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Sample records for syncope

  1. [Syncope].

    Science.gov (United States)

    Ungar, Andrea; Rafanelli, Martina

    2013-03-01

    Syncope is quite common in older patients, with a 10% prevalence and a 33% 2-year recurrence rate. Syncope-associated morbidity is also common in older patients, ranging from loss of confidence or depressive symptoms due to fear of falling, to fractures and consequent disability and institutionalization. Moreover, advanced age is associated with significant short- and long-term mortality after syncope. Neurally mediated (51%) and orthostatic syncope (12%) are the two most common forms of syncope in the elderly. Indeed, those older than 75 years have orthostatic hypotension in 30.5% of cases, a finding that confirms the clinical relevance of systematically measuring blood pressure in the supine and upright position in this age group. A standardized approach, based on initial evaluation (clinical history, physical examination, 12-lead ECG), followed by neuroautonomic assessment (tilt testing, carotid sinus massage), can obtain a definite diagnosis in more than 90% of older patients with syncope. Given the high rate of carotid sinus syndrome in the elderly, the European Society of Cardiology (ESC) guidelines for the diagnosis and management of syncope suggest carotid sinus massage as part of the initial evaluation. The diagnostic work-up can be completed by advanced tools, such as the implantable loop recorder, useful in making diagnosis when syncope is not so frequent to be detected by standard monitoring methods. The device can also be indicated at an early stage in low-risk patients with recurrent or unexplained syncope. For a comprehensive management of patients with syncope from risk stratification to diagnosis, treatment and follow-up, the ESC guidelines also suggest the implementation of functional and multidisciplinary Syncope Units, which may be successful in reducing inappropriate tests and hospitalization rates.

  2. Syncope

    NARCIS (Netherlands)

    Benditt, David G.; van Dijk, J. Gert; Sutton, Richard; Wieling, Wouter; Lin, Joseph C.; Sakaguchi, Scott; Lu, Fei

    2004-01-01

    Syncope is a syndrome consisting of a relatively short period of temporary and self-limited loss of consciousness caused by transient diminution of blood flow to the brain (most often the result of systemic hypotension). Syncope comprises part of a subset of clinical conditions in which loss of

  3. Syncope.

    Science.gov (United States)

    Ray, Jordan C; Kusumoto, Fred; Goldschlager, Nora

    2016-02-01

    Syncope is common representing approximately 3% of ED visits and up to 6% of hospital admissions, with a cost close to 2 billion dollars per year. Diagnostic testing is often poorly sensitive and evaluations commonly lack a standardized approach. A mindful and systematic approach can increase sensitivity and improve diagnostic accuracy. A thorough history and physical exam is paramount, as conclusions drawn from the history and exam will guide further assessment. Developing a strategy for the first and, if necessary, subsequent tests will improve the accuracy of identifying the etiology of syncope and reduce cost. Although syncope has a favorable prognosis, identification of patients with structural heart disease is critical, as these patients are at greatest risk for mortality. Several risk scoring systems have been developed to help separate high risk from low risk patients. © The Author(s) 2014.

  4. Vasovagal Syncope

    Science.gov (United States)

    ... may also be called neurocardiogenic syncope. The vasovagal syncope trigger causes your heart rate and blood pressure to drop ... spell, especially if you never had one before. Causes Vasovagal syncope occurs when the part of your nervous system ...

  5. Cough syncope.

    Science.gov (United States)

    Dicpinigaitis, Peter V; Lim, Leonard; Farmakidis, Constantine

    2014-02-01

    Loss of consciousness following cough was first described in 1876 as "laryngeal vertigo" Since then, several hundred cases of what is now most commonly termed cough syncope have been reported, often in association with various medical conditions. Some early authors assumed this entity to be a form of epilepsy, but by the mid-20th century, general consensus reflected that post-tussive syncope was a consequence of markedly elevated intrathoracic pressures induced by coughing. A typical profile of the cough syncope patient emerging from the literature is that of a middle-aged, large-framed or overweight male with obstructive airways disease. Presumably, such an individual would be more likely to generate the extremely high intrathoracic pressures associated with cough-induced fainting. The precise mechanism of cough syncope remains a matter of debate. Theories proposed include various consequences of the marked elevation of intrathoracic pressures induced by coughing: diminished cardiac output causing decreased systemic blood pressure and, consequently, cerebral hypoperfusion; increased cerebrospinal fluid (CSF) pressure causing increased extravascular pressure around cranial vessels, resulting in diminished brain perfusion; or, a cerebral concussion-like effect from a rapid rise in CSF pressure. More recent mechanistic studies suggest a neurally mediated reflex vasodepressor-bradycardia response to cough. Since loss of consciousness is a direct and immediate result of cough, elimination of cough will eliminate the resultant syncopal episodes. Thus, the approach to the patient with cough syncope requires thorough evaluation and treatment of potential underlying causes of cough, as summarized in several recently published cough management guidelines. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Evaluation of syncope.

    Science.gov (United States)

    Gauer, Robert L

    2011-09-15

    Syncope is a transient and abrupt loss of consciousness with complete return to preexisting neurologic function. It is classified as neurally mediated (i.e., carotid sinus hypersensitivity, situational, or vasovagal), cardiac, orthostatic, or neurogenic. Older adults are more likely to have orthostatic, carotid sinus hypersensitivity, or cardiac syncope, whereas younger adults are more likely to have vasovagal syncope. Common nonsyncopal syndromes with similar presentations include seizures, metabolic and psychogenic disorders, and acute intoxication. Patients presenting with syncope (other than neurally mediated and orthostatic syncope) are at increased risk of death from any cause. Useful clinical rules to assess the short-term risk of death and the need for immediate hospitalization include the San Francisco Syncope Rule and the Risk Stratification of Syncope in the Emergency Department rule. Guidelines suggest an algorithmic approach to the evaluation of syncope that begins with the history and physical examination. All patients presenting with syncope require electrocardiography, orthostatic vital signs, and QT interval monitoring. Patients with cardiovascular disease, abnormal electrocardiography, or family history of sudden death, and those presenting with unexplained syncope should be hospitalized for further diagnostic evaluation. Patients with neurally mediated or orthostatic syncope usually require no additional testing. In cases of unexplained syncope, further testing such as echocardiography, grade exercise testing, electrocardiographic monitoring, and electrophysiologic studies may be required. Although a subset of patients will have unexplained syncope despite undergoing a comprehensive evaluation, those with multiple episodes compared with an isolated event are more likely to have a serious underlying disorder.

  7. Syncope and Raynaud's disease.

    Science.gov (United States)

    Guiloff, Roberto J; Rajakulendran, Sanjeev; Angus-Leppan, Heather

    2012-05-01

    To investigate an association between syncope and Raynaud's disease (RD), its clinical features, and the effect of treatment with nifedipine. One-year prospective study of new outpatients after 3 initial clinical observations. Neurology clinics at Chelsea and Westminster, Royal Free, Barnet, and Edgware Hospitals. Ten women and 1 man. The group had a mean (SD) age of 33 (17) years. Mean (SD) follow-up was 24 (36) months. Treatment with nifedipine. Observed vs expected frequency of syncope in RD, temporal relation between syncope and Raynaud's phenomenon, clinical features, and response to nifedipine treatment. Eight additional patients with syncope and RD were identified from 603 new patients (1.3%); we had expected only 1 patient to be identified with syncope and RD (P=.003). A chance association between RD and migraine with recurrent syncope was unlikely (P=.01). The prevalence of RD in patients with syncope with migraine was higher than expected (P=.03), but that of migraine in patients with RD was not (P=.2). All 11 patients had 5 or more syncopal episodes for a median of 2 years (range, 0.1-62 years). Three patients had previous diagnoses of nonepileptic attacks. Syncope was preceded by or contemporaneous with Raynaud's phenomenon in 10 patients (P=.02). Nine patients had migraine; headache was contemporaneous with syncope in 4 patients as expected by chance (P=1.0). In all patients, syncope was preceded by brainstem or vertebrobasilar symptoms, and it ceased after treatment with nifedipine. Raynaud's disease and migraine improved less. The association of syncope to RD was unrelated to chance or migraine. The temporal relation between syncope and Raynaud's phenomenon but not headache was statistically significant. Treatment with nifedipine stopped recurrent syncope in all patients. Syncope related to RD may result from brainstem ischemia. Unexplained recurrent syncope should prompt screening for RD.

  8. Epidemiology of reflex syncope

    NARCIS (Netherlands)

    Colman, N.; Nahm, K.; Ganzeboom, K. S.; Shen, W. K.; Reitsma, J.; Linzer, M.; Wieling, W.; Kaufmann, H.

    2004-01-01

    Cost-effective diagnostic approaches to reflex syncope require knowledge of its frequency and causes in different age groups. For this purpose we reviewed the available literature dealing with the epidemiology of reflex syncope. The incidence pattern of reflex syncope in the general population and

  9. Recurrent Laughter-induced Syncope

    NARCIS (Netherlands)

    Gaitatzis, A.; Petzold, A.F.S.

    2012-01-01

    Introduction: Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing,

  10. Epidemiological studies on syncope

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth

    2013-01-01

    thesis demonstrated that the ICD-10 discharge diagnosis could reliably identify a cohort of patients admitted for syncope and that the discharge code carried a high number of unexplained cases despite use of numerous tests. The last studies showed that syncope is a common cause for hospital contact......The epidemiology and prognosis of ''fainting'' or syncope has puzzled physicians over the years. Is fainting dangerous? This is a question often asked by the patient--and the answer is ''it depends on a lot of things''. The diverse pathophysiology of syncope and the underlying comorbidites...... of the patients play an essential role. In epidemiology these factors have major impact on the outcome of the patients. Until recently, even the definition of syncope differed from one study to another which has made literature reviews difficult. Traditionally the data on epidemiology of syncope has been taken...

  11. Syncope: Approach to diagnosis

    OpenAIRE

    Om Murti Anil

    2016-01-01

    Syncope is a transient loss of consciousness (LOC) due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Here, the term "transient LOC" encompasses all disorders characterized by self-limited LOC irrespective of the mechanism. Central point in pathophysiology of the development of syncope is fall in systemic blood pressure (BP) with a decrease in global cerebral blood flow. The evaluation and treatment of syncope are ve...

  12. Neurally Mediated Syncope

    OpenAIRE

    Zaqqa, Munir; Massumi, Ali

    2000-01-01

    Neurally mediated syncope is a disorder of the autonomic regulation of postural tone, which results in hypotension, bradycardia, and loss of consciousness. A wide variety of stimuli can trigger this reflex, the most common stimulus being orthostatic stress. Typically, a patient with neurally mediated syncope experiences nausea, lightheadedness, a feeling of warmth, and pallor before abruptly losing consciousness. If the cause of syncope is unclear, a stepwise approach is necessary to arrive a...

  13. Syncope: Case Studies.

    Science.gov (United States)

    Kleyman, Inna; Weimer, Louis H

    2016-08-01

    Syncope, or the sudden loss of consciousness, is a common presenting symptom for evaluation by neurologists. It is not a unique diagnosis but rather a common manifestation of disorders with diverse mechanisms. Loss of consciousness is typically preceded by a prodrome of symptoms and sometimes there is a clear trigger. This article discusses several cases that illustrate the various causes of syncope. Reflex syncope is the most common type and includes neurally mediated, vasovagal, situational, carotid sinus hypersensitivity, and atypical forms. Acute and chronic autonomic neuropathies and neurodegenerative disorders can also present with syncope. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Syncope: Approach to diagnosis

    Directory of Open Access Journals (Sweden)

    Om Murti Anil

    2016-01-01

    Full Text Available Syncope is a transient loss of consciousness (LOC due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Here, the term "transient LOC" encompasses all disorders characterized by self-limited LOC irrespective of the mechanism. Central point in pathophysiology of the development of syncope is fall in systemic blood pressure (BP with a decrease in global cerebral blood flow. The evaluation and treatment of syncope are very challenging because syncope is not the only cause of transient LOC. Moreover, symptoms of syncope are fleeting, patient is usually asymptomatic at the time of evaluation, and most of the events are often unwitnessed. The guiding principle of assessment is to differentiate syncope from other causes of transient LOC and the more benign causes of syncope from the potentially serious ones. Initial assessment of syncope consists of a detailed history and examination complemented by 12-lead electrocardiography and supine and standing BP. If the cause is suspected, then further investigations may be needed to confirm the particular disorder. A deliberate approach based on initial risk stratification is more likely to give a correct diagnosis. Despite the difficulties, a thorough evaluation of the cause of syncope is warranted in all patients, not just in those deemed to be at high mortality risk. The goal in every case should be to determine the cause with sufficient confidence to provide a reliable assessment of prognosis and treatment options.

  15. Syncope diagnostic scores.

    Science.gov (United States)

    Sheldon, Robert

    2013-01-01

    The diagnosis of syncope poses unique challenges. Syncope has multiple etiologies, with most carrying benign prognoses, and a few less common causes carrying a risk of serious morbidity or death. The history at first glance carries few clues. Faced with this many patients are heavily investigated with tests known to be both useless and expensive. For these reasons considerable emphasis has been placed on developing evidence-based and quantitative histories that might distinguish among the main causes of syncope. Quantitative histories were first developed in populations of several hundred patients with definite diagnoses of various losses of consciousness. Their derivation and use mirror those of experienced clinicians. The first score - the Calgary Syncope Seizures Score - discriminates between epileptic convulsions and syncope with a sensitivity and specificity of about 94%. The second score, the Calgary Syncope Score for normal hearts, discriminates between vasovagal syncope and other causes of syncope with a sensitivity and specificity of about 90%. The third score, the Calgary Syncope Score for Structural Heart Disease, diagnoses ventricular tachycardia with 98% sensitivity and 71% specificity. It also accurately predicts serious arrhythmic outcomes and all cause death. Gaps in the accuracy of the second score have been identified and are being addressed. These scores are proving useful in the clinic, and as entry criteria for observation studies, genetic studies, and randomized clinical trials. A very simple score predicts vasovagal syncope recurrences, based on the number of faints in the preceding year. Work from several centres indicates that scores will distinguish among competing causes of syncope in select populations, such as those with bifascicular heart block, Brugada syndrome, and Long QT syndrome. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Pathophysiological basis of syncope and neurological conditions that mimic syncope

    NARCIS (Netherlands)

    van Dijk, J. Gert; Wieling, Wouter

    2013-01-01

    The definition of syncope has clinical and pathophysiological parts. The clinical part is that syncope is a form of transient loss of consciousness (TLOC), while the pathophysiological element is that syncope differs from other forms of TLOC by virtue of the basis of true syncope - specifically

  17. Defining and classifying syncope

    NARCIS (Netherlands)

    Thijs, Roland D.; Wieling, Wouter; Kaufmann, Horacio; van Dijk, Gert

    2004-01-01

    There is no widely adopted definition or classification of syncope and related disorders. This lack of uniformity harms patient care, research, and medical education. In this article, syncope is defined as a form of transient loss of consciousness (TLOC) due to cerebral hypoperfusion. Differences

  18. Clinical classification of syncope.

    Science.gov (United States)

    Sutton, Richard

    2013-01-01

    Syncope is a presenting symptom, and in itself is not a diagnosis. An etiology or a mechanism must be sought in all cases. Currently, most clinicians classify syncope on clinical grounds by attempting to ascertain its etiology. They then use this classification to guide further management. Using this approach, reflex syncope is the most common form of syncope, occurring in approximately 60% of syncope presentations. Orthostatic hypotension presents in around 15% with arrhythmic syncope in 10% and structural heart disease as the cause of syncope in 5%; in 10% of patients no diagnosis is made. An alternative classification system uses the mechanism of syncope derived from an implanted ECG loop recorder (ILR). While this approach may be of value for optimizing therapy, it cannot be considered as the primary classification since ILRs are not typically implanted early in the evaluation process of most patients. ILRs are usually placed after "risk stratification" in those deemed not to be at high risk but remain in the uncertain etiology category. Furthermore, there exists, in current ILR technology, lack of ambulatory blood pressure monitoring capability. Thus, vasodilation leading to hypotension, the main trigger of cerebral hypoperfusion other than bradycardia, cannot be detected and is currently unavailable for use in a mechanistic-based classification. Thus, the etiological classification remains the basis for both risk stratification and subsequent clinical management. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Current Guidelines on Syncope.

