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Internal Medicine (Tokyo, Japan) Jun 2020Vasovagal reactions are the most common type of adverse reaction after blood donation; however, there are no reports of ischemic colitis as an adverse reaction after...
Vasovagal reactions are the most common type of adverse reaction after blood donation; however, there are no reports of ischemic colitis as an adverse reaction after blood donation. A previously healthy 55-year-old woman suffered loss of consciousness at the end of her first plasma donation. She was diagnosed with a vasovagal reaction and received hydration. However, she developed persistent left flank pain and watery diarrhea, followed by bloody diarrhea. Abdominal computed tomography confirmed ischemic colitis. She was asked to fast and was eventually discharged 7 days later. We should consider the possibility of ischemic colitis if patients develop persistent abdominal pain after transient hypotension, such as that observed during a vasovagal reaction.
Topics: Blood Donors; Colitis, Ischemic; Diagnostic Tests, Routine; Female; Humans; Middle Aged; Syncope, Vasovagal; Tomography, X-Ray Computed
PubMed: 32188808
DOI: 10.2169/internalmedicine.4219-19 -
Frontiers in Cardiovascular Medicine 2019Only humans faint, and not all do so. Syncope tends to recur, and the predisposition to syncope can persist over many decades. Observations such as these have suggested... (Review)
Review
Only humans faint, and not all do so. Syncope tends to recur, and the predisposition to syncope can persist over many decades. Observations such as these have suggested that there may be a genetic predisposition to vasovagal syncope. It seems to have a high prevalence in some families; having a parent who faints increases the likelihood of an offspring fainting, and this is increased even further if both biological parents faint. Numerous studies have correlated a number of genotypes with positive tilt tests. However, the control subjects are usually those who faint, but have negative tilt tests, making the conclusions about association with the clinical phenotype less certain. Twin studies, highly focused genome-wide association studies, and gene duplicate studies all suggest there are sites in the genome that associate with vasovagal syncope, although the specific genes, pathways, and proteins are unknown. A recent large, candidate gene study of kindreds with high, multigenerational prevalence of the vasovagal syncope identified 3 genes that associate with vasovagal syncope. Our understanding of the genetic correlates of vasovagal syncope is in its infancy, with much to be understood.
PubMed: 31850372
DOI: 10.3389/fcvm.2019.00175 -
Archives of Cardiovascular Diseases Jan 2018A 55-year-old hypertensive patient presents atrial fibrillation after vasovagal syncope. Non-invasive cardiac workup is normal. Without antiarrhythmic therapy, the... (Review)
Review
A 55-year-old hypertensive patient presents atrial fibrillation after vasovagal syncope. Non-invasive cardiac workup is normal. Without antiarrhythmic therapy, the patient has no recurrence for the next 3years, then presents with a stroke. Echocardiography eventually reveals left atrial dilation. This sequence of events illustrates the well-known links between age, arterial hypertension, atrial fibrillation, atrial neuromyopathy and stroke. A frequently neglected common denominator in this equation is impaired sympathovagal balance. Contrary to what is often stated, autonomic imbalance is not a simple modulation factor of atrial fibrillation; both the trigger and the substrate of atrial fibrillation can be influenced by abnormal cardiac innervation. Here, we review the neurogenic theory of atrial fibrillation, based on literature and original data. We also provide evidence that this concept may help to improve atrial fibrillation prediction, early diagnosis and therapy.
Topics: Action Potentials; Animals; Atrial Fibrillation; Atrial Function; Autonomic Nervous System; Female; Heart; Heart Conduction System; Heart Rate; Humans; Ion Channels; Male; Middle Aged; Risk Factors; Syncope, Vasovagal; Vagus Nerve
PubMed: 29229215
DOI: 10.1016/j.acvd.2017.11.001 -
Medical Sciences (Basel, Switzerland) Jul 2022Vasovagal reactions are a benign but common outcome of interventional pain management procedures that can negatively impact patient care, including aborted procedures... (Review)
Review
Vasovagal reactions are a benign but common outcome of interventional pain management procedures that can negatively impact patient care, including aborted procedures and fear of future procedures that would otherwise help the patient. Research has been done on the incidence, risk factors, and management of vasovagal reactions resulting from such procedures, but less is known about how to prevent these reactions from occurring. In this paper, we present a literature review of the pathophysiology, incidence, risk factors, prevention, and management of vasovagal reactions during interventional pain management procedures, with an emphasis on the relative lack of research and conflicting advice on preventive measures. We found that moderate sedation and anxiolytics have been used prophylactically to prevent vasovagal reactions, but their side-effect profiles prevent them from being used commonly. Less studied is the prophylactic administration of antimuscarinics and IV fluids, despite the potential benefit of these measures and relatively low side-effect profile. We explore these topics here and offer advice for future research to fill the gaps in our knowledge.
Topics: Conscious Sedation; Humans; Incidence; Pain Management; Risk Factors; Syncope, Vasovagal
PubMed: 35893121
DOI: 10.3390/medsci10030039 -
International Heart Journal 2015Autonomic dysfunction has been associated with paroxysmal atrial fibrillation (PAF). The head-up tilt test (HUTT) is an important diagnostic tool for autonomic...
