-
Minerva Medica Apr 2022
Topics: Forecasting; Humans; Syncope
PubMed: 35575152
DOI: 10.23736/S0026-4806.22.08048-X -
Medicine Nov 2022We investigated head-up tilt test (HUTT) results across age-groups in syncope/presyncope patients to establish pediatric postural orthostatic tachycardia syndrome (POTS)...
We investigated head-up tilt test (HUTT) results across age-groups in syncope/presyncope patients to establish pediatric postural orthostatic tachycardia syndrome (POTS) characteristics. We retrospectively reviewed syncope patients' medical records. Adolescents were defined as 10 to 19 years old, adults as 20 to 59 years old, and older individuals as ≥60 years old. From HUTT results, we determined POTS prevalence and differences among the age-groups. We included 147 adolescents, 269 adults, and 123 older patients. Seventy (13.0%) patients (61.4% females; median age: 20 [17-25] years) were diagnosed with POTS. The syndrome was more prevalent among adolescents (33 [22.4%]) than adults (37 [13.8%]), and was absent among older individuals. Affected adolescents had significantly lower resting diastolic blood pressure (DBP) and heart rate (HR), and converted to maximum HR more rapidly than adolescents without the syndrome during the passive phase. Adolescents with POTS demonstrated several unique characteristics compared to adults with and adolescents without this syndrome. POTS may be underrecognized among syncope and presyncope patients, among which 22.4% of adolescents were diagnosed with the syndrome. POTS should be considered when evaluating syncope patients.
Topics: Adult; Female; Humans; Adolescent; Child; Young Adult; Middle Aged; Male; Postural Orthostatic Tachycardia Syndrome; Tilt-Table Test; Retrospective Studies; Syncope; Heart Rate
PubMed: 36397456
DOI: 10.1097/MD.0000000000031513 -
Clinical Medicine (London, England) May 2020Cardiac syncope and epileptic seizure are two very similar presentations and difficult to differentiate without a proper history, physical examination and...
Cardiac syncope and epileptic seizure are two very similar presentations and difficult to differentiate without a proper history, physical examination and investigations. In a former study, 10 out of 22 episodes of induced ventricular tachycardia or fibrillation can result in stereotypical tonic-clonic movement with varied electroencephalography changes. We present a case which was diagnosed as ventricular tachycardia from seizure-like attack. It is to emphasise the importance of including ventricular tachycardia among other differential diagnoses of seizure-like activity in a patient with cardiovascular risks.
Topics: Arrhythmias, Cardiac; Electrocardiography; Electroencephalography; Humans; Seizures; Syncope; Tachycardia, Ventricular
PubMed: 32414733
DOI: 10.7861/clinmed.2020-0046 -
Revue Medicale de Liege Jul 2016Syncope accounts for nearly 5 % of the emergency intake causes. Swallow syncope is a rare form of cardio-neurogenic syncope. Less than a hundred cases were reported... (Review)
Review
Syncope accounts for nearly 5 % of the emergency intake causes. Swallow syncope is a rare form of cardio-neurogenic syncope. Less than a hundred cases were reported since its first description in the mid-18th century. We present the case of an 83-year-old patient with recurrent syncope occurring during meals. Telemetry monitoring revealed a severe bradycardia with complete AV block and a pause of 8 seconds. A dual chamber pacemaker was implanted and the syncopal episodes were abolished. We shall briefly review the diagnostic methods, mechanisms, and therapy of swallow syncope.
Topics: Aged, 80 and over; Carotid Stenosis; Deglutition; Deglutition Disorders; Electrocardiography; Humans; Male; Pacemaker, Artificial; Syncope
PubMed: 28383846
DOI: No ID Found -
Cardiology Journal 2018The aim of this study was to evaluate implantable loop recorders (ILRs) in an unselected cohort in order to determine diagnostic yield, time to pacemaker/implantable...
BACKGROUND
The aim of this study was to evaluate implantable loop recorders (ILRs) in an unselected cohort in order to determine diagnostic yield, time to pacemaker/implantable cardioverter-defibrillator (ICD) implantation, predictors thereof, safety issues, and syncope management including usage of preceding diagnostic tools.
METHODS
Patients who underwent ILR evaluation in any of three centers in Region Gävleborg, Swe-den, between April 2007 and April 2013 were included and their medical records retrieved. Logistic regression was used to evaluate predictors of pacemaker/ICD outcome expressed as odds ratios (ORs) and Kaplan-Meier estimates for time-dependent analysis.
RESULTS
A total of 173 patients (52.6% females) with a mean age of 56.2 years received an ILR dur-ing a mean follow-up of 605 days. In the 146 patients evaluated for syncope/presyncope, 28.1% received a pacemaker (n = 39) or ICD (n = 2). The cumulative incidence at 6, 12, and 18 months were 8.8%, 21.3%, and 26.7%, respectively. Age > 75 years was the only significant predictor for outcome (p = 0.010) and the following variables showed a tendency toward significance: abnormal elevation of the biomarker B-type natriuretic peptide (OR 2.05, p = 0.100), a history of trauma (OR 1.71, p = 0.179), and patho-logic electrocardiogram (OR 1.68, p = 0.231). A computerized tomography of the skull was performed in 52.1% of the syncope cases.