    Science.gov (United States)

    Gedela, Maheedhar; Rajpurohit, Naveen; Shaikh, Kashif A; Omar, Muhammad; Pham, Scott

    2016-11-01

    Syncope is a very commonly encountered clinical problem in general practice and in the emergency department. In the evaluation of syncope, it is important to identify the specific cause to determine the treatment, to estimate the precise risk to a patient, and to reduce recurrence. Sometimes, making a diagnosis of syncope is difficult, as different mechanisms may often coexist. Syncope causes a significant impact on quality of life due to associated risk of physical injury. In particular, syncope can be a precursor to sudden cardiac death in patients with underlying cardiac disease. It is crucial to identify patients at increased risk of death, such as those with myocardial ischemia and/or potentially life-threatening genetic diseases (e.g., Long-QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and arrhythmogenic right ventricular dysplasia). After these conditions have been excluded, other benign conditions that cause syncope must be identified, and efforts should be made to improve quality of life. The lack of a gold-standard clinical tool to aid in diagnosing syncope as well as improper use of various diagnostic tests, are leading to high economic burdens in this area. Copyright© South Dakota State Medical Association.

  20. Therapy for Syncope.

    Science.gov (United States)

    Moya, Angel

    2015-08-01

    The diagnostic process in patients with syncope is not always easy and includes a detailed clinical history, physical examination and baseline electrocardiogram; according to the results of these initial approaches, some additional tests must be performed. Using this strategy, the cause of syncope is diagnosed in 60% to 80% of patients; in the remaining patients, risk stratification can be established to identify those patients at risk of having cardiac events or death at midterm follow-up. This article reviews the treatment of patients with syncope according to the different causes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Syncope in a child

    Directory of Open Access Journals (Sweden)

    Goutam Datta

    2013-01-01

    Full Text Available Acute rheumatic fever (ARF is a well-characterized illness. However, syncope in ARF due to advanced heart block is very rare. A 10-year-old boy was admitted with recurrent syncope for 12 h. The patient was diagnosed as ARF because of arthritis, elevated acute phase reactants, advanced heart block, high antistreptolysin O titer, and echocardiographic evidence of mitral regurgitation. On the 9 th day of hospitalization, the electrocardiogram revealed normal sinus rhythm.

  2. Pacing for Vasovagal Syncope

    Directory of Open Access Journals (Sweden)

    Nevin T Wijesekera

    2002-10-01

    Full Text Available Vasovagal syncope is a common condition, usually associated with a benign prognosis. Most sufferers experience only occasional symptoms, and can be treated with reassurance and lifestyle advice. However, a minority of patients are debilitated by frequent fainting that can infringe on daily living, or even mimic sudden death. This has been termed "malignant" vasovagal syncope because of the associated falls and physical injury. In these cases, a more interventional approach may be appropriate. Pharmacological measures have been the mainstay of treatment for recurrent vasovagal syncope: beta-blockers (e.g. atenolol, serotonin reuptake inhibitors (e.g. paroxetine, certain vasoconstricting drugs (e.g. midodrine and fluid retaining agents (e.g. fludrocortisone have been of particular interest. However, there is only mixed support from randomised controlled trials for the efficacy of these agents in preventing vasovagal syncope. 1,2,3 In the last few years, cardiac pacing has been advocated for the treatment of some forms of vasovagal syncope. This article reviews the literature and discusses the indications for pacing in vasovagal syncope.

  3. Evaluation and management of syncope.

    Science.gov (United States)

    Veltmann, C; Borggrefe, M; Wolpert, C; Schimpf, R

    2010-12-01

    Syncope is a common symptom and accounts for approximately 1% of all emergency visits. There are four main causes of syncope: reflex, neurally mediated syncope, orthostatic hypotension and cardiac syncope. The prognosis of patients with reflex syncopes is good, whereas patients with cardiac syncope are at increased risk for sudden cardiac death. The first diagnosic step after transient loss of consciousness the diagnosis syncope has to be established. It has to be differentiated from other forms of loss of consciousness according to current definition. Careful evaluation of the patient with syncope is mandatory. If the underlying cause of syncope can be diagnosed during initial evaluation, the patient should be treated accordingly. If the cause of syncope remains unclear, the patient has to be stratified with respect to the risk of a cardiovascular event and sudden cardiac death and further evaluation initiated. This review gives a comprehensive summary of definition, work-up and treatment of syncope based on the current guidelines for the evaluation of syncope.

  4. Summer syncope syndrome redux.

    Science.gov (United States)

    Huang, Jennifer Juxiang; Desai, Chirag; Singh, Nirmal; Sharda, Natasha; Fernandes, Aaron; Riaz, Irbaz Bin; Alpert, Joseph S

    2015-10-01

    While antihypertensive therapy is known to reduce the risk for heart failure, myocardial infarction, and stroke, it can often cause orthostatic hypotension and syncope, especially in the setting of polypharmacy and possibly, a hot and dry climate. The objective of the present study was to investigate whether the results of our prior study involving continued use of antihypertensive drugs at the same dosage in the summer as in the winter months for patients living in the Sonoran desert resulted in an increase in syncopal episodes during the hot summer months. All hypertensive patients who were treated with medications and admitted with International Classification of Diseases, 9th Revision code diagnosis of syncope were included. This is a 3-year retrospective chart review study. They were defined as "cases" if they presented during the summer months (May to September) and "controls" if they presented during the winter months (November to March). The primary outcome measure was the presence of clinical dehydration. The statistical significance was determined using the 2-sided Fisher's exact test. A total of 834 patients with an International Classification of Diseases, 9th Revision code diagnosis of syncope were screened: 477 in the summer months and 357 in the winter months. In patients taking antihypertensive medications, there was a significantly higher number of cases of syncope secondary to dehydration during the summer months (40.5%) compared with the winter months (29%) (P = .04). No difference was observed in the type of antihypertensive medication used and syncope rate. The number of antihypertensives used did not increase the cases of syncope in either summer or winter. An increased number of syncope events was observed in the summer months among people who reside in a dry desert climate and who are taking antihypertensive medications. The data confirm our earlier observations that demonstrated a greater number of cases of syncope among people who reside

  5. Syncope: therapeutic approaches.

    Science.gov (United States)

    Benditt, David G; Nguyen, John T

    2009-05-12

    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.

  6. ECG monitoring in syncope.

    Science.gov (United States)

    Ruwald, Martin H; Zareba, Wojciech

    2013-01-01

    Electrocardiographic (ECG) monitoring is a well-established procedure in the work-up of patients with syncope or for diagnosing arrhythmias. The investigation of syncope remains, however, challenging and physicians have an increasing armamentarium of diagnostic tools available and with advances in technology the role of these tools has to be continuously evaluated. The gold standard for the diagnosis of syncope is a symptom-ECG correlation, and while many studies have investigated the use and indications of both short-term and long-term monitoring; there is still some uncertainty in their clinical utility and practical approach. The use of ECG monitoring and other diagnostic tools is often subject to a "shot-gun approach" rather than a strict guideline algorithm. A systematic approach and selection of ECG monitoring tools helps permit an effective usage of the limited health care resources available for the management of unexplained syncope. In this review we aim to focus and clarify the role of short-term (Holter and external loop recorders) and long-term (implantable loop recorders) ECG monitoring in the diagnosis and management of patients with unexplained syncope. © 2013.

  7. Arrhythmogenic causes of syncope.

    Science.gov (United States)

    Swayampakula, Anil Kumar; Fong, Jane; Kulkarni, Aparna

    2014-12-01

    Syncope is one of the common presenting complaints in the pediatric emergency department. The evaluation may begin with consideration of the most common causes. However, it is important to exclude the rare causes, including cardiac arrhythmias that may lead to sudden death in young patients. Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia are some of the rare causes of primary electrical disorders of the heart. High suspicion of these disorders in the evaluation, and appropriate referral to a cardiologist may prevent sudden deaths in these patients. Here, we report 2 children with arrhythmogenic causes of syncope.

  8. The management of vasovagal syncope.

    Science.gov (United States)

    Kenny, R A; McNicholas, T

    2016-12-01

    Vasovagal syncope, or the "common faint", is the most common cause of syncope. Although it is considered a benign condition, there is a significant economic burden and significant impact on quality of life in patients with recurrent syncope, particularly in older adults. Typical vasovagal syncope usually occurs in young adults, and can often be diagnosed on the basis of history, in the absence of structural heart disease. Atypical vasovagal syncope, which is more common in older adults, can be more difficult to diagnose, however. In atypical vasovagal syncope, there is often a short or absent prodrome, and amnesia for loss of consciousness is common and it can, therefore, often be misdiagnosed, for example as falls. A more standardized approach to the diagnosis and management of patients presenting with syncope or unexplained falls is required, and it is anticipated that the number of Syncope Units will increase. Treatment of vasovagal syncope is largely conservative; however, medical or device therapy may be required when syncope is severe and refractory to conservative treatment, as there is significant impact on quality of life and it can be associated with injury. The aim of this article is to provide an overview of the diagnosis and management of vasovagal syncope. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Diagnostic algorithm for syncope.

    Science.gov (United States)

    Mereu, Roberto; Sau, Arunashis; Lim, Phang Boon

    2014-09-01

    Syncope is a common symptom with many causes. Affecting a large proportion of the population, both young and old, it represents a significant healthcare burden. The diagnostic approach to syncope should be focused on the initial evaluation, which includes a detailed clinical history, physical examination and 12-lead electrocardiogram. Following the initial evaluation, patients should be risk-stratified into high or low-risk groups in order to guide further investigations and management. Patients with high-risk features should be investigated further to exclude significant structural heart disease or arrhythmia. The ideal currently-available investigation should allow ECG recording during a spontaneous episode of syncope, and when this is not possible, an implantable loop recorder may be considered. In the emergency room setting, acute causes of syncope must also be considered including severe cardiovascular compromise due to pulmonary, cardiac or vascular pathology. While not all patients will receive a conclusive diagnosis, risk-stratification in patients to guide appropriate investigations in the context of a diagnostic algorithm should allow a benign prognosis to be maintained. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. [Treatment of syncope].

    Science.gov (United States)

    Andresen, D

    2014-06-01

    The therapy of patients with syncope is oriented to the underlying pathophysiological mechanisms. Patients with reflex syncope require careful education regarding recognition of warning signs and the avoidance of trigger factors. Treatment with beta blockers is nowadays obsolete. Even other drugs have failed to show any benefit. Pacemaker therapy should only be considered if syncope attacks are frequent and if there is a correlation between symptoms and the electrocardiogram (ECG). Because autonomic failure in patients with orthostatic hypotension is often drug-induced, reduction of the dosage or the complete elimination is the treatment of choice in these patients. A higher than normal salt and fluid intake as well as general measures to avoid delayed venous backflow, e.g. elastic stockings, may also be helpful. A change in blood pressure medication can be decisive for therapy success, especially in elderly patients with arterial hypertension. Pacemaker and defibrillator therapy is the treatment of choice in patients with bradycardia and tachycardia arrhythmias, respectively. Although these measures are simple but effective, in individual cases it is still difficult to find clinical proof that arrhythmic disorders are the causal factors for the syncope. However, also in these patients cardiac pacing should be based on a symptom ECG correlation. The recently conducted market release of the injectable miniaturized ECG recorder will alleviate the diagnostic process. The limits of this approach, however, become obvious when there is the suspicion of a life-threatening rhythm disorder, because the only difference between syncope and sudden cardiac death is that in one case the patient wakes up again.

  11. [Syncope: physiopathology, diagnosis and therapy].

    Science.gov (United States)

    Piccirillo, G; Moscucci, F; Magrì, D

    2015-01-01

    Nowadays, syncope still generates complicated challenges for clinicians for the alarm it arises in patients and, at the same time, for the multiple causes it has determined by. In almost one third of cases, syncope is neuromediated, in young subjects in vasovagal, whereas in elderly is often determinated by carotid sinus hypersensitivity. These two kinds of syncope have two completely different diagnostic approach. In some cases pace-maker implantation will be suggested to avoid new syncope episodes. In a 20% of cases, the underlying cause is arrhythmic, most of all bradiarrhythmia which is treated with pace-maker implantation. In a little number of cases, syncope is caused by ventricular arrhythmias, that require the implantation of a defibrillator device. In this review, we analyze in detail every cause of syncope with its diagnostic and therapeutic approach.

  12. Syncope in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Pejčić Ljiljana

    2017-09-01

    Full Text Available In the pediatric age group, most cases of syncope represent benign, neutrally-mediated alterations in vasomotor tone. Due to the global cerebral hypoperfusion, syncope is defined as a transient loss of consciousness followed by spontaneous recovery and/or a state of presyncope, including dizziness, lightheadedness, pallor, diaphoresis and palpitations which may precede the loss of consciousness. These symptoms could be a sign of a life-threatening event in a small subset of patients, even though most causes of syncope in childhood are benign, and life-threatening causes of syncope generally have cardiac etiology. In all these cases, routine evaluation includes history, physical examination and a 12-lead standard electrocardiogram which should be performed. Further investigation is indicated by worrying features which include syncope that occurs without warning, syncope during exercise, history of familial sudden death, and abnormalities on clinical exam or electrocardiography. The fact is that syncope generates great fear of injury or sudden death among parents and doctors, and the main aim of the present paper is to help the physician involved in the care of children to differentiate the life-threatening causes of syncope from the common, more benign neutrally-mediated syncope.

  13. An uncommon cause of syncope.

    Science.gov (United States)

    Campagna, Davide; Amaradio, Maria Domenica; Battaglia, Eliana; Demma, Shirin; Russo, Cristina; Polosa, Riccardo

    2016-04-01

    The authors present a case of a man with recurrent syncopal episodes. The patient had been hospitalized twice before reaching a correct diagnosis. The syncope was originally ascribed to a sick sinus syndrome, which led to pacemaker implantation. Nonetheless, the patient relapsed with no evidence of pacemaker dysfunction, and was readmitted to the hospital where the likely cause for his symptoms was identified: an adenocarcinoma of the lung infiltrating the vagus and recurrent laryngeal nerves. No further syncopal episodes occurred after thoracic surgery. This syncope led to an early diagnosis of lung cancer leading to appropriate and life extending treatment.

  14. Headache of neurally mediated syncope.

    Science.gov (United States)

    Khurana, Ramesh K; Van Meerbeke, Sara

    2016-12-01

    Neurally mediated syncope and migraine have a complex relationship. The aim of this study was to investigate whether patients developing syncope in the laboratory would experience migraine. Thirty-one consecutive patients were evaluated for precipitation of headache during head-up tilt (HUT)-induced syncope (reduction of systolic blood pressure [SBP] >20 mmHg and prodromal symptoms with or without loss of consciousness). Autonomic functions were assessed using heart rate response to deep breathing (HRDB), Valsalva maneuver and HUT. Blood pressure and heart rate (via electrocardiography) were continuously monitored. Headache diagnosis was based on ICHD-3 criteria. Eighteen patients (58%) experienced syncope without headache and 13 (42%) had syncope and headache (SH). No difference was observed in time of syncope onset, reduction in SBP, Valsalva ratio, HRDB or tachycardia during initial 10 minutes of HUT. Of the 13 SH patients, 11 (85%) had a past history of migraine. Two reported headache just before tilt, eight developed headache during tilt and three developed headache only after tilt. Headache resolved within 1-15 minutes in 10 out of 13 patients. No patient experienced migraine. Syncope did not precipitate migraine. Headache during syncope may be due to cerebral hypoperfusion, and cerebral hyperperfusion may cause post-syncopal headache. © International Headache Society 2016.

  15. Syncope in Patients with Pacemakers

    OpenAIRE

    Sutton, Richard

    2015-01-01

    Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5–55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative...

  16. Syncope: etiology and diagnostic approach.

    Science.gov (United States)

    Hanna, Elias B

    2014-12-01

    There are three major types of syncope: neurally mediated (the most common), orthostatic hypotensive, and cardiac (the most worrisome). Several studies have shown a normal long-term survival rate in patients with syncope who have no structural heart disease, which is the most important predictor of death and ventricular arrhythmia. The workup of unexplained syncope depends on the presence or absence of heart disease: electrophysiologic study if the patient has heart disease, tilt-table testing in those without heart disease, and prolonged rhythm monitoring in both cases if syncope remains unexplained. Copyright© 2014 The Cleveland Clinic Foundation.

