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Clinical Cardiology Apr 2011Complex regional pain syndrome (CRPS) is a debilitating pain syndrome characterized clinically by severe pain along with signs and symptoms of autonomic dysfunction....
BACKGROUND
Complex regional pain syndrome (CRPS) is a debilitating pain syndrome characterized clinically by severe pain along with signs and symptoms of autonomic dysfunction. Presyncope and syncope are common in these patients. The purpose of this study was to investigate the cause of these symptoms in these patients.
HYPOTHESIS
Patients with CRPS are more prone to presyncope and syncope as evidenced by head-up tilt table testing (HUTT).
METHODS
Patients with CRPS underwent a complete cardiac evaluation that included a 12-lead electrocardiogram, 2-dimensional echocardiography, 24-hour Holter monitoring, and HUTT.
RESULTS
Seventy-four patients with CRPS were evaluated. Eight CRPS patients (10%) could not complete a HUTT due to pain. Of the 66 CRPS patients who completed a HUTT, 15 (37.9%) reported pretest symptoms of presyncope or syncope. Twenty-eight CRPS patients (42.4%) had a positive HUTT. CRPS patients with lower limb involvement were more likely to have vasovagal syncope or orthostasis on HUTT than those with upper extremity or total body involvement (12 of 18 [67%] vs 16 of 48 [33%]; P = 0.015).
CONCLUSIONS
Syncope is common in patients with CRPS, especially with lower limb involvement. Autonomic dysregulation of the lower extremities leads to impaired sympathetic vasoconstriction and venous pooling, which can predispose these patients to syncope. Physician awareness of this syndrome will lead to improved recognition and treatment of their symptoms of presyncope or syncope.
Topics: Adult; Autonomic Nervous System; Chi-Square Distribution; Complex Regional Pain Syndromes; Echocardiography; Electrocardiography; Electrocardiography, Ambulatory; Female; Hemodynamics; Humans; Male; Middle Aged; Pain Measurement; Pennsylvania; Predictive Value of Tests; Prevalence; Risk Assessment; Risk Factors; Syncope; Tilt-Table Test
PubMed: 21462216
DOI: 10.1002/clc.20879 -
International Journal of Environmental... Apr 2023Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work,... (Review)
Review
Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work, especially for high-risk tasks. To date, it is impossible to quantify the exact impact of syncope on work and public safety since it is highly improbable to identify loss of consciousness as the fundamental cause of work or driving-related accidents, especially fatal injuries. Working at high-risk jobs such as public transport operators, in high elevations, or with exposure to moving parts, construction equipment, fireworks, or explosives demand attention and total awareness. Currently, no validated criteria or indicators are available for occupational risk stratification of a patient with reflex syncope to return to work. By drawing inspiration from the updated literature, this narrative review intends to summarise the leading knowledge required regarding the return to work for subjects affected by syncope. According to the available data, the authors highlighted some key findings, summarised in macro-items, such as defined risk stratification for vasovagal accidents, return to work after a critical event, and a focus on pacemaker (PM) implementation. Lastly, the authors proposed a flowchart for occupational physicians to help them manage the cases of workers affected by syncope and exposed to levels of risk that could represent a danger to the workers' health.
Topics: Humans; Syncope, Vasovagal; Syncope; Pacemaker, Artificial; Occupational Health; Transportation
PubMed: 37107742
DOI: 10.3390/ijerph20085460 -
Europace : European Pacing,... Mar 2023There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre...
AIMS
There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre retrospective study sought to evaluate the incidence and prognostic significance of syncope in consecutive ICD patients.
METHODS AND RESULTS
Data were collected on consecutive patients undergoing first ICD implantation between January 2009 and December 2019. The primary endpoints were the first occurrence of all-cause syncope, all-cause mortality, and all-cause hospitalization. Multivariate Cox proportional hazard models were used to identify risk factors associated with syncope and to analyse the subsequent risk of mortality and hospitalization. 1003 patients (58% primary prevention) were included in the final analysis. During a mean follow-up of 1519 ± 1055 days, 106 (10.6%) experienced syncope, 304 died (30.3%), and 477 (47.5%) were hospitalized for any cause. In an analysis adjusted for baseline variables, the first occurrence of syncope was associated with a significantly increased risk of mortality (HR 2.82, P < 0.001) and the first occurrence of hospitalization (HR 2.46, P = 0.002).
CONCLUSION
Syncope in ICD recipients is common and associated with a poor prognosis irrespective of baseline variables and ICD programming. The occurrence of syncope is associated with a significant increase in the risk of mortality and hospitalization.
