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Seizure Dec 2004Patients with syncope are usually referred to either neurology or cardiology clinics, yet the facilities for detailed syncope investigation are mostly in cardiac units.... (Review)
Review
Patients with syncope are usually referred to either neurology or cardiology clinics, yet the facilities for detailed syncope investigation are mostly in cardiac units. The diagnosis rests principally upon the history, but investigations may be required to support the clinical diagnosis. Close collaboration between the epilepsy clinician and a cardiologist is essential for effective investigation and safe management of syncope. It is frequently misdiagnosed and often erroneously treated as epilepsy. Furthermore, it is potentially a marker of sudden death when associated with certain cardiac disorders. Here we review the main syncope types and explore diagnostic approaches.
Topics: Brain; Diagnosis, Differential; Diagnostic Errors; Echocardiography; Electrocardiography; Electroencephalography; Epilepsy; Exercise Test; Humans; Hyperventilation; Magnetic Resonance Imaging; Panic Disorder; Physical Examination; Syncope; Tomography, X-Ray Computed
PubMed: 15519913
DOI: 10.1016/j.seizure.2003.12.011 -
Internal Medicine (Tokyo, Japan) Dec 2023
Topics: Humans; Speech; Tachycardia; Syncope; Tilt-Table Test
PubMed: 37062741
DOI: 10.2169/internalmedicine.1737-23 -
Cleveland Clinic Journal of Medicine Dec 2014
Topics: Humans; Syncope; Tilt-Table Test
PubMed: 25452355
DOI: 10.3949/ccjm.81pe.12001 -
Medicina (Kaunas, Lithuania) Jun 2021Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope... (Review)
Review
Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders' inputs. We then co-designed with patients and frontline teams, and developed and tested specific strategies. A total of 114 clinicians completed surveys and 32 clinicians and stakeholders participated in interviews. Results from the surveys and interviews indicated low awareness of syncope guidelines, communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change as major barriers to CPG implementation. Thirty-one patients and their family caregivers participated in interviews and expressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. Identifying change methods to address the clinician barriers and patients and family caregivers expectations informed development of the multilevel, multicomponent implementation strategy, MISSION, which includes patient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and a corresponding mobile app, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Effective multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.
Topics: Delivery of Health Care; Emergency Service, Hospital; Humans; Mobile Applications; Practice Guidelines as Topic; Surveys and Questionnaires; Syncope
PubMed: 34204986
DOI: 10.3390/medicina57060570 -
The Journal of Invasive Cardiology Oct 2023A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued,...
A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued, forceful pulsations in his abdomen followed by presyncope.
Topics: Male; Humans; Aged; Pacemaker, Artificial; Abdomen; Syncope; Equipment Design
PubMed: 37984332
DOI: 10.25270/jic/23.00210 -
Annals of Emergency Medicine May 2023
Topics: Humans; Male; Syncope
PubMed: 37085210
DOI: 10.1016/j.annemergmed.2022.10.031 -
Journal of the American College of... May 2012Significant progress has been made in the past 3 decades in our understanding of the various causes of loss of consciousness thanks to the publication of several... (Review)
Review
Significant progress has been made in the past 3 decades in our understanding of the various causes of loss of consciousness thanks to the publication of several important studies and guidelines. In particular, the recent European Society of Cardiology guidelines provide a reference standard for optimal quality service delivery. This paper gives the reader brief guidance on how to manage a patient with syncope, with reference to the above guidelines. Despite the progress made, the management of patients with syncope remains largely unsatisfactory because of the presence of a significant gap between knowledge and its application. Two new concepts aimed at filling that gap are currently under evaluation: syncope facilities with specialist backup and interactive decision-making software. Preliminary data have shown that a standardized syncope assessment, especially when coupled with interactive decision-making software, decreases admission rate and unnecessary testing and improves diagnostic yield, thus reducing cost per diagnosis. The long-term effects of such a new health care model on the rate of diagnosis and survival await future studies.
Topics: Disease Management; Electrocardiography; Global Health; Humans; Morbidity; Practice Guidelines as Topic; Prognosis; Risk Assessment; Survival Rate; Syncope
PubMed: 22538328
DOI: 10.1016/j.jacc.2011.11.056 -
WMJ : Official Publication of the State... Aug 2014A 70-year-old man presented to cardiology clinic with recurrent syncope associated with consumption of carbonated beverages. Ambulatory monitoring revealed multiple...
A 70-year-old man presented to cardiology clinic with recurrent syncope associated with consumption of carbonated beverages. Ambulatory monitoring revealed multiple symptomatic ventricular pauses. A barium esophagram was unremarkable, and the patient underwent placement of a dual chamber pacemaker for deglutition syncope with resolution of symptoms. A challenge of carbonated beverage was given, resulting in bradycardia that initiated an appropriate pacing response. This case illustrates the need for a thorough history when defining the etiology of syncope.
Topics: Aged; Carbonated Beverages; Electrocardiography; Humans; Male; Pacemaker, Artificial; Syncope
PubMed: 25211804
DOI: No ID Found -
Postgraduate Medical Journal Oct 1997Syncope and falls are often considered to be two separate diagnoses with two separate sets of aetiologies. However, although it remains controversial, the existence of... (Review)
Review
Syncope and falls are often considered to be two separate diagnoses with two separate sets of aetiologies. However, although it remains controversial, the existence of an overlap between syncope and falls is becoming increasingly acknowledged. In the elderly, determining the cause of a fall can be difficult. Approximately 30% of cognitively normal elderly people are unable to recall documented falls three months later and a witness account for syncopal events is unavailable in about 50% of patients. We have found that in almost 40% of patients in whom an attributable diagnosis of carotid sinus syndrome was made, the only presenting symptoms were falls alone or falls with dizziness; syncope was denied. Amnesia for loss of consciousness can be demonstrated in over 20% of all patients with a diagnosis of carotid sinus syndrome and in 50% of those patients who present only with falls or falls and dizziness. There is a suggestion from studies in postprandial hypotension and orthostatic hypotension, where similar haemodynamic changes are found in patients complaining of either syncope or falls, that this phenomenon may be generalisable. The importance of the presence of an overlap between syndrome and falls in the elderly lies in the healthcare implications of missed diagnoses of cardiovascular syncope for which there are established effective treatments. Consideration of syncope in the differential diagnosis of unexplained falls should reduce the numbers of falls for which no attributable diagnosis is found and result in an improved standard of health care for elderly patients who fall.
Topics: Accidental Falls; Aged; Amnesia; Carotid Artery Diseases; Carotid Sinus; Diagnosis, Differential; Humans; Syncope; Syndrome
PubMed: 9497972
DOI: 10.1136/pgmj.73.864.635 -
Clinical Autonomic Research : Official... Apr 2018
Topics: Humans; Internet; Physicians; Specialization; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 29138997
DOI: 10.1007/s10286-017-0481-z