  17. Syncope: Evaluation and Differential Diagnosis.

    Science.gov (United States)

    Runser, Lloyd A; Gauer, Robert L; Houser, Alex

    2017-03-01

    Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and orthostatic hypotension. Neurally mediated syncope is the most common type and has a benign course, whereas cardiac syncope is associated with increased morbidity and mortality. Patients with presyncope have similar prognoses to those with syncope and should undergo a similar evaluation. A standardized approach to syncope evaluation reduces hospital admissions and medical costs, and increases diagnostic accuracy. The initial assessment for all patients presenting with syncope includes a detailed history, physical examination, and electrocardiography. The initial evaluation may diagnose up to 50% of patients and allows immediate short-term risk stratification. Laboratory testing and neuroimaging have a low diagnostic yield and should be ordered only if clinically indicated. Several comparable clinical decision rules can be used to assess the short-term risk of death and the need for hospital admission. Low-risk patients with a single episode of syncope can often be reassured with no further investigation. High-risk patients with cardiovascular or structural heart disease, history concerning for arrhythmia, abnormal electrocardiographic findings, or severe comorbidities should be admitted to the hospital for further evaluation. In cases of unexplained syncope, provocative testing and prolonged electrocardiographic monitoring strategies can be diagnostic. The treatment of neurally mediated and orthostatic hypotension syncope is largely supportive, although severe cases may require pharmacotherapy. Cardiac syncope may require cardiac device placement or ablation.

  18. Cardiac syncope in pediatric patients.

    Science.gov (United States)

    Massin, Martial M; Malekzadeh-Milani, Sophie; Benatar, Avram

    2007-02-01

    To assess the epidemiology of cardiac syncope in children and evaluate the guidelines on its management. We analyzed the etiology to syncope and diagnostic workup in consecutive pediatric patients presenting with syncope in our emergency departments or cardiac outpatient clinics between 1997 and 2005, and who were subsequently diagnosed as having cardiac syncope. A primary cardiac cause was identified in 11 syncopal patients presenting to the emergency room and 14 patients to the cardiac clinic: supraventricular tachyarrhythmia in 9, ventricular tachyarrhythmia in 10, pacemaker dysfunction in 2, and isolated cases of sick sinus syndrome, hypoxic spell, hypertrophic cardiomyopathy, and primary pulmonary hypertension. Some elements suggested potential cardiac disease as a cause of syncope in all cases. The resting electrocardiogram and the echocardiogram were interpreted as positive and relevant to the diagnosis in 17 and 3 patients, respectively. Exercise electrocardiogram and Holter recording provided diagnostic information previously not seen on the resting electrocardiogram in six and three patients, respectively. Three children have died and one child has neurological sequelae following resuscitation. Our data support the premise that careful history taking with special focus on the events leading up to syncope, as well as a complete physical examination, can guide practitioners in discerning which syncopal children need further cardiac investigations. Copyright (c) 2007 Wiley Periodicals, Inc.

  19. Nonpharmacological treatment of reflex syncope

    NARCIS (Netherlands)

    Wieling, Wouter; Colman, Nancy; Krediet, C. T. Paul; Freeman, Roy

    2004-01-01

    Reflex syncope is a common medical problem. Vasovagal reflex syncope is the most frequent form. Although the prognosis of the disorder is excellent, it may impose substantial changes in life style and cause profound psychological distress. Thus, management of this disorder is an important issue.

  20. Syncope in patients with inherited arrhythmias

    Directory of Open Access Journals (Sweden)

    Yukiko Nakano

    2017-12-01

    Full Text Available Syncope, a common symptom of cerebral ischemia often shows a multifactorial etiopathogenesis. Although inherited arrhythmias causing syncope is uncommon, such an occurrence could be a warning sign preceding cardiac arrest. Long QT syndrome (LQTS is a typical inherited arrhythmia causing syncope in children. Early diagnosis and treatment of LQTS using beta-blockers prevents recurrent syncope in LQTS. Brugada syndrome, another typical inherited arrhythmia causes syncope or sudden cardiac arrest in young individuals. Syncope as a symptom is useful for risk stratification of fatal arrhythmias and in selection of appropriate therapy. Catecholaminergic polymorphic ventricular tachycardia, another rare inherited arrhythmia causing recurrent syncope is associated with poor outcomes without medication. Early detection and therapeutic intervention improve prognosis; thus, correct diagnosis of syncope is imperative in cases of these inherited arrhythmias. We describe syncope associated with three typical inherited arrhythmias and discuss various diagnostic modalities. Keywords: Syncope, Inherited arrhythmia, Long QT syndrome, Brugada syndrome, Catecholaminergic polymorphic ventricular tachycardia

  1. Syncope in patients with inherited arrhythmias

    OpenAIRE

    Yukiko Nakano; Shimizu Wataru

    2017-01-01

    Syncope, a common symptom of cerebral ischemia often shows a multifactorial etiopathogenesis. Although inherited arrhythmias causing syncope is uncommon, such an occurrence could be a warning sign preceding cardiac arrest. Long QT syndrome (LQTS) is a typical inherited arrhythmia causing syncope in children. Early diagnosis and treatment of LQTS using beta-blockers prevents recurrent syncope in LQTS. Brugada syndrome, another typical inherited arrhythmia causes syncope or sudden cardiac arres...

  2. Reflex syncope: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Richard Sutton

    2017-12-01

    Full Text Available For the diagnosis of reflex syncope, diligent history-building with the patient and a witness is required. In the Emergency Department (ED, the assessment of syncope is a challenge which may be addressed by an ED Observation Unit or by a referral to a Syncope Unit. Hospital admission is necessary for those with life-threatening cardiac conditions although risk stratification remains an unsolved problem. Other patients may be investigated with less urgency by carotid sinus massage (>40 years, tilt testing, and electrocardiogram loop recorder insertion resulting in a clear cause for syncope. Management includes, in general terms, patient education, avoidance of circumstances in which syncope is likely, increase in fluid and salt consumption, and physical counter-pressure maneuvers. In older patients, those that will benefit from cardiac pacing are now well defined. In all patients, the benefit of drug therapy is often disappointing and there remains no ideal drug. A role for catheter ablation may emerge for the highly symptomatic reflex syncope patient. Keywords: Cardiac pacing, Catheter ablation, Diagnosis, Drugs, Management, Reflex syncope

  3. Syncope in Patients with Pacemakers.

    Science.gov (United States)

    Sutton, Richard

    2015-12-01

    Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5-55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative tests approach results in pacing for AV block and those with a positive tilt test show no better results than with no pacemaker. The implication of tilt results is that a hypotensive tendency is clearly demonstrated by tilt positivity pointing to syncope recurrence with hypotension. This problem may be addressed by treatment with vasoconstrictor drugs in those who are suited or, more commonly, a reduction or cessation of hypotensive therapy in hypertensive patients. Other causes of syncope such as tachyarrhythmias are rare. The clinical approach to patients who report syncope is detailed.

  4. Predictors of mortality, rehospitalization for syncope, and cardiac syncope in 352 consecutive elderly patients with syncope.

    Science.gov (United States)

    Khera, Sahil; Palaniswamy, Chandrasekar; Aronow, Wilbert S; Sule, Sachin; Doshi, Jay V; Adapa, Sreedhar; Balasubramaniyam, Nivas; Ahn, Chul; Peterson, Stephen J; Nabors, Christopher

    2013-05-01

    To investigate the etiologies of syncope and predictors of all-cause mortality, rehospitalization, and cardiac syncope in consecutive elderly patients presenting with syncope to our emergency department. Participants were 352 consecutive patients aged 65 years or older with syncope admitted to hospital from the emergency department. Observational retrospective study. Review of medical records for history, physical examination, medications, and tests to determine causes of syncope. Cox stepwise logistic regression analysis was performed to identify significant independent prognostic factors for rehospitalization with syncope, all-cause mortality, and cardiac syncope. Of 352 patients, mean age 78 years, the etiology of syncope was diagnosed in 243 patients (69%). Vasovagal syncope was diagnosed in 12%, volume depletion in 14%, orthostatic hypotension in 5%, cardiac syncope in 29%, carotid sinus hypersensitivity in 2%, and drug overdose/others in 7% of patients. During a mean follow-up of 24 months, 10 patients (3%) were readmitted to the hospital for syncope and 39 (11%) died. Stepwise logistic regression analysis identified history of congestive heart failure (OR 5.18; 95% CI 1.23-21.84, P = .0257) and acute coronary syndrome (OR 5.95; 95% CI 1.11-31.79, P = .037) as independent risk factors for rehospitalization. Significant independent prognostic factors for mortality were diabetes mellitus (OR 2.08; 95% CI 1.09-3.99, P = .0263), history of smoking (OR 2.23; 95% CI 1.10-4.49, P = .0255), and use of statins (OR 0.37; 95% CI 0.19-0.72, P = .0036). Independent risk factors for predicting a cardiac cause of syncope were an abnormal electrocardiogram (OR 2.58; 95% CI 1.46-4.57, P = .0012) and reduced ejection fraction (OR 2.92; 95% CI 1.70-5.02, P Sincope nel Lazio scores did not predict mortality or rehospitalization in our study population. Significant independent risk factors for rehospitalization for syncope were congestive heart failure and acute coronary

  5. Syncope in Children and Adolescents

    OpenAIRE

    Pejčić Ljiljana; Janković Marija Ratković; Mileusnić-Milenović Radmila; Vasić Karin; Nikolić Ivana

    2017-01-01

    In the pediatric age group, most cases of syncope represent benign, neutrally-mediated alterations in vasomotor tone. Due to the global cerebral hypoperfusion, syncope is defined as a transient loss of consciousness followed by spontaneous recovery and/or a state of presyncope, including dizziness, lightheadedness, pallor, diaphoresis and palpitations which may precede the loss of consciousness. These symptoms could be a sign of a life-threatening event in a small subset of patients, even tho...

  6. Cardiogenic syncopal states in children and adolescents

    Directory of Open Access Journals (Sweden)

    S.Yu. Tereshchenko

    2011-01-01

    Full Text Available The article analyzes modern data on diagnostic approaches in children and adolescents with cardiogenic syncopal status. Clinical symptoms of vasovagal attack and common diagnostic algorithm of episode of syncope in children and adolescents are briefly described. Author pays attention to the main cardiac causes of syncope related to organic pathology of a heart and primary disorders of heart rate. The complex of clinical symptoms and signs from medical history is proposed as a predictor of high risk of cardiac origin of syncope; main methods of functional diagnostics in probable cardiogenic syncopal states in children and adolescents are discussed.Key words: children, adolescents, syncope, diagnostics.

  7. Syncope: epidemiology, etiology, and prognosis

    Science.gov (United States)

    da Silva, Rose M. F. L.

    2014-01-01

    Syncope is a common medical problem, with a frequency between 15% and 39%. In the general population, the annual number episodes are 18.1–39.7 per 1000 patients, with similar incidence between genders. The first report of the incidence of syncope is 6.2 per 1000 person-years. However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. It presents a recurrence rate of 35% and 29% of physical injury. Among the causes of syncope, the mediated neural reflex, known as neurocardiogenic or vasovagal syncope, is the most frequent. The others are of cardiac origin, orthostatic hypotension, carotid sinus hypersensitivity, neurological and endocrinological causes and psychiatric disorders. The diagnosis of syncope can be made by clinical method associated with the electrocardiogram in up 50% of patients. Its prognosis is determined by the underlying etiology specifically the presence and severity of cardiac disease. The annual mortality can reach between 18 and 33% if cardiac cause, and between 0 and 12% if the non-cardiac cause. Thus, it is imperative to identify its cause and risk stratification for positive impact in reducing morbidity and mortality. PMID:25538626

  8. Syncope: epidemiology, etiology and prognosis.

    Directory of Open Access Journals (Sweden)

    Rose M F Lisboa Da Silva

    2014-12-01

    Full Text Available Syncope is a common medical problem, with a frequency between 15% and 39%. In the general population, the annual number episodes are 18.1 to 39.7 per 1000 patients, with similar incidence between genders. The first report of the incidence of syncope is 6.2 per 1000 person-years. However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. It presents a recurrence rate of 35% and 29% of physical injury. Among the causes of syncope, the mediated neural reflex, known as neurocardiogenic or vasovagal syncope, is the most frequent. The others are of cardiac origin, orthostatic hypotension, carotid sinus hypersensitivity, neurological and endocrinological causes and psychiatric disorders. The diagnosis of syncope can be made by clinical method associated with the electrocardiogram in up 50% of patients. Its prognosis is determined by the underlying etiology specifically the presence and severity of cardiac disease. The annual mortality can reach between 18 and 33% if cardiac cause, and between 0 and 12% if the noncardiac cause. Thus, it is imperative to identify its cause and risk stratification for positive impact in reducing morbidity and mortality.

  9. Syncope: Approaches to Diagnosis and Management.

    Science.gov (United States)

    Palaniswamy, Chandrasekar; Aronow, Wilbert S; Agrawal, Nikhil; Balasubramaniyam, Nivas; Lakshmanadoss, Umashankar

    2016-01-01

    Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion followed by spontaneous recovery. Common causes of syncope include vasovagal syncope, situational syncope, orthostatic hypotension, carotid sinus hypersensitivity, left- and right-sided obstructive cardiac lesions, and cardiac arrhythmias. History and physical examination often provide valuable clues about the underlying etiology of syncope. Admission decisions in the emergency department can be guided by various risk prediction scores. Evaluation of a patient with syncope involves a large battery of diagnostic tests that include a 12-lead electrocardiogram, Holter monitoring, echocardiogram, tilt table testing, ischemia evaluation, electrophysiologic studies, and other imaging tests. Despite the availability of these advanced diagnostic tests, a significant proportion of patients with syncope remain undiagnosed. Therapy should be tailored based on the underlying etiology of syncope.

  10. Cardiovascular syncope: diagnostic approach and risk assessment.

    Science.gov (United States)

    Barsheshet, A; Goldenberg, I

    2011-06-01

    Cardiovascular syncope, defined as a transient loss of consciousness resulting from a global cerebral hypoperfusion characterized by rapid onset and spontaneous rapid recovery, comprises events due to bradyarrhythmias, tachyarrhythmias, and structural cardiovascular disease. The evaluation of cardiovascular syncope must be careful and thorough as this type of syncope is associated with increased subsequent morbidity and mortality. In this review we provide current data regarding specific causes of cardiovascular syncope, diagnostic approach, risk stratification, and management of patients who experience a syncope event when a cardiovascular disorder is suspected to be a precipitating factor for the syncope event. Multiple risk stratifications studies were carried out to identify patients at high risk for cardiovascular syncope; we provide several prominent examples of such risk stratifications, with special focus on the congenital long QT syndrome (LQTS) as an example of an arrhythmogenic disorder associated with syncope and sudden cardiac death in young individuals without structural heart disease.

  11. Priorities for emergency department syncope research

    NARCIS (Netherlands)

    Sun, Benjamin C.; Costantino, Giorgio; Barbic, Franca; Bossi, Ilaria; Casazza, Giovanni; Dipaola, Franca; McDermott, Daniel; Quinn, James; Reed, Matthew; Sheldon, Robert S.; Solbiati, Monica; Thiruganasambandamoorthy, Venkatesh; Krahn, Andrew D.; Beach, Daniel; Bodemer, Nicolai; Brignole, Michele; Casagranda, Ivo; Duca, Piergiorgio; Falavigna, Greta; Ippoliti, Roberto; Montano, Nicola; Olshansky, Brian; Raj, Satish R.; Ruwald, Martin H.; Shen, Win-Kuang; Stiell, Ian; Ungar, Andrea; van Dijk, J. Gert; van Dijk, Nynke; Wieling, Wouter; Furlan, Raffaello

    2014-01-01

    There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of

  12. Syncope: classification and risk stratification.

    Science.gov (United States)

    Puppala, Venkata Krishna; Dickinson, Oana; Benditt, David G

    2014-03-01

    Syncope is one of the most common reasons for emergency department and urgent care clinic visits. The management of syncope continues to be a challenging problem for front-line providers inasmuch as there are a multitude of possible causes for syncope ranging from relatively benign conditions to potentially life-threatening ones. In any event, it is important to identify those syncope patients who are at immediate risk of life-threatening events; these individuals require prompt hospitalization and thorough evaluation. Conversely, it is equally important to avoid unnecessary hospitalization of low-risk patients since unneeded hospital care adds to the healthcare cost burden. Historically, front-line providers have taken a conservative approach with admission rates as high as 30-50% among syncope patients. A number of studies evaluating both the short- and long-term risk of adverse events in patients with syncope have focused on development of risk-stratification guidelines to assist providers in making a confident and well-informed choice between hospitalization and out-patient referral. In this regard, a much needed consensus on optimal decision-making process has not been developed to date. However, knowledge from various available risk-stratification studies can be helpful. This review summarizes the findings of various risk-stratification studies and points out key differences between them. While, the existing risk-stratification methods cannot replace critical assessment by an experienced physician, they do provide valuable guidance. In addition, the various risk-assessment schemes highlight the need for careful initial clinical assessment of syncope patients, selective testing, and being mindful of the short- and long-term risks. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  13. The diagnosis and management of syncope.

