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European Heart Journal Nov 2009
Topics: Age Distribution; Ambulatory Care; Continuity of Patient Care; Cost of Illness; Diagnostic Techniques, Neurological; Exercise Test; Humans; Prevalence; Quality of Life; Recurrence; Referral and Consultation; Risk Assessment; Risk Factors; Syncope; Tilt-Table Test
PubMed: 19713422
DOI: 10.1093/eurheartj/ehp298 -
Pacing and Clinical Electrophysiology :... Oct 2020Recent studies have described several cardiovascular manifestations of COVID-19 including myocardial ischemia, myocarditis, thromboembolism, and malignant arrhythmias....
INTRODUCTION
Recent studies have described several cardiovascular manifestations of COVID-19 including myocardial ischemia, myocarditis, thromboembolism, and malignant arrhythmias. However, to our knowledge, syncope in COVID-19 patients has not been systematically evaluated. We sought to characterize syncope and/or presyncope in COVID-19.
METHODS
This is a retrospective analysis of consecutive patients hospitalized with laboratory-confirmed COVID-19 with either syncope or presyncope. This "study" group (n = 37) was compared with an age and gender-matched cohort of patients without syncope ("control") (n = 40). Syncope was attributed to various categories. We compared telemetry data, treatments received, and clinical outcomes between the two groups.
RESULTS
Among 1000 COVID-19 patients admitted to the Mount Sinai Hospital, the incidence of syncope/presyncope was 3.7%. The median age of the entire cohort was 69 years (range 26-89+ years) and 55% were men. Major comorbidities included hypertension, diabetes, and coronary artery disease. Syncopal episodes were categorized as (a) unspecified in 59.4% patients, (b) neurocardiogenic in 15.6% patients, (c) hypotensive in 12.5% patients, and (d) cardiopulmonary in 3.1% patients with fall versus syncope and seizure versus syncope in 2 of 32 (6.3%) and 1 of 33 (3.1%) patients, respectively. Compared with the "control" group, there were no significant differences in both admission and peak blood levels of d-dimer, troponin-I, and CRP in the "study" group. Additionally, there were no differences in arrhythmias or death between both groups.
CONCLUSIONS
Syncope/presyncope in patients hospitalized with COVID-19 is uncommon and is infrequently associated with a cardiac etiology or associated with adverse outcomes compared to those who do not present with these symptoms.
Topics: Adult; Aged; Aged, 80 and over; Betacoronavirus; COVID-19; Comorbidity; Coronavirus Infections; Female; Hospitalization; Humans; Incidence; Male; Middle Aged; New York City; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Syncope; Telemetry
PubMed: 32840325
DOI: 10.1111/pace.14047 -
Revista Portuguesa de Cardiologia :... Sep 2023
Topics: Humans; Syncope; Reflex; Syncope, Vasovagal
PubMed: 37023980
DOI: 10.1016/j.repc.2023.04.001 -
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 -
Internal Medicine (Tokyo, Japan) Sep 2023Speech-induced atrial tachycardia (AT) with presyncope is extremely rare. A 52-year-old woman employed at a supermarket reported recurrent presyncope while speaking out...
Speech-induced atrial tachycardia (AT) with presyncope is extremely rare. A 52-year-old woman employed at a supermarket reported recurrent presyncope while speaking out loud at her job. Holter electrocardiography revealed AT while swallowing without presyncope. The patient's blood pressure decreased during AT, and she experienced presyncope while saying "IRASSHAIMASE" loudly during a tilt table test. Accordingly, bisoprolol 1.25 mg was prescribed, and the patient did not experience episodes of presyncope with recurrence of AT for 2 years. This case suggests that provocation of arrhythmia in the tilting position may be useful for demonstrating a relationship between arrhythmia and presyncope and/or syncope.
Topics: Female; Humans; Middle Aged; Speech; Syncope; Tachycardia, Supraventricular; Arrhythmias, Cardiac; Tilt-Table Test
PubMed: 36575016
DOI: 10.2169/internalmedicine.1028-22 -
Lakartidningen Feb 2019Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as... (Review)
Review
Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as a short loss of consciousness with loss of awareness and responsiveness, and with subsequent amnesia for the event. Syncope is defined as TLOC due to cerebral hypoperfusion, with rapid onset and spontaneous complete recovery. The main categories of syncope are reflex syncope, orthostatic hypotension, and cardiac syncope. The 2018 guidelines by the European Society of Cardiology emphasizes the process of risk stratification in the initial management of suspected syncope. Risk stratification serves to separate the patients with likely orthostatic and reflex syncope with good prognosis from the patients with likely cardiac syncope and high short-term risk of an adverse outcome. It determines the appropriate next level of care. Further evaluation should be based on clinical suspicion and frequency of symptoms.
Topics: Cardiology; Critical Pathways; Diagnosis, Differential; Disease Management; Europe; Humans; Hypotension, Orthostatic; Practice Guidelines as Topic; Risk Assessment; Societies, Medical; Syncope; Syncope, Vasovagal
PubMed: 31192373
DOI: No ID Found -
Ugeskrift For Laeger Nov 2020Breath-holding spells are involuntary reflexive episodes in infants triggered by a provocation, which can result in seizures and loss of consciousness. The exact... (Review)
Review
Breath-holding spells are involuntary reflexive episodes in infants triggered by a provocation, which can result in seizures and loss of consciousness. The exact pathophysiology is yet unknown, but a dysregulation of the autonomic system seems to play a role. Several studies have examined the influence of iron, personality traits and oxidative stress, and treatment with iron has been shown to be effectful in some cases. Concentration problems and an increased risk of developing syncope later in life have been described. The level of evidence is low, and more future studies are needed, as argued in this review.
Topics: Autonomic Nervous System; Child; Humans; Infant; Iron; Seizures; Syncope
PubMed: 33280646
DOI: No ID Found -
European Journal of Pediatrics Nov 2023This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning... (Review)
Review
This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic-clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities. Conclusions: In adults, the application of the ESC guidelines reduced the number of absent diagnoses and costs; we hope this also holds for children. What is Known: • Syncope and its mimics are very common in childhood, as they are at other ages. • Syncope and its mimics provide considerable diagnostic challenges. What is New: • Application of the hierarchic framework of transient loss of consciousness (TLOC) simplifies diagnosis. • The framework stresses history-taking to diagnose common conditions while keeping an eye on cardiac danger signs.
Topics: Adult; Adolescent; Child; Humans; Hypotension, Orthostatic; Syncope; Syncope, Vasovagal; Unconsciousness; Heart Diseases
PubMed: 37470792
DOI: 10.1007/s00431-023-05114-w -
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 -
Current Cardiology Reviews 2022Syncope is a common clinical presentation defined as a transient loss of consciousness (TLOC) due to cerebral hypoperfusion, characterized by a rapid onset, short... (Review)
Review
Syncope is a common clinical presentation defined as a transient loss of consciousness (TLOC) due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery. Different clinical decision rules (CDRs) and risk stratification scores have been developed to predict short- and long-term risks for adverse outcomes after syncope. The central theme of these prediction systems is consistent with the ESC syncope guidelines. Initial assessment according to the ESC guideline is essential until an optimal and well-validated risk score is available. The focus should be accurate risk stratification to allow prevention of adverse outcomes and optimize the use of limited healthcare resources. In this review article, we summarize and critically appraise the evidence regarding the CDRs for patients presenting with syncope.
Topics: Emergency Service, Hospital; Humans; Risk Factors; Syncope
PubMed: 35319380
DOI: 10.2174/1573403X18666220321104129