CONCLUSIONS
In syncope evaluation in an unselected cohort, 28.1% were diagnosed with an arrhyth-mia necessitating a pacemaker/ICD. The only significant predictor was advanced age. Time to diag-nosis is unpredictable and prolonged ILR monitoring is warranted in addition to optimal use of other diagnostic tools.
Topics: Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Conduction System; Humans; Male; Middle Aged; Pacemaker, Artificial; Retrospective Studies; Syncope; Time Factors; Treatment Outcome
PubMed: 28840588
DOI: 10.5603/CJ.a2017.0101 -
Emergency Medicine Journal : EMJ Apr 2007Suspension trauma (also known as "harness-induced pathology" or "orthostatic shock while suspended") is the development of presyncopal symptoms and loss of consciousness... (Review)
Review
Suspension trauma (also known as "harness-induced pathology" or "orthostatic shock while suspended") is the development of presyncopal symptoms and loss of consciousness if the human body is held motionless in a vertical position for a period of time. It has been described in experiments of personal fall protection, and has been implicated in causes of death in mountaineering accidents, but it seems neither to be widely known about nor to have been presented to the medical profession. This article highlights the potential existence of suspension trauma and suggests that more robust medical research using modern harnesses and healthy volunteers would be beneficial to assess whether this is purely a theoretical risk.
Topics: Accidental Falls; Blood Pressure; Equipment Design; Humans; Hypotension, Orthostatic; Mountaineering; Protective Devices; Syncope; Unconsciousness
PubMed: 17384373
DOI: 10.1136/emj.2007.046391 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jan 2013Neurocardiogenic syncope is known to be associated with autonomic nervous system dysfunction, although the mechanism has not been entirely elucidated. In this study, we... (Review)
Review
Neurocardiogenic syncope is known to be associated with autonomic nervous system dysfunction, although the mechanism has not been entirely elucidated. In this study, we sought to highlight the pathogenic role of the autonomic nervous system in neurocardiogenic syncope and to review the associated co-morbidities known to have a dysautonomic basis. Herein we discuss migraine, orthostatic hypotension, postural orthostatic tachycardia syndrome, endothelial dysfunction, chronic fatigue syndrome, and carotid sinus hypersensitivity with a focus on the pathogenic role of the autonomic nervous system and any consecutive clinical implications. Other conditions, such as pre-syncopal heart rate acceleration and/or instability and pre-syncopal breathing instability, which occur during a tilt test, are discussed in the same perspective.
Topics: Autonomic Nervous System; Autonomic Nervous System Diseases; Humans; Postural Orthostatic Tachycardia Syndrome; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 23518945
DOI: 10.5543/tkda.2013.44420 -
Progress in Cardiovascular Diseases 2013Patients with vasovagal syncope and neurogenic orthostatic hypotension can both present with pre-syncope and syncope resulting from systemic hypotension. While not... (Review)
Review
Patients with vasovagal syncope and neurogenic orthostatic hypotension can both present with pre-syncope and syncope resulting from systemic hypotension. While not directly responsible for increased mortality, both of these conditions can have a tremendous deleterious impact on the daily lives of patients. This negative impact can take the form of both physical symptoms and injury, but also a psychological impact from living in fear of the next syncopal episode. Despite these similarities, these are different disorders with fixed damage to the autonomic nerves in neurogenic orthostatic hypotension, as opposed to a transient reflex hypotension in "neurally mediated" vasovagal syncope. The treatment approaches for both disorders are parallel. The first step is to educate the patient about the pathophysiology and prognosis of their disorder. Next, offending medications should be withdrawn when possible. Non-pharmacological therapies and maneuvers can be used, both in an effort to prevent the symptoms and to prevent syncope at the onset of presyncope. This is all that is required in many patients with vasovagal syncope. If needed, pharmacological options are also available for both vasovagal syncope and neurogenic orthostatic hypotension, many of which are focused on blood volume expansion, increasing cardiac venous return, or pressor agents to increase vascular tone. There is a paucity of high-quality clinical trial data to support the use of these pharmacological agents. We aim to review the literature on these different therapy choices and to give recommendations on tailored approaches to the treatment of these conditions.
Topics: Cardiac Pacing, Artificial; Cardiovascular Agents; Fluid Therapy; Humans; Hypotension, Orthostatic; Patient Education as Topic; Physical Therapy Modalities; Risk Factors; Syncope, Vasovagal; Treatment Outcome
PubMed: 23472781
DOI: 10.1016/j.pcad.2012.11.004 -
Internal Medicine (Tokyo, Japan) May 2024A 74-year-old woman presented to our hospital with syncope after a coronavirus disease 2019 (COVID-19) infection. Upon admission, she passed out, and an 8 second sinus...