Topics: Humans; Retrospective Studies; Defibrillators, Implantable; Prognosis; Risk Factors; Syncope
PubMed: 36638366
DOI: 10.1093/europace/euac281 -
Neurology India 2020
Topics: Humans; Seizures; Syncope
PubMed: 32859852
DOI: 10.4103/0028-3886.293489 -
BMJ (Clinical Research Ed.) Jan 2007
Review
Topics: Adult; Awareness; Female; Humans; Medical History Taking; Physical Examination; Syncope
PubMed: 17235097
DOI: 10.1136/bmj.39070.390961.DE -
Cardiology Journal 2008
Review
Topics: Aged; Aged, 80 and over; Amiodarone; Combined Modality Therapy; Defibrillators, Implantable; Electrocardiography; Electrocardiography, Ambulatory; Female; Heart Failure; Humans; Male; Middle Aged; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Survival Rate; Syncope; Treatment Outcome
PubMed: 18698538
DOI: No ID Found -
Neurology Nov 2016To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis.
OBJECTIVE
To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis.
METHODS
This was a retrospective cohort study of patients with PPS referred in 2007 to 2015 to a tertiary referral center for syncope. We reviewed patient records and studied attack frequency, factors affecting attack frequency, health care use, and quality of life using a questionnaire. We explored influences on attack freedom and attack frequency in the 6 months before follow-up for age, sex, education level, duration until diagnosis, probability of diagnosis, additional syncope, and acceptance of diagnosis.
RESULTS
Forty-seven of 57 patients with PPS could be traced, of whom 35 (74%) participated. Twelve (34%) were attack-free for at least 6 months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communicating and explaining the diagnosis resulted in immediate reduction of attack frequency (p = 0.007) from the month before diagnosis (median one attack, range 0-156) to the month after (median one attack, range 0-16). In the 6 months before follow-up, the number of admissions decreased from 19 of 35 to 0 of 35 (p = 0.002). The use of somatic and mental health care shifted toward the latter (p < 0.0001). Quality of life at follow-up (Short Form Health Survey 36) showed lower scores for 7 of 8 domains compared to matched Dutch control values; quality of life was not influenced by attack freedom.
CONCLUSIONS
After communication of the diagnosis in PPS, attack frequency decreased and health care use shifted toward mental care. Low quality of life underlines that PPS is a serious condition.
Topics: Adolescent; Adult; Aged; Databases, Factual; Female; Follow-Up Studies; Humans; Male; Middle Aged; Psychophysiologic Disorders; Quality of Life; Retrospective Studies; Socioeconomic Factors; Surveys and Questionnaires; Syncope; Tertiary Care Centers; Young Adult
PubMed: 27784771
DOI: 10.1212/WNL.0000000000003361 -
Journal of Internal Medicine Apr 2013
Review
Topics: Brain Ischemia; Hemodynamics; Humans; Syncope; Syndrome; Unconsciousness
PubMed: 23510363
DOI: 10.1111/joim.12039 -
Reviews in Cardiovascular Medicine Jan 2022Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM...
BACKGROUND
Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM implantation in a large, heterogeneous cohort of pediatric and young adult patients.
METHODS
Single centre, retrospective analysis of patients who underwent ICM implantation in 2010-2019. Patients were analysed according to age, symptoms, arrhythmias and underlying heart disease.
RESULTS
A total of 200 consecutive patients (58% male), aged 11.5 ± 5.8 years at ICM implantation, were included. Follow-up was 31 ± 18 months. Electrophysiologic study (EPS) was initially performed in 123 patients and was negative in 85%. Patients had no heart disease (57.5%), congenital heart defects (21%), channelopathies (14.5%), cardiomyopathies/heart tumors (8%). The commonest symptoms were syncope/presyncope (45.5%) and palpitations (12.5%). A definite diagnosis was made in 63% of patients (positive diagnosis in 25%, negative in 38%) after 8 (2-19) months of monitoring. EPS results and the presence/absence of an arrhythmia before ICM implantation had no impact on the diagnostic yield. Symptomatic patients as well as patients without structural heart disease showed higher diagnostic yield. Patients with a positive diagnosis underwent pacemaker/implantable cardioverter-defibrillator implantation (13%), pharmacological treatment (10.5%), or catheter ablation (1.5%).
CONCLUSIONS
In a large cohort of 200 children and young adults, ICMs with remote monitoring showed a high diagnostic yield (63%), especially in symptomatic patients and in patients without structural heart disease.
Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Female; Heart Defects, Congenital; Humans; Male; Retrospective Studies; Syncope; Young Adult
PubMed: 35092219
DOI: 10.31083/j.rcm2301027 -
American Family Physician Mar 2021
Review
Topics: Adult; Canada; Decision Support Techniques; Emergency Service, Hospital; Humans; Syncope
PubMed: 33719371
DOI: No ID Found