    Science.gov (United States)

    Sutton, Richard; Brignole, Michele; Benditt, David; Moya, Angel

    2010-10-01

    The European Society of Cardiology has recently revised its guidelines on the diagnosis and management of syncope. This article summarizes the recommendations of these guidelines, outlining the initial evaluation of transient loss of consciousness, risk stratification, diagnostic testing, and the recommended treatment for patients with syncope of various etiologies. Special points regarding the evaluation of syncope in children and the elderly are outlined, and the role of syncope management units in hospitals is discussed.

  14. Autonomic and electrocardiographic changes in cardioinhibitory syncope

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Kaijer, Michelle Nymann; Mehlsen, Anne-Birgitte

    2008-01-01

    Cardioinhibitory syncope (CS) is a neurally mediated response causing bradycardia or asystole. This study reports on changes in blood pressure, heart rate variability (HRV), and ECG patterns before and after syncope with asystole.......Cardioinhibitory syncope (CS) is a neurally mediated response causing bradycardia or asystole. This study reports on changes in blood pressure, heart rate variability (HRV), and ECG patterns before and after syncope with asystole....

  15. Etiology of syncope in hospitalized patients

    OpenAIRE

    Saravi, Mehrdad; Ahmadi Ahangar, Alijan; Hojati, Mohammad Masood; Valinejad, Ebrahim; Senaat, Ahmad; Sohrabnejad, Reza; Khosoosi Niaki, Mohammad Reza

    2015-01-01

    Background: Syncope is a common clinical problem which can be remarkably debilitating and associated with high health care costs. Syncope is a clinical syndrome with many potential causes. The aim of the study was to determine the etiologies of patients with syncope in the emergency department (ED) of a referral and general university hospital. Methods: One hundred sixty-five consecutive patients aged more than 18 years old with syncope were admitted to the emergency department of Ayatollah R...

  16. [Causes of unexplained syncope in children].

    Science.gov (United States)

    Kang, Mei-Hua; Xu, Yi; Wang, Cheng; Wu, Li-Jia; Lin, Ping; Li, Fang; Xie, Zhen-Wu

    2012-10-01

    To investigate the common causes of unexplained syncope in children. A total of 434 children with unexplained syncope who were aged from 3.0 to 17.9 years (192 males and 242 females) and who saw the doctor between January 2006 and October 2011. were examined in order to explore the detailed histories and causes of syncope and to analyze variance in causes among different ages, genders, syncope frequencies and head-up tilt test (HUTT) results. (1) The causes of occasional syncope included persistent standing (30%), movement (13%), change in body position(9%), sitting(7%), and playing(6%). Persistent standing was more common as a cause in females than in males (Psyncope was mainly seen in males. Sultry weather was the main cause of syncope in females. Change in body position was a more common cause in the ≥12 years group than in the causes showed no significant differences among different age groups. Change in body position was a more common cause of syncope in children with negative HUTT results than in those with positive HUTT results (Pcauses of occasional syncope can induce repeated syncope, and most repeated syncope (56%) had the same cause. The common causes of unexplained syncope include persistent standing, movement and changes of body position in children. Avoiding these causes is helpful for prevention of childhood syncope.

  17. [Syncope in adolescents. Diagnostic and therapeutic approach].

    Science.gov (United States)

    Eirís Puñal, J; Rodríguez Núñez, A; Gómez Lado, C; Martinón-Torres, F; Castro-Gago, M; Martinón Sánchez, J María

    2005-10-01

    Syncopal episodes are frequent in adolescence. Syncope is usually a benign, self-limiting condition but it may be a warning sign of serious disease that must be diagnosed and appropriately treated. The present article provides a review of the basic principles of the differential diagnosis of syncope in the adolescent patient and treatment recommendations.

  18. Evaluation and Management of Syncope

    Directory of Open Access Journals (Sweden)

    Paveljit S. Bindra

    2008-01-01

    Full Text Available Context Syncope is a commonly encountered by primary care physicians and cardiologists. Etiology is frequently not apparent, and patients may undergo unnecessary tests. Treatment must be tailored to the likely etiology. Complexities of diagnosis and treatment often warrant referral to a specialist. Objective To highlight the evolving recommendations for managing syncope in a clinically and cost effective manner. Evidence Acquisition An electronic literature search was undertaken of the Medline database from January 1996 to April 2006, using the Medical Subject Heading syncope, defibrillators, pacemakers, echocardiogram, cardiomyopathy, long QT syndrome, Arrhythmogenic right ventricular dysplasia , and Brugada syndrome. Abstracts and titles were reviewed to identify English-language trials. Bibliographies from the references as well as scientific statements from the Heart Rhythm Society, American Heart Association, and American College of Cardiology were reviewed. Evidence Synthesis A methodical approach to syncope can improve diagnosis, limit testing, and identify patients at risk of fatal outcome. A thorough history, physical exam and electrocardiogram are critical to the initial diagnosis. Presence of heart disease determines the extent of work-up and treatment. A trans-thoracic echocardiogram should be performed in patients with an unclear diagnosis and a positive cardiac history or an abnormal ECG. Ventricular arrhythmias are the most common cause of syncope in patients with structural heart disease. Patients with an ejection fraction less than 30 percent should receive an implantable defibrillator with few exceptions. An electrophysiology study may assist risk stratification in syncopal patients with borderline ventricular function. In patients without structural heart disease, the presence of a well defined arrhythmia syndrome consistent with a genetically determined risk of sudden death must be sought. The 12-lead electrocardiogram

  19. Right Atrial Myxoma and Syncope.

    Science.gov (United States)

    Babs Animashaun, Islamiyat; Akinseye, Oluwaseun A; Akinseye, Leah I; Akinboboye, Olakunle O

    2015-09-21

    Right atrial myxoma accounts for 15-20% of cardiac myxomas and syncope is a very rare manifestation. We present the case of an 89-year-old man with right atrial myxoma and syncope, and discuss the role of cardiac magnetic resonance imaging (MRI) in the diagnosis of myxomas. An 89-year-old man with a history of hypertension, hyperlipidemia, chronic kidney disease stage 4, mild dementia, and benign prostatic hyperplasia presented to the emergency department with an episode of syncope. Physical examination demonstrated normal and regular heart sounds, and normal respiratory rate and oxygen saturation. Echocardiogram described a well-circumscribed echo-dense mass in the right atrial cavity, which was attached to the septum but not obstructing the tricuspid annulus, measuring 1.7×2.2 cm at its widest diameter. Cardiac MRI revealed a mass with dark intensity which enhanced heterogeneously following intravenous administration of gadolinium-chelate, consistent with a myxoma. The location of this myxoma, coupled with the presence of a stalk allowing mobility, provides a clue to how this patient experienced transient obstruction of the tricuspid valve leading to syncope. Right heart tumors should be considered in the differential diagnosis of unexplained syncope. Cardiac MRI with gadolinium-chelate administration can help differentiate this tumor from a right-sided atrial thrombus, which can pose a diagnostic challenge.

  20. The inpatient management of syncope.

    Science.gov (United States)

    Tattersall, Laura C; Reed, Matthew J

    2010-11-01

    The management and risk stratification of patients with syncope in the Emergency Department (ED) has been the emphasis of much recent research, however little is known about inpatient management especially in the UK. The aim of this study was to examine the inpatient management of patients with syncope admitted to hospital from a UK ED. This was a single centre prospective observational cohort study, recruiting patients with syncope admitted to hospital from a UK ED. Inpatient management was examined focusing on length of stay and investigations undertaken. Between 3 March 2007 and 22 July 2008, 540 patients presenting with syncope to the ED of the Royal Infirmary of Edinburgh, UK were admitted and enrolled. Median and mean length of stay was 1 day (IQR 1-4) and 6.3 days (SD 15.5). In all, 392 (73%) patients were admitted to General/Acute Medicine, 39 (7%) to Cardiology, 35 (7%) to Medicine of the Elderly, 33 (6%) to surgical specialities and the rest to other specialities. A diagnosis was finally made in 342 (63%) patients including 33 (85%) of the 39 admitted to Cardiology and 239 (61%) of the 392 patients admitted to General/Acute Medicine. The use of diagnostic tests varied between specialities with more intensive investigation undertaken in patients admitted to Cardiology. The current approach to the inpatient management of syncope is speciality dependent. Standardised diagnostic pathways may improve diagnostic yield and cost effectiveness.

  1. Syncope causes transient focal neurological symptoms.

    Science.gov (United States)

    Ryan, D J; Harbison, J A; Meaney, J F; Rice, C P; King-Kallimanis, B; Kenny, R A

    2015-09-01

    The prevalence of focal neurology (FN) as a consequence of syncope is unknown. The aim of the study was to determine its prevalence, risk factors and short-term consequences. A consecutive sample of syncope-unit attendees during a 9-month period had detailed diagnostic syncope evaluation as per European Cardiac Society guidelines coupled with assessment for FN present during syncope/pre-syncope by screening questionnaire, follow-up interview and neuroimaging (1.5T magnetic resonance imaging [MRI]). All participants were followed up for 24 months. Risk factors for FN were identified by comparing FN cases with syncope controls without FN (3:1 ratio). Five-hundred and forty consecutively attended for investigation of syncope (n = 401) and pre-syncope (n = 139). Thirty-one (5.7%) had FN events during hypotensive symptoms, mean age 49 years (19-85). The majority of FN cases had vasovagal syncope (VVS); 22 (71%), whereas eight had OH (25.8%) and one (3.2%) had cardiac arrhythmia. Median duration of FN was 15 min (IQR: 34.5). MRI in 28 (90%) was normal and in 3, old cerebral infarction was evident. Risk factors for FN/syncope were frequent syncope (P = 0·008), childhood syncope (P syncope/pre-syncope have co-extant FN, which during 24-month follow-up, does not progress to a persistent deficit (>24 h). Awareness of co-occurrence of FN and syncope is important as stroke misdiagnosis results in aggressive anti-hypertensive management and future events may ensue. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Syncope in Children and Adolescents.

    Science.gov (United States)

    Yeh, Jay

    2015-12-01

    Syncope is an abrupt loss of consciousness and postural tone frequently due to disturbance of the normal autonomic nervous system reflexive mechanisms in regulating peripheral vascular resistance, blood pressure, and heart rate. This leads to a transient decrease in cerebral blood flow. It is a common presenting complaint in children and adolescents. In many cases, there is a characteristic preceding prodrome of dizziness, nausea, diaphoresis, and pallor. Although most cases of syncope are benign in etiology, it frequently causes stress and anxiety in regard to potential cardiovascular disease and possible sudden cardiac death. With careful screening by detailed patient history, comprehensive physical examination, and electrocardiogram (ECG), a significant majority of patients with serious underlying cardiac conditions will be identified. The routine use of echocardiography, ambulatory ECG, tilt-table tests, and exercise stress tests is expensive and frequently of low diagnostic yield. With benign forms of syncope, patient reassurance and education should be the first-line treatment. Copyright 2015, SLACK Incorporated.

  3. Syncope in the Older Person.

    Science.gov (United States)

    Matthews, Iain G; Tresham, Isabel A E; Parry, Steve W

    2015-08-01

    Syncope in the older person carries a high morbidity, mortality, and health economic burden. While neurally mediated disorders and orthostatic hypotension account for the majority of syncopal episodes in this age group, around a third of causes are cardiac, predominantly arrhythmic. Clinicians need to be aware of the management of potential comorbid issues such as osteoporosis and cognitive impairment and if not in a position to act on them, ensure that appropriate specialist help is sought. Further work is needed to understand the pathophysiology and hence the management of syncope in the older patient, with ongoing studies helping to tease out some of the treatment controversies. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Confounders of vasovagal syncope: postural tachycardia syndrome.

    Science.gov (United States)

    Nwazue, Victor C; Raj, Satish R

    2013-02-01

    Most patients who present to a cardiologist with syncope have vasovagal (reflex) syncope. A busy syncope practice often also sees patients with postural tachycardia syndrome, often presenting with severe recurrent presyncope. Recognition of this syncope confounder might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. Postural tachycardia syndrome can often be differentiated from vasovagal syncope by its hemodynamic pattern during tilt table test and differing clinical characteristics. This article reviews the presentation of postural tachycardia syndrome and its putative pathophysiology and presents an approach to nonpharmacologic and pharmacologic management. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Structural cure for reflex syncope?

    Science.gov (United States)

    Sulke, Neil; Eysenck, William; Badiani, Sveeta; Furniss, Stephen

    2016-01-20

    The ROX Coupler is a device that allows creation of a central arteriovenous anastomosis at the iliac level. The device has been shown to improve exercise capacity in patients with chronic obstructive pulmonary disease and is CE marked for the treatment of resistant and uncontrolled hypertension. Reflex syncope is a challenging clinical condition with limited proven therapeutic options. We describe the resolution of symptoms and tilt table response of a patient who underwent insertion of a ROX Coupler to treat hypertension, and also incidentally had pre-existing vasodepressor syncope. 2016 BMJ Publishing Group Ltd.

  6. Risk stratification key in patients with syncope.

    Science.gov (United States)

    Leo, Milena; Betts, Tim R

    2013-01-01

    Many conditions may mimic syncope, including epilepsy, TIA, coma, hypoxia, hypoglycaemia, hyperventilation, falls, drop attacks, and psychogenic pseudosyncope. An episode of loss of consciousness is highly likely to be syncope if it is complete, transient, has rapid onset and short duration, with associated loss of postural tone and is followed by a spontaneous and complete recovery without sequelae. Reflex syncope has a more favourable, benign prognosis but structural and primary electrical heart diseases are major risk factors for sudden cardiac death. The initial assessment in patients with suspected syncope should aim to confirm the syncopal nature of the episode, identify the most likely cause of syncope and stratify the risk of major cardiovascular events or sudden arrhythmic death. Vasovagal syncope represents the most common cause of syncope, irrespective of age, sex and comorbidity. Cardiac syncope is the second most common cause. A detailed history should be taken, and a thorough physical examination and an ECG performed as initial assessment in suspected syncope. A detailed account of the episode should be obtained from the patient, and any witnesses, as well as a drug history. Treatment of reflex syncope and orthostatic hypotension is based on lifestyle modifications. It is important first of all to identify and treat the potential secondary causes of arrhythmic syncope. Cardiac pacing is indicated in patients with bradycardia-induced syncope. For patients with tachycardia-induced syncope, drug therapy, catheter ablation or ICD implantation are potential options. Because of its high efficacy, catheter ablation is the first choice in most supraventricular tachycardias and in patients with ventricular tachycardia and a normal heart.

  7. Syncope, cerebral perfusion, and oxygenation

    NARCIS (Netherlands)

    van Lieshout, Johannes J.; Wieling, Wouter; Karemaker, John M.; Secher, Niels H.

    2003-01-01

    During standing, both the position of the cerebral circulation and the reductions in mean arterial pressure (MAP) and cardiac output challenge cerebral autoregulatory (CA) mechanisms. Syncope is most often associated with the upright position and can be provoked by any condition that jeopardizes

  8. The role of autonomic testing in syncope.

    Science.gov (United States)

    Jones, Pearl K; Gibbons, Christopher H

    2014-09-01

    Syncope is a common presenting complaint in both the inpatient and outpatient settings. The main goals in the clinical evaluation of syncope are to identify an underlying etiology, to stratify risk and to guide plans for therapeutic intervention. Testing begins with an initial electrocardiogram to screen for any cardiac rhythm abnormalities. Heart rate variability to paced breathing provides a standard measure of cardiac parasympathetic function and offers clues towards an autonomic cause of syncope. A Valsalva maneuver is used to evaluate for parasympathetic dysfunction through the Valsalva ratio. In addition, sympathetic adrenergic function is assessed through evaluation of blood pressure response during the Valsalva maneuver. Abnormalities to the Valsalva maneuver can suggest clues towards an autonomic cause of syncope. Head-up tilt table testing is an important part of the autonomic evaluation of patients with syncope, and can be diagnostic for many disorders that result in syncope including orthostatic hypotension, neurally mediated syncope, postural tachycardia syndrome or delayed orthostatic hypotension. Autonomic function testing provides a safe and controlled environment for evaluation of patients, and plays a pivotal role in the diagnosis of syncope, particularly in challenging cases. While the initial clinical evaluation of syncope involves a detailed history and physical examination; in situations where the diagnosis is unknown, the addition of autonomic testing is complementary and can lead to identification of autonomic causes of syncope. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Syncope: Outcomes and Conditions Associated with Hospitalization.