Autonomic dysfunction has been associated with paroxysmal atrial fibrillation (PAF). The head-up tilt test (HUTT) is an important diagnostic tool for autonomic dysfunction. The aim of this study was to examine atrial fibrillation recurrence after RFCA by performing HUTT. A total of 488 consecutive patients with PAF who underwent RFCA were prospectively enrolled. HUTT was positive in 154 (31.6%) patients after a mean follow-up of 22.7 ± 3.5 months, and 163 (33.4%) had a recurrence. HUTT positive was significantly higher in PAF patients with recurrence compared to those without (68 (41.7%) versus 86 (26.5%), P < 0.001). Multivariate Cox regression analysis revealed that HUTT positive (HR: 1.96; 95% CI: 1.49-2.48, P < 0.001), left atrial diameter (HR: 1.77; 95%CI: 1.15-2.11, P = 0.004), AF duration (HR: 1.27; 95%CI: 0.98-1.83, P = 0.014), and sleep apnea (HR: 1.02; 95%CI: 0.81-1.53, P = 0.032) were independent predictors of clinical recurrence after RFCA. The success rate of ablation was 70.4% in patients in the HUTT negative group compared with 58.4% in patients in the HUTT positive group (log-rank P = 0.006). Patients with a positive headup tilt test were at an increased risk of AF recurrence after catheter ablation. Our results suggest that HUTT was a significant predictor for AF recurrence after catheter ablation for PAF.
Topics: Adult; Atrial Fibrillation; Autonomic Nervous System; Catheter Ablation; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Recurrence; Reproducibility of Results; Risk Factors; Syncope, Vasovagal; Tilt-Table Test
PubMed: 26370369
DOI: 10.1536/ihj.15-039 -
Autonomic Neuroscience : Basic &... Sep 2014Vasovagal syncope (VVS) is a common disorder of the autonomic nervous system. While recurrent syncope can cause very impaired quality of life, the spells are not... (Review)
Review
Vasovagal syncope (VVS) is a common disorder of the autonomic nervous system. While recurrent syncope can cause very impaired quality of life, the spells are not generally life-threatening. Both non-pharmacological and pharmacological approaches can be used to treat patients. Conservative management with education, exercise and physical maneuvers, and aggressive volume repletion is adequate for controlling symptoms in most patients. Unfortunately, a minority of patients will continue to have recurrent syncope despite conservative therapy, and they may require medications. These could include vasopressor agents, beta-blockers, or neurohormonal agents. Some patients may require more aggressive device based therapy with pacemakers or radiofrequency ablation, which are emerging therapies for VVS. This paper will review non-procedure based treatments for VVS.
Topics: Animals; Humans; Syncope, Vasovagal
PubMed: 24996861
DOI: 10.1016/j.autneu.2014.06.004 -
European Heart Journal Jul 2023
Topics: Humans; Syncope, Vasovagal; Nitroglycerin; Isoproterenol; Tilt-Table Test
PubMed: 37317895
DOI: 10.1093/eurheartj/ehad359 -
Vaccine Sep 2022Coronavirus disease 2019 (COVID-19) vaccine administration started in February 2021 in Japan. As of December 2021, approximately 75% of the population aged ≥12 years...
Coronavirus disease 2019 (COVID-19) vaccine administration started in February 2021 in Japan. As of December 2021, approximately 75% of the population aged ≥12 years had received two doses of vaccine. We conducted a study to investigate vasovagal reactions (VVR) after COVID-19 vaccination using data on adverse events following immunization. The crude reporting rate of VVR (cases/1,000,000 doses) after vaccination was 9.6 in all age groups combined, and was more frequent in the younger age groups: 28.6 and 37.2 in individuals aged 10-19 years and 20-29 years, respectively. In individuals aged 10-29 years, the rate was similar in males and females (33.0 and 34.2, respectively, p = 0.53); but was higher after dose 1 than after dose 2 (57.4 and 8.8, respectively, p < 0.001). Based on these results, caution needs to be exercised when vaccinating adolescents and young adults, especially with dose 1 of COVID-19 vaccines.
Topics: Adolescent; Adult; COVID-19; COVID-19 Vaccines; Child; Female; Humans; Japan; Male; Syncope, Vasovagal; Vaccination; Young Adult
PubMed: 36068111
DOI: 10.1016/j.vaccine.2022.08.056 -
Neuroscience Bulletin Jun 2020Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of... (Review)
Review
Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.
Topics: Adolescent; Child; Hemodynamics; Humans; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome; Syncope, Vasovagal
PubMed: 32367250
DOI: 10.1007/s12264-020-00497-4 -
International Journal of Environmental... Jun 2022In children, vasovagal syncope and postural tachycardia syndrome constitute the major types of orthostatic intolerance. The clinical characteristics of postural... (Review)
Review
In children, vasovagal syncope and postural tachycardia syndrome constitute the major types of orthostatic intolerance. The clinical characteristics of postural tachycardia syndrome and vasovagal syncope are similar but their treatments differ. Therefore, their differential diagnosis is important to guide the correct treatment. Therapeutic methods vary in patients with the same diagnosis because of different pathomechanisms. Hence, in patients with vasovagal syncope or postural tachycardia syndrome, routine treatments have an unsatisfactory efficacy. However, biomarkers could increase the therapeutic efficacy significantly, allowing for an accurate and detailed assessment of patients and leading to improved therapeutic effects. In the present review, we aimed to summarize the current state of research into biomarkers for distinguishing the diagnosis of pediatric vasovagal syncope from that of postural tachycardia syndrome. We also discuss the biomarkers that predict treatment outcomes during personalized therapy for each subtype.
Topics: Biomarkers; Child; Hemodynamics; Humans; Postural Orthostatic Tachycardia Syndrome; Syncope, Vasovagal; Tilt-Table Test
PubMed: 35742222
DOI: 10.3390/ijerph19126974