A 74-year-old woman presented to our hospital with syncope after a coronavirus disease 2019 (COVID-19) infection. Upon admission, she passed out, and an 8 second sinus arrest was detected during telemetry monitoring. During the next syncope episode, telemetry monitoring showed that her heart rate decreased from 80 to 36 bpm, accompanied by a 2.4 second pause. A permanent pacemaker was implanted; however, the patient still experienced syncope. The head-up tilt test revealed a vasodepressor reflex syncope. The need for permanent pacemakers in patients with syncope following COVID-19 therefore remains controversial.
Topics: Humans; COVID-19; Aged; Female; Syncope; Pacemaker, Artificial; SARS-CoV-2; Tilt-Table Test; Telemetry; Syncope, Vasovagal
PubMed: 38432984
DOI: 10.2169/internalmedicine.3324-23 -
The Cochrane Database of Systematic... Apr 2016The most recent syncope guideline recommends that implantable loop recorders (ILRs) are implanted in the early phase of evaluation of people with recurrent syncope of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The most recent syncope guideline recommends that implantable loop recorders (ILRs) are implanted in the early phase of evaluation of people with recurrent syncope of uncertain origin in the absence of high-risk criteria, and in high-risk patients after a negative evaluation. Observational and case-control studies have shown that loop recorders lead to earlier diagnosis and reduce the rate of unexplained syncopes, justifying their use in clinical practice. However, only randomised clinical trials with an emphasis on a primary outcome of specific ILR-guided diagnosis and therapy, rather than simply electrocardiogram (ECG) diagnosis, might change clinical practice.
OBJECTIVES
To assess the incidence of mortality, quality of life, adverse events and costs of ILRs versus conventional diagnostic workup in people with unexplained syncope.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2015), MEDLINE, EMBASE, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) Search Portal in April 2015. No language restriction was applied.
SELECTION CRITERIA
We included all randomised controlled trials of adult participants (i.e. ≥ 18 years old) with a diagnosis of unexplained syncope comparing ILR with standard diagnostic workup.
DATA COLLECTION AND ANALYSIS
Two independent review authors screened titles and abstracts of all potential studies we identified as a result of the literature search, extracted study characteristics and outcome data from included studies and assessed risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We contacted authors of trials for missing data. We analysed dichotomous data (all-cause mortality and aetiologic diagnosis) as risk ratios (RR) with 95% confidence intervals (CI). We used the Chi(2) test to assess statistical heterogeneity (with P < 0.1) and the I² statistic to measure heterogeneity among the trials. We created a 'Summary of findings' table using the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness and publication bias) to assess the quality of a body of evidence as it relates to the studies which contribute data to the meta-analyses for the prespecified outcomes.
MAIN RESULTS
We included four trials involving a total of 579 participants. With the limitation that only two studies reported data on mortality and none of them had considered death as a primary endpoint, the meta-analysis showed no evidence of a difference in the risk of long-term mortality between participants who received ILR and those who were managed conventionally at follow-up (RR 0.97, 95% CI 0.41 to 2.30; participants = 255; studies = 2; very low quality evidence) with no evidence of heterogeneity. No data on short term mortality were available. Two studies reported data on adverse events after ILR implant. Due to the lack of data on adverse events in one of the studies' arms, a formal meta-analysis was not performed for this outcome.Data from two trials seemed to show no difference in quality of life, although this finding was not supported by a formal analysis due to the differences in both the scores used and the way the data were reported. Data from two studies seemed to show a trend towards a reduction in syncope relapses after diagnosis in participants implanted with ILR. Cost analyses from two studies showed higher overall mean costs in the ILR group, if the costs incurred by the ILR implant were counted. The mean cost per diagnosis and the mean cost per arrhythmic diagnosis were lower for participants randomised to ILR implant.Participants who underwent ILR implantation experienced higher rates of diagnosis (RR (in favour of ILR) 0.61, 95% CI 0.54 to 0.68; participants = 579; studies = 4; moderate quality evidence), as compared to participants in the standard assessment group, with no evidence of heterogeneity.
AUTHORS' CONCLUSIONS
Our systematic review shows that there is no evidence that an ILR-based diagnostic strategy reduces long-term mortality as compared to a standard diagnostic assessment (very low quality evidence). No data were available for short-term all-cause mortality. Moderate quality evidence shows that an ILR-based diagnostic strategy increases the rate of aetiologic diagnosis as compared to a standard diagnostic pathway. No conclusive data were available on the other end-points analysed.Further trials evaluating the effect of ILRs in the diagnostic strategy of people with recurrent unexplained syncope are warranted. Future research should focus on the assessment of the ability of ILRs to change clinically relevant outcomes, such as quality of life, syncope relapse and costs.
Topics: Adult; Electrocardiography; Electrodes, Implanted; Humans; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Syncope
PubMed: 27092427
DOI: 10.1002/14651858.CD011637.pub2