    Science.gov (United States)

    Joy, Parijat Saurav; Kumar, Gagan; Olshansky, Brian

    2017-06-01

    Syncope is a perplexing problem for which hospital admission and readmission are contemplated but outcomes remain uncertain. Our purpose was to determine the incidence of admissions and readmissions for syncope and compare associated conditions, in-hospital outcomes, and resource utilization. The 2005-2011 California Statewide Inpatient Database was utilized. Patients of age ≥18 years admitted under International Classification of Diseases, Ninth Revision, Clinical Modification code 780.2 ("syncope or collapse") were selected. Records with a primary discharge diagnosis of syncope were classified as primary syncope. Primary outcome was mortality and secondary outcome measures were cardiopulmonary resuscitation, mechanical ventilation, discharge disposition, length of stay, frequency of readmission and hospital charges. An estimated 1.52 ± 0.02% admissions every year are related to syncope. Among admissions for syncope, in 42.1%, the cause remained unknown; 23% of syncope admissions were for recurrent episodes. The top 5 associated new diagnoses were hypokalemia (0.24%), ventricular tachycardia (0.17%), atrial fibrillation (0.16%), dehydration (0.12%), and hyponatremia (0.12%). Mortality rates are lower for primary vs secondary syncope (0.2% vs 1.4%; P syncope were pulmonary hypertension (odds ratio 12.3; 95% confidence interval, 3.34-45.04) and metastatic cancer (odds ratio 7.22; 95% confidence interval, 4.50-11.58). Major adverse events showed a decreasing trend for patients with multiple syncope admissions. Older patients and defibrillators or pacemaker recipients are admitted more often but experience negligible adverse events. Over a decade, median hospital charge for a single syncope admission has increased by 1.5 times. Despite a good prognosis, syncope is a frequent cause for hospitalization, particularly in the elderly. Present evaluation strategies are expensive and lack diagnostic value. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. [Psychological profile of children with neurogenic syncope].

    Science.gov (United States)

    Vallone, Roberta; Placidi, Silvia; Pennacchia, Massimo; Gentile, Simonetta; Drago, Fabrizio

    2014-10-01

    At present, syncope is still a matter of great concern and anxiety for both parents and children. Neurocardiogenic syncope is the most common type of syncope in children with an incidence of 70%. It usually has a benign etiology, with rapid loss of consciousness and spontaneous resolution. In case of neurocardiogenic syncope, it is important to assess the emotional and/or adaptive capacity of the patient. From a psychological point of view, the presence of a traumatic area of development has been reported in pediatric patients with syncope. This area is characterized by symptoms of anxiety and/or depression, self-withdrawal, somatic complaints and dissociation. Neurocardiogenic syncope in pediatric age can be the expression of a psychosomatic disorder underlying psychopathological vulnerability.

  11. [Syncope: electrocardiogram and autonomic function tests].

    Science.gov (United States)

    Uribe, William; Baranchuk, Adrián; Botero, Federico

    2016-12-23

    Syncope represents one of the most frequent reasons for consultation in the emergency department. A proper identification will allow a precise etiologic approach and the optimization of delivery of health resources.
Once knowing the classification of syncope; it is the clinical interrogatory what enables to discriminate which of these patients present with a neurogenic mediated syncope or a cardiac mediated syncope. The use of diagnostic methods such as the tilt test, will clarify what type of neurally mediated syncope predominates in the patient.
The electrocardiogram is the cornerstone in the identification of those patients who had a true episode of self-limited or aborted sudden death as the first manifestation of their syncope, a fact which provides prognostic and therapeutic information that will impact the morbidity and mortality.

  12. Syncope and Motor Vehicle Crash Risk

    DEFF Research Database (Denmark)

    Numé, Anna-Karin; Gislason, Gunnar; Christiansen, Christine Benn

    2016-01-01

    IMPORTANCE: Syncope may have serious consequences for traffic safety. Current clinical guideline recommendations on driving following syncope are primarily based on expert consensus. OBJECTIVE: To identify whether there is excess risk of motor vehicle crashes among patients with syncope compared...... identified 41 039 individuals with a first-time diagnosis of syncope from emergency department or hospital. MAIN OUTCOMES AND MEASURES: Rate of motor vehicle crashes (including nonfatal and fatal crashes), based on multivariate Poisson regression models, using the total Danish population as reference....... RESULTS: The 41 039 patients with syncope had a median age of 66 years (interquartile range [IQR], 47-78 years); 51.0% were women; and 34.8% had cardiovascular disease. Through a median follow-up of 2.0 years (IQR, 0.8-3.3 years), 1791 patients with syncope (4.4%) had a motor vehicle crash, 78.1% of which...

  13. Diagnosing vasovagal syncope based on quantitative history-taking: validation of the Calgary Syncope Symptom Score

    NARCIS (Netherlands)

    Romme, Jacobus J. C. M.; van Dijk, Nynke; Boer, Kimberly R.; Bossuyt, Patrick M. M.; Wieling, Wouter; Reitsma, Johannes B.

    2009-01-01

    Aims It can be difficult to distinguish vasovagal syncope, the most common cause of transient loss of consciousness (T-LOC), from other causes of syncope by history taking. The Calgary Syncope Symptom Score (Calgary Score) is a toot developed for this purpose. We studied its performance in a series

  14. Fibroelastoma as a Culprit of Syncope

    Directory of Open Access Journals (Sweden)

    Giuliano De Portu

    2013-01-01

    Full Text Available We present a case of a valvular mass diagnosed by emergency department bedside ultrasonography in a young patient with syncope. Bedside ultrasound has become a valuable tool in the evaluation of patients with syncope in the emergency department. This patient was believed to have a fibroelastoma on ultrasound that was confirmed by magnetic resonance and ultimately by postsurgical pathological evaluation. The indications and findings of using ultrasonography as part of the workup of syncope in the emergency department are discussed.

  15. Recognizing life-threatening causes of syncope.

    Science.gov (United States)

    Khoo, Clarence; Chakrabarti, Santabhanu; Arbour, Laura; Krahn, Andrew D

    2013-02-01

    While the overall prognosis of syncope is favorable, the identification of individuals with a potentially life-threatening cause is of paramount importance. Cardiac syncope is associated with an elevated risk of mortality, and includes both primary arrhythmic and obstructive etiologies. Identification of these individuals is contingent on careful clinical assessment and judicious use of diagnostic investigations. This article focuses on life-threatening causes of syncope and a diagnostic approach to facilitate their identification. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. The management of syncope in older adults.

    Science.gov (United States)

    Ungar, A; Morrione, A; Rafanelli, M; Ruffolo, E; Brunetti, M A; Chisciotti, V M; Masotti, G; Del Rosso, A; Marchionni, N

    2009-08-01

    Syncope is a frequent symptom in older patients. The diagnostic and therapeutic management may be complex, particularly in older adults with syncope and comorbidities or cognitive impairment. Morbidity related to syncope is more common in older persons and ranges from loss of confidence, depressive illness and fear of falling, to fractures and consequent institutionalization. Moreover, advan-ced age is associated with short and long-term morbidity and mortality after syncope. A standardized approach may obtain a definite diagnosis in more than 90% of the older patients with syncope and may reduce diagnostic tools and hospitalizations. The initial evaluation, including anamnesis, medical examination, orthostatic hypotension test and electrocardiogram (ECG), may be more difficult in the elderly, specially for the limited value of medical history, particularly for the certain diagnosis of neuro-mediated syncope. For this reason neuroautonomic assessment is an essential step to confirm a suspect of neuromediated syncope. Orthostatic blood pressure measurement, head up tilt test, carotid sinus massage and insertable cardiac monitor are safe and useful investigations, particularly in older patients. The most common causes of syncope in the older adults are orthostatic hypotension, carotid sinus hypersensitivity, neuromediated syncope and cardiac arrhythmias. The diagnostic evaluation and the treatment of cardiac syncope are similar in older and young patients and for this reason will not be discussed. In older patients unexplained falls could be related to syncope, particularly in patients with retrograde amnesia. There are no consistent differences in the treatment of syncope between older and younger population, but a specific approach is necessary for orthostatic hypotension, drug therapy and pacemaker implantation.

  17. The Role of the Syncope Management Unit.

    Science.gov (United States)

    Kenny, Rose Anne; Rice, Ciara; Byrne, Lisa

    2015-08-01

    Syncope is a common symptom, experienced by 15% of persons less than 18 years old and up to 23% of elderly nursing home residents, so it is important to consider optimizing strategies for the management of these patients. The strategy selected will inevitably differ from place to place. However, an organized structure offers more cost-effective care. This article discusses possible health care delivery models for syncope management and reviews the current status of the organization of syncope care, to show the value of a multidisciplinary approach to the organized management of patients with syncope. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. A practical approach to investigation of syncope.

    Science.gov (United States)

    Hatoum, Tarek; Sheldon, Robert

    2014-06-01

    Syncope is caused by cerebral hypoperfusion. Most fainting is simply vasovagal syncope and the challenge lies in identifying the few patients who have potentially life-threatening causes of syncope. Syncope patients constitute 1%-2% of emergency department visits and approximately 30%-50% are admitted to hospital. The known causes are vasovagal syncope (50%), and orthostatic hypotension and cardiac syncope (7% each). Structural heart disease is noted in 3%. The 30-day mortality is only 0.7%, and the 30-day adverse outcome is 4.5%. Risk stratification and diagnosis are important. High-risk patients might have a fatal cause, and low-risk patients do not. Risk markers include syncope while supine or with marked exertion, without a prodrome, with structural heart disease or heart failure, with a family history of sudden death, and with an abnormal electrocardiographic findings. Ischemic heart disease and hypotension are also risk factors. The history captures the preceding situation or activity, prodromal symptoms, and symptoms after syncope. Very simple diagnostic scores exist to help. Investigations beyond an electrocardiogram are not usually needed, and aim to: (1) assess whether a structural substrate exists; (2) capture risk factor data, assuming it is related to the syncope; (3) capture data during clinical syncope; and (4) induce syncope under controlled conditions. The most commonly used tests are implantable loop recorders, which establish a diagnosis in 30%-40% of patients over 2-3 years; and tilt table testing. Neither are needed most of the time. A good history provides more useful and more accurate information in most patients. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Syncope: Evaluation and management | Mohamed | Libyan Journal ...

    African Journals Online (AJOL)

    Syncope is a sudden transient loss of consciousness and postural tone with spontaneous recovery. Loss of consciousness results from a reduction of blood flow to the reticular activating system located in the brain stem. Syncope is an important clinical problem which accounts for 1% of hospital admissions and 3% of ...

  20. Management of syncope in adults: an update.

    Science.gov (United States)

    Chen, Lin Y; Benditt, David G; Shen, Win-Kuang

    2008-11-01

    Syncope is a clinical syndrome characterized by transient loss of consciousness and postural tone that is most often due to temporary and spontaneously self-terminating global cerebral hypoperfusion. A common presenting problem to health care systems, the management of syncope imposes a considerable socioeconomic burden. Clinical guidelines, such as the European Society of Cardiology Guidelines on Management of Syncope, have helped to streamline its management. In recent years, we have witnessed intensive efforts on many fronts to improve the evaluation process and to explore therapeutic options. For this update, we summarized recent active research in the following areas: the role of the syncope management unit and risk prediction rules in providing high-quality and cost-effective evaluation in the emergency department, the implementation of structured history taking and standardized guideline-based evaluation to improve diagnostic yield, the evolving role of the implantable loop recorder as a diagnostic test for unexplained syncope and for guiding management of neurally mediated syncope, and the shift toward nonpharmacological therapies as mainstay treatment for patients with neurally mediated syncope. Syncope is a multidisciplinary problem; future efforts to address critical issues, including the publication of clinical guidelines, should adopt a multidisciplinary approach.

  1. Clinical approach to syncope in children.

    Science.gov (United States)

    Moodley, Manikum

    2013-03-01

    Pediatric syncope is one of the most common neurological problems in the pediatric population in both the office setting and in the emergency department. The abrupt brief loss of consciousness is usually dramatic and alarming to patients, family, onlookers, and providers. The differential diagnosis of syncope is wide but most cases are benign. A comprehensive but focused history and a thorough clinical examination are usually the cornerstones in the diagnosis of high-risk patients. It should be noted that the evaluation of syncope in children is costly and testing provides a low diagnostic yield. This chapter reviews the various types of syncope and provides a succinct clinical approach to the diagnosis, investigation, and management of syncope in children. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Etiology of syncope in hospitalized patients

    Science.gov (United States)

    Saravi, Mehrdad; Ahmadi Ahangar, Alijan; Hojati, Mohammad Masood; Valinejad, Ebrahim; Senaat, Ahmad; Sohrabnejad, Reza; Khosoosi Niaki, Mohammad Reza

    2015-01-01

    Background: Syncope is a common clinical problem which can be remarkably debilitating and associated with high health care costs. Syncope is a clinical syndrome with many potential causes. The aim of the study was to determine the etiologies of patients with syncope in the emergency department (ED) of a referral and general university hospital. Methods: One hundred sixty-five consecutive patients aged more than 18 years old with syncope were admitted to the emergency department of Ayatollah Rouhani Hospital. Initially organized, systematic approach included detailed medical history and structured questionnaires for history taking, physical examination, ECG and cardiac monitoring, cardiology and neurology were done. Advanced diagnostic tests were carried out if the etiology of syncope remained unexplained. Results: Out of the 165 patients who presented to the ED between February 2012 and February 2013, 124 had definition of syncope. The mean age of male patients was 59.5±19.8, 58. The etiology of syncope was diagnosed in 104 (83%) patients. Neurocardiogenic syncope was found in 36 (29.03%) patients, cardiac arrhythmias in 40 (32.25%) patients, and acute coronary syndrome in 8 (6.45%) patients. There are some infrequent etiologies like intracranial hemorrhage in 5 patients, aortic stenosis in 4 patients, hypertrophic cardiomyopathy and aortic dissection in 3 patients, Brugada and pulmonary embolism in 2 patients and carotid hypersensitivity in one patient. Conclusion: We found that cardiac arrhythmias and neurocardiogenic type are the frequent causes of syncope. In about one-sixth of the patients, no etiology was found. Approximately one-third of patients had traumatic syncope. PMID:26644899

  3. Etiology of syncope in hospitalized patients.

    Science.gov (United States)

    Saravi, Mehrdad; Ahmadi Ahangar, Alijan; Hojati, Mohammad Masood; Valinejad, Ebrahim; Senaat, Ahmad; Sohrabnejad, Reza; Khosoosi Niaki, Mohammad Reza

    2015-01-01

    Syncope is a common clinical problem which can be remarkably debilitating and associated with high health care costs. Syncope is a clinical syndrome with many potential causes. The aim of the study was to determine the etiologies of patients with syncope in the emergency department (ED) of a referral and general university hospital. One hundred sixty-five consecutive patients aged more than 18 years old with syncope were admitted to the emergency department of Ayatollah Rouhani Hospital. Initially organized, systematic approach included detailed medical history and structured questionnaires for history taking, physical examination, ECG and cardiac monitoring, cardiology and neurology were done. Advanced diagnostic tests were carried out if the etiology of syncope remained unexplained. Out of the 165 patients who presented to the ED between February 2012 and February 2013, 124 had definition of syncope. The mean age of male patients was 59.5±19.8, 58. The etiology of syncope was diagnosed in 104 (83%) patients. Neurocardiogenic syncope was found in 36 (29.03%) patients, cardiac arrhythmias in 40 (32.25%) patients, and acute coronary syndrome in 8 (6.45%) patients. There are some infrequent etiologies like intracranial hemorrhage in 5 patients, aortic stenosis in 4 patients, hypertrophic cardiomyopathy and aortic dissection in 3 patients, Brugada and pulmonary embolism in 2 patients and carotid hypersensitivity in one patient. We found that cardiac arrhythmias and neurocardiogenic type are the frequent causes of syncope. In about one-sixth of the patients, no etiology was found. Approximately one-third of patients had traumatic syncope.

