, =0.87, =0.001). Conclusions Our data indicate that the HeartGuide BP monitor can detect low BP during presyncope and that its measure of SBP change is consistent with that simultaneously obtained through continuous BP monitoring, despite some intrapatient variability. Thus, this device might be useful in determining the hypotensive nature of spontaneous (pre)syncopal symptoms, a possibility that should be verified by field studies.
Topics: Adult; Aged; Aged, 80 and over; Blood Pressure; Feasibility Studies; Female; Humans; Hypotension; Middle Aged; Reproducibility of Results; Syncope, Vasovagal; Wearable Electronic Devices
PubMed: 35929469
DOI: 10.1161/JAHA.122.026420 -
Archives of Disease in Childhood Apr 2003Syncope in childhood is very common. The vast majority of episodes are benign, and are due to neurocardiogenic syncope. Only a minority are due to something potentially... (Review)
Review
Syncope in childhood is very common. The vast majority of episodes are benign, and are due to neurocardiogenic syncope. Only a minority are due to something potentially more serious or life threatening. The diagnosis and differentiation of benign from more serious causes of syncope is made primarily by the history. Investigations are often unfruitful. The mainstay of management in neurocardiogenic syncope is reassurance. An increase in dietary fluid and salt can be helpful. Drug treatment is reserved for those with more frequent and severe attacks. Cardiac pacemakers should be reserved for those with very severe symptoms who are refractory to drug therapy.
Topics: Autonomic Nervous System Diseases; Cardiac Pacing, Artificial; Child; Electrocardiography; Electroencephalography; Humans; Recurrence; Syncope; Tilt-Table Test
PubMed: 12651770
DOI: 10.1136/adc.88.4.350 -
CMAJ : Canadian Medical Association... Oct 2011The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been validated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes.
METHODS
We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics.
RESULTS
We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79-0.93), and the pooled estimate of specificity was 0.52 (95% CI 0.43-0.62). There was substantial between-study heterogeneity (resulting in a 95% prediction interval for sensitivity of 0.55-0.98). The probability of a serious outcome given a negative score with the San Francisco Syncope Rule was 5% or lower, and the probability was 2% or lower when the rule was applied only to patients for whom no cause of syncope was identified after initial evaluation in the emergency department. The most common cause of false-negative classification for a serious outcome was cardiac arrhythmia.
INTERPRETATION
The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department. Consideration of all available electrocardiograms, as well as arrhythmia monitoring, should be included in application of the San Francisco Syncope Rule. Between-study heterogeneity was likely due to inconsistent classification of arrhythmia.
Topics: Arrhythmias, Cardiac; Decision Support Techniques; Emergency Service, Hospital; False Negative Reactions; Humans; Prognosis; Risk Assessment; Sensitivity and Specificity; Syncope
PubMed: 21948723
DOI: 10.1503/cmaj.101326 -
Medicina (Kaunas, Lithuania) Jun 2021: Falls represent a major cause of morbidity, hospitalizations, and mortality in older persons. The identification of risk conditions for falling is crucial. This study...
: Falls represent a major cause of morbidity, hospitalizations, and mortality in older persons. The identification of risk conditions for falling is crucial. This study investigated the presence of syncope as a possible cause of falls in older persons admitted to a Sub-Acute Care Unit (SACU) with a diagnosis of accidental fall after initial management in an emergency department and acute hospitalization. : A retrospective monocentric study of patients aged ≥65 years, consecutively admitted to a SACU with a diagnosis of fall-related trauma. All patients underwent a complete assessment of the index event and clinical status. Patients were categorized into three groups according to the identified cause of falls: (1) transient loss of consciousness (T-LOC), (2) unexplained fall (UF), and (3) definite accidental fall (AF). : A total of 100 patients were evaluated. T-LOC was present in 36 patients, UF in 37, and AF in 27. Of the 36 patients with T-LOC, a probable origin was identified in most cases ( = 33, 91%), 19 subjects (53%) had orthostatic hypotension, 9 (25%) a cardiac relevant disturbance, 2 (6%) a reproduced vaso-vagal syncope, 2 (6%) severe anemia, and 1 (3%) severe hypothyroidism. The T-LOC group was older and more clinically complex than the other groups. : In older patients who recently experienced a fall event, the prevalence of syncope is relevant. In frail and clinically complex patients with falls, the identification of the underlying cause is pivotal and can be achieved through prolonged monitoring and a comprehensive assessment of the person.
Topics: Aged; Aged, 80 and over; Humans; Hypotension, Orthostatic; Retrospective Studies; Syncope; Syncope, Vasovagal
PubMed: 34203693
DOI: 10.3390/medicina57060623 -
Circulation Journal : Official Journal... 2015Syncope is a common occurrence. The presence of J-wave, also known as early repolarization, on electrocardiogram is often seen in the general population, but the... (Clinical Trial)
Clinical Trial
BACKGROUND
Syncope is a common occurrence. The presence of J-wave, also known as early repolarization, on electrocardiogram is often seen in the general population, but the relationship between syncope and J-wave is unclear.
