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Europace : European Pacing,... Jul 2023
Topics: Humans; Syncope, Vasovagal; Syncope; Reflex
PubMed: 37363927
DOI: 10.1093/europace/euad179 -
Medicina (Kaunas, Lithuania) Aug 2021The baseline electrocardiogram (ECG) is less informative in neurally mediated syncope (NMS) than in arrhythmic syncope. However, some of the ECG patterns present in NMS... (Review)
Review
The baseline electrocardiogram (ECG) is less informative in neurally mediated syncope (NMS) than in arrhythmic syncope. However, some of the ECG patterns present in NMS can have diagnostic and prognostic value in such patients. Electrocardiographic documentation of a syncopal spell and thus identification of the ECG changes can be performed during tilt table test (TTT) or during prolonged ECG monitoring. This work reviews the specific ECG patterns in NMS, which are primarily related to the cardioinhibitory reflex. In addition, there are other ECG findings present in patients with NMS that are being analyzed, such as increased heart rate variability as well as specific QRS voltage patterns. In addition to the diagnostic and prognostic value, these ECG patterns in NMS may help improving the selection of patients for pacemaker implant.
Topics: Arrhythmias, Cardiac; Electrocardiography; Humans; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 34441014
DOI: 10.3390/medicina57080808 -
Current Problems in Cardiology Jan 2024This review looks into the use of Artificial Intelligence (AI) in the management of syncope, a condition characterized by a brief loss of consciousness caused by... (Review)
Review
This review looks into the use of Artificial Intelligence (AI) in the management of syncope, a condition characterized by a brief loss of consciousness caused by cerebral hypoperfusion. With rising prevalence, high costs, and difficulty in diagnosis and risk stratification, syncope poses significant healthcare challenges. AI has the potential to improve symptom differentiation, risk assessment, and patient management. Machine learning, specifically Artificial Neural Networks, has shown promise in accurate risk stratification. AI-powered clinical decision support tools can improve patient evaluation and resource utilization. While AI holds great promise for syncope management, challenges such as data quality, class imbalance, and defining risk categories remain. Ethical concerns about patient privacy, as well as the need for human empathy, complicate AI integration. Collaboration among data scientists, clinicians, and ethics experts is critical for the successful implementation of AI, which has the potential to improve patient outcomes and healthcare efficiency in syncope management.
Topics: Humans; Artificial Intelligence; Risk Assessment; Syncope
PubMed: 37716544
DOI: 10.1016/j.cpcardiol.2023.102079 -
Arquivos Brasileiros de Cardiologia Jul 2018Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new...
BACKGROUND
Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of ≤ 85 mmHg to refine the vasodepressor (VD) response diagnosis.
OBJECTIVE
To determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria.
METHODS
CSM was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole ≥ 3 seconds, or as VD for SBP decrease ≥ 50 mmHg.
RESULTS
No differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value < 0.050 was considered statistically significant. During the maneuvers, 45 (45.45%) and 34 (51.5%) patients in the symptomatic and asymptomatic groups achieved SBP below ≤ 85 mmHg. Symptoms were reported especially in those patients in whom CSM caused a SBP decrease to below 90 mmHg and/or asystole > 2.5 seconds, regardless of the pattern of response or the presence of previous syncope.
CONCLUSION
The response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.
Topics: Carotid Sinus; Humans; Syncope
PubMed: 30110049
DOI: 10.5935/abc.20180114 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2017Elderly syncope currently accounts a substantial number of emergency admissions. Unfortunately, in elderly syncope we are faced with major difficulties while providing...
Elderly syncope currently accounts a substantial number of emergency admissions. Unfortunately, in elderly syncope we are faced with major difficulties while providing diagnostic and therapeutic decisions. It is quite necessary to distinguish between syncope and non-syncopal causes which create further difficulties during diagnostic work-up because of co-morbid conditions and poly-pharmacy used by the elderly. The present article aims to describe causes of elderly syncope and its differential diagnosis as well as tips and tricks during diagnostic process.
Topics: Aged; Aged, 80 and over; Comorbidity; Diagnosis, Differential; Humans; Syncope
PubMed: 28976385
DOI: 10.5543/tkda.2017.00180 -
Journal of the American College of... May 2009Syncope is a common clinical problem characterized by transient, spontaneously self-terminating loss of consciousness with complete and prompt recovery; the cause is... (Review)
Review
Syncope is a common clinical problem characterized by transient, spontaneously self-terminating loss of consciousness with complete and prompt recovery; the cause is insufficiency of cerebral oxygen/nutrient supply most often due to a transient fall of systemic arterial pressure to levels below those tolerated by cerebrovascular autoregulation. Careful and thorough evaluation of the cause of syncope is warranted in all patients. Determining that certain individuals are at "low mortality risk" is inadequate; syncope, although often benign from a mortality perspective, tends to recur, is associated with risk of physical injury, diminishes quality-of-life, and might lead to restriction from employment or avocation. However, the diagnostic evaluation and treatment of syncope is challenging for many reasons. First, syncope is only 1 of many causes of transient loss of consciousness. Second, the patient's symptoms are fleeting, and the patient is generally fully recovered when seen in the clinic; only infrequently are there helpful physical findings. Third, spontaneous events are often unwitnessed by medical professionals; consequently, the medical history of symptom events is usually a "second-hand" or "third-hand" story. Finally, there is often an excessive sense of diagnostic "urgency" that tends to result in a rush to undertake multiple poorly considered "diagnostic" testing procedures; a deliberate approach based on initial risk stratification is more likely to reap the dual rewards of a correct diagnosis and initiation of effective treatment in a cost-effective manner.