  4. Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity.

    Science.gov (United States)

    Buttà, C; Tuttolomondo, A; Casuccio, A; Di Raimondo, D; Giarrusso, L; Miceli, G; Lo Vecchio, S; Canino, B; Licata, G; Pinto, A

    2014-07-01

    This study aimed to evaluate the use of QT intervals, their diagnostic predictive value in patients with syncope and their relationship with syncope severity. One hundred and forty nine patients with a diagnosis of syncope were admitted to Internal Medicine departments at the University of Palermo, Italy, between 2006 and 2012, and 140 control subjects hospitalised for other causes were enrolled. QT maximum, QT minimum, QTpeak, QT corrected, QT dispersion and Tpeak-to-Tend interval were compared between two groups. The paper medical records were used for scoring with San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in SYncope Study (EGSYS) score and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score. Mean QTc (p 424.8 ms (sensibility: 81.88 - specificity: 57.86) showed the greatest predictive value for diagnosis of syncope. On the EGSYS score and on the OESIL score, QTc was significantly prolonged in high-risk patients compared with low-risk patients. On the San Francisco Syncope Rule, QTc and QTdisp were significantly prolonged in high-risk patients compared with low-risk patients. Mean QTc, mean QTdisp, mean TpTe, mean QTmax and mean QTpeak were significantly longer in patients with syncope compared with control subjects. Furthermore, prolonged QTc and QTdisp were associated with major severe syncope according to San Francisco Syncope Rule, EGSYS and OESIL risk scores. © 2014 John Wiley & Sons Ltd.

  5. Syncope caused by iatrogenic hyperkalemia.

    Science.gov (United States)

    Giancaspro, Giuseppe; Suppa, Marianna; Genuini, Igino; Caselli, Stefano; Fedele, Francesco

    2009-01-01

    Symptomatic bradycardia in the emergency department may have several causes (excessive vagal tone, drug toxicity, acute myocardial ischemia, sick sinus syndrome, heart block, and electrolyte imbalance); among these, hyperkalemia may develop as a complication of chronic medical treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and must be considered in the early approach to the bradyarrhythmic patient with possible electrocardiographic signs of hyperkalemia. We report a case of an 87-year-old woman with a clinical history of chronic angiotensin-receptor blocker consumption that led her to dangerous bradyarrhythmia, cardiogenic syncope, and risk of sudden cardiac death.

  6. Underlying diseases in syncope of children in China

    Science.gov (United States)

    Li, Chen; Cheng, Wang; Hongwei, Wang; Hong, Tian; Chaoshu, Tang; Hongfang, Jin; Junbao, Du

    2011-01-01

    Summary Background Syncope accounts for about 1–2% of emergency department visits, but the etiology in many patients with syncope is unclear. Recently, with the use of the head-up tilt test (HUT), the number of patients with unexplained syncope (UPS) has been decreasing; however, the spectrum of underlying diseases of syncope in children is unclear. This retrospective study aimed to analyze the spectrum of underlying diseases in children with syncope. Material/Methods This multi-center clinical study consisted of 888 children (417 males, 471 females, aged 5–18 yrs, median age 12.0±3.0 yrs) with syncope who came from Beijing city, Hunan province, Hubei province and Shanghai from August 1999 to March 2009. The clinical and laboratory data of children were studied and the spectrum of underlying diseases in children with syncope was analyzed. Results In 888 children with syncope, 175 (19.7%) had vasovagal syncope (VVS) with vasoinhibitory response, 35 (3.9%) had VVS with cardioinhibitory response, 73 (8.2%) had VVS with mixed response, 286 (32.2%) had postural orthostatic tachycardia syndrome (POTS), 19 (2.1%) had orthostatic hypotension, 7 (0.9%) had situational syncope, 13 (1.5%) had cardiogenic syncope, and 280 (31.5%) had unexplained syncope. Conclusions The data suggest that neurally-mediated syncope was the most common cause in children with syncope. POTS and VVS were the most common hemodynamic patterns of neurally-mediated syncope. PMID:21629199

  7. Management of syncope in the Emergency Department.

    Science.gov (United States)

    Reed, M J

    2009-08-01

    Syncope is a common presenting complaint to the emergency department (ED). Its assessment is difficult. Some serious causes of syncope are transient and patients with a potentially life threatening condition may appear well by the time they reach the ED. Accurate history taking is vital and is often diagnostic whilst identification of a cardiac cause is associated with an increased mortality. This is related to underlying cardiac disease; patients presenting with syncope who have significant cardiac disease should be investigated thoroughly to determine the nature of the underlying heart disease and the cause of syncope. Early work suggested that as many as 30% of patients with cardiac syncope died within one year of presentation. This led to physicians admitting many patients with unexplained syncope however presently there is little evidence that focussed investigation, or even admission leads to an improved prognosis. Studies looking at syncope clinical decision units have though shown these to be of some benefit. Risk stratification studies on syncope in the ED have attempted to help emergency physicians target high-risk patients once those with clearly identifiable conditions have been identified and managed. These clinical decision rules have suffered from poor external validation and in the USA where many of these tools were developed, a universal consensus approach remains lacking. Although no individual tool has yet been successfully implemented into standard practice, as a whole they have probably enabled emergency physicians to become more aware of the risk factors that are likely to lead to poor outcome. It is likely that serious outcome in syncope although significant, is not quite as common as previously thought. Presently the American College of Emergency Physician (ACEP) guidelines are the most useful guidelines written for the emergency physician. With biochemical markers showing some promise, further work may lead to incorporation of these into

  8. Prevalence of fibromyalgia in vasovagal syncope.

    Science.gov (United States)

    Vallejo, Maite; Martínez-Martínez, Laura-Aline; Grijalva-Quijada, Saulo; Olguín-Ruvalcaba, Hector-Manuel; Salas, Elizabeth; Hermosillo, Antonio G; Cárdenas, Manuel; Martínez-Lavín, Manuel

    2013-04-01

    Vasovagal syncope is an acute manifestation of autonomic nervous system dysfunction. This type of syncope is often associated with other dysautonomic expressions such as migraine, gastroparesis, or postural tachycardia syndrome. Autonomic nervous system dysfunction has been proposed as a key element in the pathogenesis of fibromyalgia. The objectives of this study were to estimate the frequency of fibromyalgia in a sample of patients with vasovagal syncope and also to correlate the presence of syncope and fibromyalgia with different dysautonomic manifestations. We studied 50 consecutive patients with vasovagal syncope seen at the Syncope Unit of the National Cardiology Institute of Mexico between June 2009 and June 2012. All individuals filled out the Composite Autonomic Symptoms and Signs questionnaire and the Fibromyalgia Impact Questionnaire. All cases underwent a head-up tilt test. A rheumatologist examined all participants to assess the presence of fibromyalgia. The median age of the studied population was 21 years. Sixty-eight percent of participants were women. Eight cases (16%) had concomitant fibromyalgia. Significantly, all fibromyalgia cases were female. This subgroup of fibromyalgia subjects had more secretomotor complaints (mainly dry eyes and dry mouth) and more bowel constipation than the remainder of the group. Also in this subgroup of fibromyalgia subjects, several significant associations were found between age, blood pressure, number of syncopal episodes, constipation, insomnia, pupillomotor impairment, and disability. In contrast, no correlations were found in the subgroup of fainters without fibromyalgia. Fibromyalgia was relatively frequent in these women with vasovagal syncope and could be associated with dysautonomic symptoms. Therefore, it seems important to search for dysautonomic comorbidities in patients with vasovagal syncope and/or fibromyalgia, to provide a patient-centered holistic approach, instead of the often currently used

  9. Etiology of Syncope and Unexplained Falls in Elderly Adults with Dementia: Syncope and Dementia (SYD) Study.

    Science.gov (United States)

    Ungar, Andrea; Mussi, Chiara; Ceccofiglio, Alice; Bellelli, Giuseppe; Nicosia, Franco; Bo, Mario; Riccio, Daniela; Martone, Anna Maria; Guadagno, Livia; Noro, Gabriele; Ghidoni, Giulia; Rafanelli, Martina; Marchionni, Niccolò; Abete, Pasquale

    2016-08-01

    To investigate the etiology of transient loss of consciousness (T-LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. Prospective, observational, multicenter study. Acute care wards, syncope units or centers for the diagnosis of dementia. Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T-LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. The causes of T-LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. Of 357 individuals enrolled, 181 (50.7%) had been referred for T-LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  10. Recurrent Syncope Associated with Lung Cancer

    Directory of Open Access Journals (Sweden)

    Dingguo Zhang

    2015-01-01

    Full Text Available Syncope is an important problem in clinical practice with many possible causes that might be misdiagnosed. We present an unusual case of syncope, which has a normal chest X-ray. Exercise EKG and coronary angioplasty results confirmed the existence of serious coronary heart disease. The patient was treated with coronary stent transplantation. However, scope occurred again and the elevated tumor makers cytokeratin-19-fragment and neuron-specific enolase revealed the bronchogenic carcinoma, which was confirmed by enhanced CT examination. The treatment of carcinoma by chemotherapy was indeed sufficient for prompt elimination of the syncope symptoms.

  11. The Cost-Effective Evaluation of Syncope.

    Science.gov (United States)

    Angus, Steven

    2016-09-01

    Syncope is a common clinical problem that carries a high socioeconomic burden. A structured approach in the evaluation of syncope with special emphasis on a detailed history, comprehensive physical examination that includes orthostatic vital signs, and an electrocardiogram, proves to be the most cost-effective approach. The need for additional testing and hospital admission should be based on the results of the initial evaluation and use of risk-stratification tools that help identify those syncope patients at highest risk for poor outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Orthostatic convulsive syncope in a burn patient.

    Science.gov (United States)

    Primrose, Matthew; McDermid, Robert C; Tredget, Edward E; Khadaroo, Rachel G

    2012-01-01

    Orthostatic convulsive syncope is defined as a decrease in cerebral blood supply resulting in convulsive, seizure-like symptoms. The authors present the first case report of orthostatic convulsive syncope in a burn patient. There are many causes of transient loss of consciousness in patients. An algorithm is presented to aid in the workup and management strategies for this diagnosis. This approach in conjunction with a neurology consult should add in the assessment and treatment of transient loss of consciousness and orthostatic convulsive syncope in a burn patient.

  13. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management.

    Science.gov (United States)

    Shen, Win K; Decker, Wyatt W; Smars, Peter A; Goyal, Deepi G; Walker, Ann E; Hodge, David O; Trusty, Jane M; Brekke, Karen M; Jahangir, Arshad; Brady, Peter A; Munger, Thomas M; Gersh, Bernard J; Hammill, Stephen C; Frye, Robert L

    2004-12-14

    The primary aim and central hypothesis of the study are that a designated syncope unit in the emergency department improves diagnostic yield and reduces hospital admission for patients with syncope who are at intermediate risk for an adverse cardiovascular outcome. In this prospective, randomized, single-center study, patients were randomly allocated to 2 treatment arms: syncope unit evaluation and standard care. The 2 groups were compared with chi2 test for independence of categorical variables. Wilcoxon rank sum test was used for continuous variables. Survival was estimated with the Kaplan-Meier method. One hundred three consecutive patients (53 women; mean age 64+/-17 years) entered the study. Fifty-one patients were randomized to the syncope unit. For the syncope unit and standard care patients, the presumptive diagnosis was established in 34 (67%) and 5 (10%) patients (Ppatients (Ppatient-hospital days were reduced from 140 to 64. Actuarial survival was 97% and 90% (P=0.30), and survival free from recurrent syncope was 88% and 89% (P=0.72) at 2 years for the syncope unit and standard care groups, respectively. The novel syncope unit designed for this study significantly improved diagnostic yield in the emergency department and reduced hospital admission and total length of hospital stay without affecting recurrent syncope and all-cause mortality among intermediate-risk patients. Observations from the present study provide benchmark data for improving patient care and effectively utilizing healthcare resources.

  14. Syncope: risk stratification and clinical decision making.

    Science.gov (United States)

    Peeters, Suzanne Y G; Hoek, Amber E; Mollink, Susan M; Huff, J Stephen

    2014-04-01

    Syncope is a common occurrence in the emergency department, accounting for approximately 1% to 3% of presentations. Syncope is best defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. The spectrum of etiologies ranges from benign to life threatening, and a structured approach to evaluating these patients is key to providing care that is thorough, yet cost-effective. This issue reviews the most relevant evidence for managing and risk stratifying the syncope patient, beginning with a focused history, physical examination, electrocardiogram, and tailored diagnostic testing. Several risk stratification decision rules are compared for performance in various scenarios, including how age and associated comorbidities may predict short-term and long-term adverse events. An algorithm for structured, evidence-based care of the syncope patient is included to ensure that patients requiring hospitalization are managed appropriately and those with benign causes are discharged safely.

  15. Autonomic and electrocardiographic changes in cardioinhibitory syncope

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Kaijer, Michelle Nymann; Mehlsen, Anne-Birgitte

    2008-01-01

    Aims Cardioinhibitory syncope (CS) is a neurally mediated response causing bradycardia or asystole. This study reports on changes in blood pressure, heart rate variability (HRV), and ECG patterns before and after syncope with asystole. Methods and results Thirty-five patients with CS and a matched...... control group were submitted to 60 head-up tilt for 20 min with the addition of nitroglycerin. Syncope developed after a tilt-duration of 1.082 (range 50-1.734 s). Asystole Lasted for 21.3 s (range 3.4-80.2 s) and was preceded by sinus rhythm in 21, junctional rhythm in 10, and atrioventricular block...... in four. Asystole was followed by sinus rhythm in four, junctional rhythm in 24, atrioventricular block in four, and atria[ fibrillation in three. The two groups did not differ with respect to supine heart rate, HRV or blood pressure. Prior to syncope, patients showed significant increases in total...

  16. Initial Evaluation of Patients with Presumed Syncope

    OpenAIRE

    Ilknur Can, MD; David G. Benditt, MD

    2008-01-01

    Syncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC). The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with sufficient confidence to assess prognosis and initiate an effective treatment strategy. The initial evaluation of these patients, which usually takes place in an emergency department (ED. or acute...

  17. Managing fatigue in the syncope unit.

    Science.gov (United States)

    Newton, Julia L

    2012-12-01

    The symptom of fatigue is frequently described by patients attending the syncope unit with a wide range of conditions including vasovagal syncope and postural orthostatic tachycardia syndrome. It is possible that the presence of autonomic dysfunction provides the common pathogenetic mechanism linking neurally mediated hypotension and fatigue. Managing this debilitating symptom can often be challenging but, with a structured approach, immensely rewarding, and as a result improve how patients cope with their disease.

  18. Anoxic seizures: self-terminating syncopes.

    Science.gov (United States)

    Stephenson, J B

    2001-01-01

    This review focuses on anoxic seizures induced by self terminating syncopes in the young. Anoxic seizures are nonepileptic events consequent upon abrupt interruption of the energy supply to metabolically active cerebral neurones. Anoxic seizures are the most common paroxysmal events misdiagnosed as epilepsy. Neurally mediated syncopes have numerous appellations, especially in the young. This proliferation of terminology likely results from uncertainty regarding pathophysiology. The most important type of self-limiting syncope from the point of view of diagnostic difficulty has been called neurocardiogenic or vasovagal syncope and reflex anoxic seizure, amongst other names: this review includes a video clip of such a child with prolonged asystole. It also includes a detailed case history emphasising the feelings of a patient with this type of syncope who was misdiagnosed as having epilepsy for many years. The second class of self-terminating syncope discussed and illustrated on video is the so-called breath-holding spell of young children. The third example illustrated is the compulsive Valsalva manoeuvre of individuals with autistic spectrum disorder, in which anoxic seizures - as shown on the video clips - are easily misdiagnosed as epileptic seizures, with unfortunate consequences.

  19. Syncope

    Science.gov (United States)

    ... J. Shukla , Peter J. Zimetbaum Download PDF https://doi.org/10.1161/CIRCULATIONAHA.105.602250 Circulation. 2006; 113: ... e715-e717 , originally published April 24, 2006 https://doi.org/10.1161/CIRCULATIONAHA.105.602250 Citation Manager Formats ...