METHODS AND RESULTS
After excluding 67 patients with structural heart disease from 326 with syncope, we classified 259 patients according to the presence or absence of J-wave (≥1 mm) in at least 2 inferior or lateral leads. Head-up tilt test (HUT) was performed for 30 min. If no syncope or presyncope occurred, HUT was repeated after drug loading. Before tilt, 97/259 (37%) had J-wave (57 male, 47.6±22.5 years) and 162 patients had no remarkable change (89 male, 51.1±21.2 years). HUT-positive rate was higher in patients with J-wave, compared with patients without (P<0.0001). The combination of J-wave and descending/horizontal ST segment in the inferior leads was more strongly associated with positive HUT than J-wave with ascending ST segment (odds ratio, 3.23).
CONCLUSIONS
Prevalence of J-wave in the inferior or lateral leads was high in patients with syncope and was associated with HUT-induced neurally mediated reflex syncope (NMRS). Furthermore, the combination of J-wave and descending/horizontal ST segment in the inferior leads could be associated with a much higher risk of NMRS.
Topics: Adult; Aged; Electrocardiography; Female; Humans; Male; Middle Aged; Syncope
PubMed: 26255611
DOI: 10.1253/circj.CJ-15-0340 -
Journal of the American College of... Jul 2011
Topics: Adenosine; Adolescent; Adult; Aged; Aged, 80 and over; Cardiology; Electrocardiography; Humans; Middle Aged; Prognosis; Syncope
PubMed: 21570227
DOI: 10.1016/j.jacc.2011.01.039 -
Canadian Medical Association Journal Jun 1985Swallowing is considered a rare cause of syncope. The five patients described in this report had a spectrum of gastrointestinal tract or cardiovascular disease. For each...
Swallowing is considered a rare cause of syncope. The five patients described in this report had a spectrum of gastrointestinal tract or cardiovascular disease. For each patient there was a clear association between swallowing and the onset of syncope. Prompt diagnosis of this potentially lethal condition is essential, and electrocardiographic monitoring during swallowing is advisable in all cases in which syncope is suspected.
Topics: Aged; Bradycardia; Deglutition; Electrocardiography; Female; Heart Block; Humans; Male; Middle Aged; Pacemaker, Artificial; Syncope
PubMed: 3995448
DOI: No ID Found -
Indian Pediatrics Feb 2021To describe the clinical profile of children with syncope.
OBJECTIVE
To describe the clinical profile of children with syncope.
METHODS
Hospital records were reviewed for clinical and laboratory details of children presenting with real or apparent syncope. Five diagnostic categories were identified: neurocardiogenic syncope (NCS), psychogenic pseudosyncope (PPS), cardiac, neurological and indeterminate.
RESULTS
30 children (aged 4 to 17 years)were included. The commonest cause of syncope was NCS (63.3%), followed by PPS (13.3%), cardiac (10%), neurological (10%) and indeterminate (3.3%). Exercise, loud noise or emotional triggers and family history were associated with cardiac etiology, and electrocardiogram (ECG) was diagnostic in the majority. Children with PPS and cardiacsyncope had frequent episodes when compared with other groups. Indiscriminate antiepileptic use was found in 5 children, including two cardiac cases.
CONCLUSIONS
Frequent recurrences of syncope may suggest PPS or cardiac cause. Cardiac etiology may be readily identified on history and ECG alone.
Topics: Child; Electrocardiography; Humans; Recurrence; Syncope
PubMed: 33632942
DOI: No ID Found -
Revue Medicale de Liege May 2018Syncope is one of the most common reasons of emergency admission and hospitalisation. Management of syncope remains challenging for the medical staff as there are a... (Review)
Review
Syncope is one of the most common reasons of emergency admission and hospitalisation. Management of syncope remains challenging for the medical staff as there are a multitude of possible etiologies ranging from benign to potentially life-threatening causes. Historically, 30-40% of patients presenting for syncope are hospitalized for further exploration, resulting in a significant cost to health care. The purpose of this article is to clarify the etiologies of syncope and to stratify their risk for a better managment.
Topics: Diagnosis, Differential; Emergency Service, Hospital; Humans; Risk; Syncope; Triage
PubMed: 29926561
DOI: No ID Found -
Australian Family Physician May 2014Dizziness is a common presentation in general practice. However, the symptom of dizziness represents a spectrum of pathology from benign to serious. (Review)
Review
BACKGROUND
Dizziness is a common presentation in general practice. However, the symptom of dizziness represents a spectrum of pathology from benign to serious.
OBJECTIVE
This review provides an evaluation of a patient presenting with presyncope/syncope.
DISCUSSION
Dizziness can be a symptom of one of four conditions: vertigo, presyncope, disequilibrium or light-headedness. It is often unclear what patients mean by dizziness as they use this term loosely. Hence, clinicians must be vigilant in evaluating patients presenting with dizziness and be mindful of red flags that may indicate serious pathology. This review begins with a case study describing the wide range of causes of dizziness. Careful history taking and physical examination are pivotal in evaluating patients presenting with dizziness.
Topics: Aged; Arrhythmias, Cardiac; Diagnosis, Differential; Dizziness; Female; General Practice; Heart Diseases; Humans; Male; Postural Balance; Sensation Disorders; Syncope; Vertigo
PubMed: 24791765
DOI: No ID Found