Topics: Adrenergic beta-Antagonists; Anti-Inflammatory Agents; Arrhythmias, Cardiac; Cardiac Pacing, Artificial; Electrophysiology; Fludrocortisone; Humans; Risk Factors; Syncope; Tilt-Table Test; Vasoconstrictor Agents
PubMed: 19422980
DOI: 10.1016/j.jacc.2008.12.065 -
Congestive Heart Failure (Greenwich,... 2008Knowledge of what occurs during spontaneous syncope is the gold standard for evaluation. Initially, implantable loop recorders (ILRs) were used in patients with... (Review)
Review
Knowledge of what occurs during spontaneous syncope is the gold standard for evaluation. Initially, implantable loop recorders (ILRs) were used in patients with unexplained syncope at the end of unsuccessful full, conventional work-up. In pooled data regarding 247 patients, a correlation between syncope and electrocardiographic findings was found in 84 patients (34%); of these, 52% had a bradycardia or asystole at the time of the recorded event, 11% had tachycardia, and 37% had no arrhythmia. Presyncope-electrocardiography correlation was observed in another third of the patients; presyncope was much less likely to be associated with an arrhythmia than was syncope. The diagnostic yield was similar in patients with and without structural heart diseases and was higher in older than in younger patients. Recent studies showed that ILR implantation can be safely performed in an early phase of the diagnostic evaluation--provided that patients at risk for life-threatening events are carefully excluded--in the patients who have a severe presentation of syncope (because of high risk of trauma or high frequency of episodes) which can be a benefit of a mechanism-specific therapy.
Topics: Electrocardiography; Humans; Monitoring, Ambulatory; Syncope
PubMed: 19891290
DOI: 10.1111/j.1751-7133.2008.tb00014.x -
Journal of Internal Medicine Apr 2013Syncope is a common condition. It is frequently due to a benign cause, but may occasionally be due to a potentially life-threatening disorder. The presence of structural... (Review)
Review
Syncope is a common condition. It is frequently due to a benign cause, but may occasionally be due to a potentially life-threatening disorder. The presence of structural heart disease in patients with syncope is associated with a poor prognosis and may be a predictor of sudden cardiac death. In patients who present with syncope, the presence of structural heart disease and primary electrophysiological disorders should be considered and further cardiac evaluation performed as indicated by the clinical history, physical examination and electrocardiographic findings.
Topics: Death, Sudden, Cardiac; Electrocardiography; Heart Diseases; Humans; Syncope
PubMed: 23510364
DOI: 10.1111/joim.12027 -
Trends in Cardiovascular Medicine Aug 2018Neuroendocrine syncope is a newly proposed term to embody both syncope of reflex and adenosine-related etiology. Recent publications on tilt testing have revealed the... (Review)
Review
Neuroendocrine syncope is a newly proposed term to embody both syncope of reflex and adenosine-related etiology. Recent publications on tilt testing have revealed the presence of a hypotensive tendency in some patients, even in the face of severe cardioinhibition. This new understanding may allow better selection of older reflex syncope patients, documented by ECG loop recorder, for successful pacing where tilt testing is ideally negative for a good result in terms of few syncope recurrences and prompts a less aggressive management policy when hypotensive medication is required. Furthermore, plasma adenosine levels not only define a new group of patients who have low adenosine and will respond well to cardiac pacing but also, by assessing adenosine receptor affinity, offer a possible explanation for vasodepression accompanying severe cardioinhibition. The question of the timing of loss of consciousness in reflex syncope needs to be addressed because, if consciousness is lost before asystole, pacing is likely to be ineffective.
Topics: Adenosine; Algorithms; Biomarkers; Cardiac Pacing, Artificial; Clinical Decision-Making; Electrocardiography; Heart; Humans; Patient Selection; Predictive Value of Tests; Reflex; Syncope; Tilt-Table Test; Treatment Outcome
PubMed: 29452744
DOI: 10.1016/j.tcm.2018.01.009 -
Revue Medicale de Liege May 2004Syncope remains a clinical challenge. Accurate history taking, physical examination and EKG are mainstays of the diagnosis work up. The most important parameter for... (Review)
Review
Syncope remains a clinical challenge. Accurate history taking, physical examination and EKG are mainstays of the diagnosis work up. The most important parameter for prognosis and requiring aggressive management is a structural heart disease. Patient without cardiopathy presenting multiple episodes may be candidate for tilt testing and loop EKG recorder.
Topics: Diagnosis, Differential; Electrocardiography; Heart Diseases; Humans; Medical History Taking; Prognosis; Syncope
PubMed: 15264582
DOI: No ID Found