  20. Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway.

    Science.gov (United States)

    de Ruiter, Susanne C; Wold, Johan F H; Germans, Tjeerd; Ruiter, Jaap H; Jansen, René W M M

    2017-05-17

    To assess the diagnostic outcomes of a multidisciplinary pathway for elderly syncope patients. Observational cohort study at a Fall and Syncope Clinic, including consecutive syncope patients aged ≥65 years between 2011 and 2014. Measurements: The sort, number, and accuracy of diagnoses resulting in syncope. Secondary outcomes: reliability of the medical history and the number of electrocardiogram (ECG) abnormalities. The 117 included patients (72% females) had a mean age of 80 ± 6.5 years and a mean of 11 ± 5 (mainly cardiovascular) comorbidities. We found 212 contributing diagnoses. Symptomatic orthostatic/postprandial hypotension was present in 45%, cardiac causes in 44% (rhythm or conduction disorders 24%, aortic stenosis 4%, cardiomyopathies 2%, suspected cardiac causes 15%), and reflex syncope in 21%; 6% remained without any explanation. The diagnosis of the cause of syncope was uncertain in 34.2%, probable in 15.4%, and definite/most likely in 50.4%. Cognitive impaired patients were less likely to give a reliable medical history regarding their syncope (72% vs. 98% in cognitive intact patients, P = 0.001). In only 25% of patients a useful eyewitness account was available. 64% of ECGs showed relevant abnormalities; 26% was suggestive of cardiac syncope, of which 20% showed an indication for device implantation. The majority of our elderly syncope patients had multiple contributing factors, often in addition to their primary diagnosis. Orthostatic/postprandial hypotension and cardiac disorders were the most frequent. Using a multidisciplinary approach, one or more possible explanations for the syncope were found in 94% of patients, with a definite diagnosis in 50%. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  1. Characteristics of syncope in patients with dilated cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Abdel-Hadi Rami

    2016-04-01

    Conclusion: In patients with DCM, syncope is a relatively rare finding. Cardiac causes (arrhythmias and conduction disorders are responsible for the majority of cases. Risk factors for syncope in these patients remain to be determined.

  2. Fainting during Urination (Micturition Syncope): What Causes It?

    Science.gov (United States)

    ... urinating. His doctor said he might have micturition syncope. What causes this, and what can he do about it? ... at night after a deep sleep. The exact cause of micturition syncope isn't fully understood. But it may be ...

  3. Initial Evaluation of Patients with Presumed Syncope

    Directory of Open Access Journals (Sweden)

    Ilknur Can, MD

    2008-01-01

    Full Text Available Syncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC. The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with sufficient confidence to assess prognosis and initiate an effective treatment strategy. The initial evaluation of these patients, which usually takes place in an emergency department (ED. or acute care facility, is challenging since patients are usually asymptomatic when they come for medical attention, may have little or no recall of the event, and witnesses, if any, often cannot provide reliable information. Given these circumstances, it is understandable that frontline physicians often tend to take a seemingly ‘safe’ approach, and admit both high-risk and intermediate-risk syncope patients to hospital. This strategy has many implications, including life-style and economic concerns for the patient, and health care management issues for physicians, hospital administrators and the overall health care system. The European Society of Cardiology (ESC. guidelines and several clinical studies provide helpful advice regarding “risk stratification” to help guide physicians in selecting patients for either early hospital admission or later oupatient subspeciality evaluation. The utility of syncope management units in the ED, and a guideline-based approach to the syncope patient, has tended to both diminish the number of undiagnosed cases and reduce the hospital admission rate. In this review, we have attempted to both highlight a cost-effective diagnostic pathway beginning with the initial evaluation of the patient with suspected syncope, and to provide criteria which may help frontline physicians better base their decisions regarding need for in-hospital versus outpatient clinic evaluation of syncope patients.

  4. Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

    OpenAIRE

    Casini, Alessandro; Tschanz, Elisabeth; Dietrich, Pierre-Yves; Nendaz, Mathieu

    2011-01-01

    Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus b...

  5. Single center experience in Japanese patients with syncope.

    Science.gov (United States)

    Onuki, Tatsuya; Ito, Hiroyuki; Ochi, Akinori; Chiba, Yuta; Kawasaki, Shiro; Onishi, Yoshimi; Munetsugu, Yumi; Kikuchi, Miwa; Minoura, Yoshino; Watanabe, Norikazu; Adachi, Taro; Asano, Taku; Tanno, Kaoru; Kobayashi, Youichi

    2015-11-01

    The present diagnostic method and features of syncope in Japan are unclear. Implantable loop recorder (ILR) and head-up tilt tests have recently become available for diagnosing syncope. The examination method and rates of diagnosing syncope may vary. This study aimed to clarify the present diagnostic method and features of syncope in a single Japanese medical center. We retrospectively reviewed the medical records of consecutive patients who were seen at our hospital from January 1, 2009, to December 31, 2012. A total of 547 patients (328 men, 60.4±21.5 years) with syncope were seen at our hospital. Reflex syncope was diagnosed in 29.1% of the cases, orthostatic hypotension in 11.7%, cardiac syncope in 34.0%, and unexplained syncope in 23.9% by initial and early evaluations. The number of patients with situational syncope and orthostatic hypotension that could be diagnosed in the initial evaluation of the first examination was significantly greater than that in subsequent evaluations. Forty-three percent of the unexplained syncope patients received an ILR. The consent rate for ILR implantations in the unexplained syncope patients with a suspected arrhythmia nature was 53.1%. The cumulative ILR diagnostic rates were 47% and 65% at 1 and 2 years after the ILR implantation, respectively. The estimated ILR diagnostic rates were significantly greater than that for conventional test without using an ILR. When patients with unexplained syncope could be diagnosed, the recurrent symptoms were greatly reduced. Syncope is induced by various causes in Japan. It is important that we understand the characteristics of each syncope cause. The consent rate for implanting an ILR in appropriate unexplained syncope patients is low. We need to educate these patients about the importance of making a diagnosis of syncope. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  6. Vasovagal syncope developed after spinal anesthesia: a case report

    OpenAIRE

    Alparslan, Mustafa Muhlis; Ekim, Mustafa Şevki; Yılmaz, Adem

    2015-01-01

    AbstractSyncope is a transient loss of consciousness that is associated with the sudden loss of muscle tone and often resolved spontaneously. It is developed as a result of cardiac, metabolic, psychiatric and neurological causes. Vasovagal syncope is the most common type of syncope that is seen in healthy individuals and is frequently related to emotional stress. It is usually induced by a fear, panic attack, pain or an exercise. In this case report, an approach to vasovagal syncope will be d...

  7. [Permanent cardiac pacing in vasovagal syncope and carotid sinus syndrome].

    Science.gov (United States)

    Dupliakov, D V; Golovina, G A; Zemlianova, M E; Khokhlunov, S M; Poliakov, V P

    2011-01-01

    Vasovagal syncope and carotid sinus syndrome are common conditions in young and elderly people, respectively, mostly with benign prognosis. Nevertheless, severe or "malignant" syncopal attacks in some patients may be associated with life-threatening injury. Unfortunately, up to now almost all drug trials have failed to demonstrate any benefit in preventing syncope and interventional approach (pacemaker) may be appropriate. This article contains literature review and discussion of indications for pacing in vasovagal syncope and carotid sinus syndrome.

  8. Sleep syncope: Important clinical associations with phobia and vagotonia

    NARCIS (Netherlands)

    Busweiler, L.; Jardine, D. L.; Frampton, C. M.; Wieling, W.

    2010-01-01

    Objectives: To compare demographic and clinical data from patients with sleep syncope to those of patients with "classical" vasovagal syncope [VVS] collected over the last 8 years. Design: Retrospective case-controlled study. Setting: Syncope unit. Patients and methods: Fifty-four patients with a

  9. The Etiology of Syncope in an Emergency Hospital

    Directory of Open Access Journals (Sweden)

    Bădilă Elisabeta

    2016-09-01

    Full Text Available Background. Syncope is a commonly encountered problem in an emergency hospital. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients for whom syncope is a symptom of a potentially life-threatening condition.

  10. Syncope due to Autonomic Dysfunction: Diagnosis and Management.

    Science.gov (United States)

    Adkisson, Wayne O; Benditt, David G

    2015-07-01

    Syncope is one of several disorders that cause transient loss of consciousness. Cerebral hypoperfusion is the proximate cause of syncope. Transient or fixed autonomic nervous system dysfunction is a major contributor in many causes. A structured approach to the evaluation of syncope allows for more effective therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Syncope in children with hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    I. V. Leontyeva

    2014-01-01

    Full Text Available Seventy children aged 7 to 17 years with hypertrophic cardiomyopathy (HCM were examined; among them there were 11 syncope patients and 5 presyncope patients. The screening program included standard electrocardiography (ECG, Doppler echocardiogra-phy, 24-hour Holter ECG monitoring, and an incremental exercise testing (Bruce treadmill test. The markers of myocardial electrical instability were determined. In the children with HCM, syncope was established to be heterogeneous; it had an arrhythmogenic origin and, in most cases, occurred in the presence of tachyarrhythmia (44% or bradyarrythmia (25%; its vasovagal genesis was probable in one third of the examinees. The children with syncope were typified by the asymmetric, obstructive form of HCM, at the same tone there was most commonly left ventricular hypertrophy concurrent with left atrial enlargement. 24-hour Holter monitoring showed that bradycardia was prevalent in the patients, 3 patients were found to have more than 2-second cardiac rhythm pauses caused by second-degree atrioventricular block in 1 case or by sick sinus syndrome in 2. Nonsustained ventricular tachycardia was noted in two patients. The children with syncope were typified by the signs of myocardial electrical instability as a reduction in the early phase of heart rate turbulence and by impaired QT/RR interval adaptation as hyperadaptation. The paper presents the developed management tactics for children with syncope and indications for the implantation of a cardioverter defibrillator, a pacemaker, or an ECG loop recorder.

  12. Evaluation of syncope and palpitations in women.

    Science.gov (United States)

    Misiri, Juna; Candler, Shawn; Kusumoto, Fred M

    2011-10-01

    Syncope and palpitations are common complaints that all physicians confront during daily clinical practice. Single center and multicenter cohort studies have found that syncope accounts for 1%-3% of emergency department evaluations and that palpitations are the primary symptom for approximately 16% of patients who arrive at an outpatient clinic with a cardiac complaint. For both conditions, women make up approximately 60% of the cohorts. In general, the evaluation of both syncope and palpitations can be challenging because of the heterogeneity of causes and, consequently, the variability of clinical outcomes, ranging from a single isolated event with no effect on morbidity and mortality to the first sign of a potentially life-threatening problem and sudden cardiac death. For all women with syncope or palpitations, the history, physical examination, and a baseline electrocardiogram (ECG) form the basis of the initial workup and focus on identifying patients with cardiovascular abnormalities who are at the highest risk for sudden cardiac death. More advanced tests must be chosen using a problem-specific approach, but generally, documentation of the cardiac rhythm during symptoms is critical for all patients with syncope or palpitations. Although the diagnostic testing strategy is generally similar for men and women, gender-related differences in treatment response have been identified. Antiarrhythmic medications, such as dofetilide and sotalol, that prolong the QT interval are more likely to be associated with proarrhythmia in women. In addition, higher complication rates for invasive cardiac procedures, such as device implantation, are observed in women.

  13. Are syncopes in sitting and supine positions different? Body positions and syncope: A study of 111 patients

    OpenAIRE

    Satish V Khadilkar; Rakhil S Yadav; Kamlesh A Jagiasi

    2013-01-01

    Context: Syncope is a common cause of transient loss of consciousness. In the analysis of patients having syncope, body position has not been systematically studied and correlated with triggers, prodromal symptoms and circumstances. This correlation is important in differentiating syncope from its mimics. Aims: To study syncope with respect to body positions, triggers, prodromal symptoms and circumstances. Settings and Design: Prospective study set in Neurology Department of Tertiary Care Cen...

  14. Syncope and Idiopathic (Paroxysmal) AV Block.

    Science.gov (United States)

    Brignole, Michele; Deharo, Jean-Claude; Guieu, Regis

    2015-08-01

    Syncope due to idiopathic AV block is characterized by: 1) ECG documentation (usually by means of prolonged ECG monitoring) of paroxysmal complete AV block with one or multiple consecutive pauses, without P-P cycle lengthening or PR interval prolongation, not triggered by atrial or ventricular premature beats nor by rate variations; 2) long history of recurrent syncope without prodromes; 3) absence of cardiac and ECG abnormalities; 4) absence of progression to persistent forms of AV block; 5) efficacy of cardiac pacing therapy. The patients affected by idiopathic AV block have low baseline adenosine plasma level values and show an increased susceptibility to exogenous adenosine. The APL value of the patients with idiopathic AV block is much lower than patients affected by vasovagal syncope who have high adenosine values. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Life threatening causes of syncope: channelopathies and cardiomyopathies.

    Science.gov (United States)

    Herman, Adam; Bennett, Matthew T; Chakrabarti, Santabhanu; Chakrabarti, Santabahnu; Krahn, Andrew D

    2014-09-01

    Syncope is common, has a high recurrence rate and carries a risk of morbidity and, dependent on the cause, mortality. Although the majority of patients with syncope have a benign prognosis, syncope as a result of cardiomyopathy or channelopathy carries a poor prognosis. In addition, the identification of these disorders allows for the institution of treatments, which are effective at reducing the risk of both syncope and mortality. It is for these reasons that the identification of a cardiomyopathy or channelopathy in patients with syncope is crucial. This review article will describe the characteristics of common cardiomyopathies and channelopathies and their investigation. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Neurally mediated syncope in electroconvulsive therapy maintenance.

    Science.gov (United States)

    Arbaizar, Beatriz; Llorca, Javier

    2012-03-01

    Electroconvulsive therapy (ECT) is especially necessary to revert some types of depressive disease; nevertheless, it has some widely recognized adverse effects, such as short-term memory loss. Moreover, some articles have reported its potential association with falls; this literature is, however, scanty and mainly consists of case reports. We present the case of a man who has a diagnosis of neurally mediated syncope at the age of 79 years, during the maintenance ECT. The patient had a significant increase in syncope frequency in the period he was treated with ECT, followed by a dramatic decrease when ECT was discontinued.

  17. Ictal asystole and ictal syncope: insights into clinical management.

    Science.gov (United States)

    Bestawros, Michael; Darbar, Dawood; Arain, Amir; Abou-Khalil, Bassel; Plummer, Dale; Dupont, William D; Raj, Satish R

    2015-02-01

    Ictal asystole is a rare, serious, and often treatable cause of syncope. There are currently limited data to guide management. Characterization of ictal syncope predictors may aid in the selection of high-risk patients for treatments such as pacemakers. We searched our epilepsy monitoring unit database from October 2003 to July 2013 for all patients with ictal asystole events. Clinical, electroencephalogram, and ECG data for each of their seizures were examined for their relationships with ictal syncope events. In 10 patients with ictal asystole, we observed 76 clinical seizures with 26 ictal asystole episodes, 15 of which led to syncope. No seizure with asystole duration≤6 s led to syncope, whereas 94% (15/16) of seizures with asystole duration>6 s led to syncope (P=0.02). During ictal asystole events, 4 patients had left temporal seizure onset, 4 patients had right temporal seizure onset, and 2 patients had both. Syncope was more common with left temporal (40%) than with right temporal seizures (10%; P=0.002). Treatment options included antiepileptic drug changes, epilepsy surgery, and pacemaker implantation. Eight patients received pacemakers. During follow-up of 72±95 months, all patients remained syncope free. Ictal asystole>6 s is strongly associated with ictal syncope. Ictal syncope is more common in left than in right temporal seizures. A permanent pacemaker should be considered in patients with ictal syncope if they are not considered good candidates for epilepsy surgery. © 2014 American Heart Association, Inc.

  18. Micturition Syncope in Childhood: How to Recognize and Manage It.

    Science.gov (United States)

    Marzuillo, Pierluigi; Guarino, Stefano; Tipo, Vincenzo; Apicella, Andrea; Grandone, Anna; Diplomatico, Mario; Polito, Cesare; Miraglia Del Giudice, Emanuele; La Manna, Angela; Perrone, Laura

    2017-11-14

    Frequently, general pediatricians could face a patient with syncope, which represents approximately 1% to 3% of emergency visits. Micturition syncope is a transient loss of consciousness with onset immediately before, during, or after micturition. Literature evidence indicates that healthy young men are a population with major risk for presenting micturition syncope, with a peak of incidence around 40 to 50 years of age. Usually, this syncope occurs in the morning, after wake-up, or, more generally, when the male patients assume the orthostatic position after a period of supine position in a warm bed. No information on micturition syncope clinical presentation and prevalence in childhood is available in the literature, and probably, this kind of syncope is unrecognized in childhood. We describe 4 unreported pediatric patients with a diagnosis of micturition syncope and well-defined clinical presentation. In all patients, the syncope has been presented in the same conditions: in the morning; after wake-up; in an orthostatic position; just before, after, or during urinary bladder voiding; and with spontaneous recovery in few minutes. Interestingly, 1 patient presented with the syncope during urinary bladder voiding by autocatheterization. In our patients, all investigations made as the first approach in the pediatric emergency department did not show any abnormal results, possibly underlying the syncope episodes. By describing our experience, we want to underline the clinical presentation of micturition syncope and give to the clinicians the elements to recognize and manage it easily in children.

  19. Physiological phenomenology of neurally-mediated syncope with management implications.

    Science.gov (United States)

    Schroeder, Christoph; Tank, Jens; Heusser, Karsten; Diedrich, André; Luft, Friedrich C; Jordan, Jens

    2011-01-01

    Due to lack of efficacy in recent trials, current guidelines for the treatment of neurally-mediated (vasovagal) syncope do not promote cardiac pacemaker implantation. However, the finding of asystole during head-up tilt -induced (pre)syncope may lead to excessive cardioinhibitory syncope diagnosis and treatment with cardiac pacemakers as blood pressure is often discontinuously measured. Furthermore, physicians may be more inclined to implant cardiac pacemakers in older patients. We hypothesized that true cardioinhibitory syncope in which the decrease in heart rate precedes the fall in blood pressure is a very rare finding which might explain the lack of efficacy of pacemakers in neurally-mediated syncope. We studied 173 consecutive patients referred for unexplained syncope (114 women, 59 men, 42 ± 1 years, 17 ± 2 syncopal episodes). All had experienced (pre)syncope during head-up tilt testing followed by additional lower body negative suction. We classified hemodynamic responses according to the modified Vasovagal Syncope International Study (VASIS) classification as mixed response (VASIS I), cardioinhibitory without (VASIS IIa) or with asystole (VASIS IIb), and vasodepressor (VASIS III). Then, we defined the exact temporal relationship between hypotension and bradycardia to identify patients with true cardioinhibitory syncope. Of the (pre)syncopal events during tilt testing, 63% were classified as VASIS I, 6% as VASIS IIb, 2% as VASIS IIa, and 29% as VASIS III. Cardioinhibitory responses (VASIS class II) progressively decreased from the youngest to the oldest age quartile. With more detailed temporal analysis, blood pressure reduction preceded the heart-rate decrease in all but six individuals (97%) overall and in 10 out of 11 patients with asystole (VASIS IIb). Hypotension precedes bradycardia onset during head-up tilt-induced (pre)syncope in the vast majority of patients, even in those classified as cardioinhibitory syncope according to the modified VASIS

  20. New concepts in the assessment of syncope.

    Science.gov (United States)

    Brignole, Michele; Hamdan, Mohamed H

    2012-05-01

    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. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Vasovagal Syncope during Epidural Catheterization before ...

    African Journals Online (AJOL)

    The risk factors can be patient related (young, athletics, hypertensive, history of syncope, inferior myocardial infarction and others), anaesthesia related (light anaesthesia, spinal, epidural anaesthesia, airway manipulation, hypercapnia, hypoxia and others) and surgical related (strabismus, anal dilatation, abdominal and ...

  2. History of syncope in the cardiac literature.

    Science.gov (United States)

    Cannom, David S

    2013-01-01

    The rich cardiology literature of the past 100 years in which the most important forms of syncope are described - including vasodepressor syncope, postural orthostatic hypotension, and Morgagni-Stokes-Adams syncope - is fascinating. These conditions were of interest to some of our most astute clinicians who were also excellent writers. We thus have available for review the remarkable description of patients with these entities written by clinicians such as Soma Weiss, Sir Thomas Lewis, Laurence Ellis, David Sherf, Milton Shy, and Glenn Drager. In their detailed clinical descriptions we identify the pertinent symptoms and signs we see in our patients today years later. A group of brilliant basic physiologists and cardiologists was able to explain the altered physiology responsible for the clinical presentations of syncope patients. Basic investigations were done by investigators such as Arnold Weissler, James Warren, J. Erlanger and clinical cardiologists including John Parkinson, Cornelio Papp, and William Evans to name just a few. Between the early precise clinical descriptions and the subsequent thorough definition of the altered physiology, a surprisingly complete understanding of these clinical entities was established 50 years ago. It took another generation before clinicians developed methods of caring for patients with these clinical entities. The development of implantable devices, e.g., pacemakers and defibrillators, for use in Morgagni-Adams-Stokes attacks is the best example of curative therapies catching up with clinical diagnoses. Other more simple relevant therapies were developed for patients with vasodepressor syncope and postural orthostatic hypotension. Finally, the development and acceptance of clinical guidelines for the treatment of these conditions brought the original clinical observations and description of altered physiology into focus and ushered in a new generation of improved care for these patients. Copyright © 2013. Published by

  3. Regional cerebral perfusion in cardiovascular reflex syncope

    International Nuclear Information System (INIS)

    Toeyry, J.P.; Kuikka, J.T.; Laensimies, E.A.

    1997-01-01

    Little is known about the regional cerebral perfusion in subjects with presyncope or syncope, and the impact that autonomic nervous dysfunction has on it. Seven subjects with cardiovascular vasodepressor reflex syncope were studied. A baseline test was performed with the patients standing in the 70 upright position, while the passive head-up tilt table test with and without isoprenaline infusion was employed for provocation. Regional cerebral perfusion was assessed by means of single-photon emission tomography with technetium-99m labelled V-oxo-1,2-N,N 1 -ethylenedylbis-l-cysteine diethylester (baseline, and during blood pressure decline in the provocation test) and the autonomic nervous function by means of spectral analysis of heart rate variability (baseline, and before blood pressure decline in the provocation test). Every subject showed an abrupt decline in blood pressure in the provocation test (five with presyncope and two with syncope). The systolic and diastolic blood pressures decreased significantly (P<0.001) between the baseline and the provocation study time points (radiopharmaceutical injection and lowest systolic blood pressure). Mean cerebral perfusion as average count densities decreased upon provocation as compared with baseline (190±63 vs 307±90 counts/voxel, respectively, P=0.013). Hypoperfusion was most pronounced in the frontal lobe. These results suggest that cerebral perfusion decreases markedly during presyncope or syncope with systemic blood pressure decline in subjects with cardiovascular vasodepressor syncope. Furthermore, the autonomic nervous function remains unchanged before the systemic blood pressure decline. (orig.). With 3 figs., 2 tabs

  4. Key challenges in the current management of syncope.

    Science.gov (United States)

    Sutton, Richard; Brignole, Michele; Benditt, David G

    2012-10-01

    Patients commonly present with syncope at emergency departments and other facilities for urgent care. Syncope is understood by physicians to be a transient, self-terminating period of cerebral hypoperfusion that usually results from systemic hypotension, and clinical guidelines for the care of patients with presumed syncope are available. However, the diagnosis and management of such patients continue to pose important diagnostic, therapeutic, and economic challenges, which are the focus of this Review. First, we discuss how to improve symptom characterization to distinguish syncope from other forms of transient loss of consciousness and syncope mimics. Second, we compare methods of risk stratification in patients with suspected syncope, and recommend the introduction of syncope clinics with enhanced interdisciplinary collaboration to optimize patient care at reduced expense. Third, we highlight the importance of the appropriate selection of diagnostic tools and treatment strategies in these syncope clinics. Finally, we address the difficulties associated with therapy for the most-common form of syncope--vasovagal or reflex syncope.

  5. Are syncopes in sitting and supine positions different? Body positions and syncope: a study of 111 patients.

    Science.gov (United States)

    Khadilkar, Satish V; Yadav, Rakhil S; Jagiasi, Kamlesh A

    2013-01-01

    Syncope is a common cause of transient loss of consciousness. In the analysis of patients having syncope, body position has not been systematically studied and correlated with triggers, prodromal symptoms and circumstances. This correlation is important in differentiating syncope from its mimics. To study syncope with respect to body positions, triggers, prodromal symptoms and circumstances. Prospective study set in Neurology Department of Tertiary Care Center. Patients fulfilling guidelines set by The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) were recruited. Detailed clinical history, examination and investigations (ECG, 2D-ECHO, Head Up Tilt Test, Holter monitor, EEG, MRI Brain) were carried out. Out of the 111 recruited patients, 67 developed syncope in standing, 16 in sitting, 23 in both standing and sitting, 1 in both sitting and supine and 4 in all three positions. Prodromal symptoms were present in 81% while triggers in 42% and circumstances in 41% of patients. Black out, sweating, dizziness and headache were most common prodromal symptoms. Intense pain, smell and fear were most common triggers while prolonged standing, hot crowded room and fasting were most common circumstances associated with syncope. Against common belief, syncope can occur in sitting as well as in supine position. Emotional triggers were commoner in patients with syncope in supine and sitting positions while prodromal symptoms and circumstances were similar for all positions. Syncope should be considered in body positions other than standing.

  6. A standardized education protocol significantly reduces traumatic injuries and syncope recurrence: an observational study in 316 patients with vasovagal syncope.

    Science.gov (United States)

    Aydin, M Ali; Mortensen, Kai; Salukhe, Tushar V; Wilke, Iris; Ortak, Michelle; Drewitz, Imke; Hoffmann, Boris; Müllerleile, Kai; Sultan, Arian; Servatius, Helge; Steven, Daniel; von Kodolitsch, Yskert; Meinertz, Thomas; Ventura, Rodolfo; Willems, Stephan

    2012-03-01

    The aim of this study was to assess the role of a non-pharmacological approach on the frequency of traumatic injuries and syncope recurrence in patients with vasovagal syncope and normal hearts. We report the experience in our syncope centre with a standardized education and teaching protocol for patients with vasovagal syncope. The treatment of vasovagal syncope is often complex and discouraging. Besides medical options, behaviour modification is a main component of therapy but has no statistical evidence to support its use. Between January 1999 and September 2006, we prospectively enrolled all patients with vasovagal syncope. The patients were counselled about the benign nature of their disease. Specific recommendations were made according to a standardized education protocol established at our syncope centre. A pre-/post-study was conducted to investigate the effectiveness of our approach on syncope recurrence and frequency of injury as the study endpoints. Complete follow-up data were available from 85% of the study population (316 of 371) after a mean time of 710 ± 286 days (mean age 50 years; standard deviation ± 18 years, 160 female). Eighty-seven patients (27.5%) had a syncope recurrence with 22 suffering an injury during syncope. During the follow-up period, the syncope burden per month was significantly reduced from 0.35 ± 0.03 at initial presentation to 0.08 ± 0.02 (Psyncope was significantly lower at the time of recurrence compared with the initial presentation (25 vs. 42%; McNemar's test P= 0.02). A standardized education protocol significantly reduces traumatic injuries and syncope recurrence in patients with vasovagal syncope.

  7. Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    A. Casini

    2011-09-01

    Full Text Available Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus by metastases of a carcinoma of the esophagus, successfully treated by radiotherapy. In such cases, surgery, chemotherapy or radiotherapy can be performed. Because syncope may be an early sign of neck or cervical cancer, the diagnostic approach of syncope in patients with a past history of cancer should include the possibility of neck tumor recurrence or metastasis and an oncologic workout should be considered.

  8. Syncope and Its Impact on Occupational Accidents and Employment

    DEFF Research Database (Denmark)

    Numé, Anna Karin; Kragholm, Kristian; Carlson, Nicolas

    2017-01-01

    Background - First-time syncopal episodes usually occur in adults of working age, but their impact on occupational safety and employment remains unknown. We examined the associations of syncope with occupational accidents and termination of employment. Methods and Results - Through linkage...... of the syncope event. Over a median follow-up of 3.2 years (first to third quartiles, 2.0-4.5), 622 people with syncope had an occupational accident requiring hospitalization (2.1/100 person-years). In multiple Poisson regression analysis, the incidence rate ratio in the employed syncope population was higher......, 2.34-2.91). Conclusions - In this nationwide cohort, syncope was associated with a 1.4-fold higher risk of occupational accidents and a 2-fold higher risk of termination of employment compared with the employed general population....

  9. Prevalence of family history in patients with reflex syncope

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Benn, Marianne; Kaijer, Michelle Nymann

    2013-01-01

    among subtypes of reflex syncope, as these have different autonomic responses and pathogeneses may be diverse. The present study aimed to assess the prevalence of a positive family history of syncope and cardiovascular characteristics in patients with cardioinhibitory and vasodepressor reflex syncope......Reflex syncope is defined by a rapid transient loss of consciousness caused by global cerebral hypoperfusion resulting from vasodilatation and/or bradycardia attributable to inappropriate cardiovascular reflexes. A hereditary component has been suggested, but prevalence of family history may differ....... Patients (n=74) were classified into subtypes of reflex syncope - cardioinhibition/asystole (Vasovagal Syncope International Study subtypes II-B [VASIS II-B], n=38) or vasodepressor (VASIS III, n=36) - using the head-up tilt test. Family history was obtained by questionnaires supplemented by interview...

  10. Epidemiological studies on syncope--a register based approach

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth

    2013-01-01

    thesis demonstrated that the ICD-10 discharge diagnosis could reliably identify a cohort of patients admitted for syncope and that the discharge code carried a high number of unexplained cases despite use of numerous tests. The last studies showed that syncope is a common cause for hospital contact......The epidemiology and prognosis of ‘fainting’ or syncope has puzzled physicians over the years. Is fainting dangerous? This is a question often asked by the patient--and the answer is ‘it depends on a lot of things’. The diverse pathophysiology of syncope and the underlying comorbidites...... of the patients play an essential role. In epidemiology these factors have major impact on the outcome of the patients. Until recently, even the definition of syncope, differed from one study to another which has made literature reviews difficult. Traditionally the data on epidemiology of syncope has been taken...

  11. Management of syncope: from evidence to clinical practice

    OpenAIRE

    Tiziana M. Attardo; Immacolata Ambrosino; Elena Magnani; Nathan Artom; Nicola Battino; Deasy Cervo; Massimiliano Chiuch; Mariella Frualdo; Miriam Gino; Federico Pasin; Carlo Zaninetti

    2016-01-01

    Syncope is defined as a transient loss of consciousness due to temporary global cerebral hypoperfusion. It is characterized by rapid onset, short duration, loss of postural tone possibly causing patient fall, and spontaneous full recovery. Syncope has a high prevalence and incidence within the general population with a relevant impact on both quality of life and health care costs. The diagnosis of syncope is often inaccurate and subject to delay, and management is greatly variable. The main o...

  12. Physiological Phenomenology of Neurally-Mediated Syncope with Management Implications

    OpenAIRE

    Schroeder, Christoph; Tank, Jens; Heusser, Karsten; Diedrich, Andr?; Luft, Friedrich C.; Jordan, Jens

    2011-01-01

    BACKGROUND: Due to lack of efficacy in recent trials, current guidelines for the treatment of neurally-mediated (vasovagal) syncope do not promote cardiac pacemaker implantation. However, the finding of asystole during head-up tilt -induced (pre)syncope may lead to excessive cardioinhibitory syncope diagnosis and treatment with cardiac pacemakers as blood pressure is often discontinuously measured. Furthermore, physicians may be more inclined to implant cardiac pacemakers in older patients. W...

  13. [The syncope in Emergency Department: usual management vs guidelines].

    Science.gov (United States)

    Bianchi, A; Baldini, E; Suppa, M; Rosa, A; Coppola, A; Cavicchi, F; Contu, E; Petroni, C; Strano, S; Scarpellini, M G

    2011-01-01

    The syncope is a common cause of admission to Emergency Departments, representing around 1-3% of all admissions to the service. However, elderly age and important comorbidities often hinder a definite etiologic diagnosis, with increasing requests for diagnostic tests and longer periods of hospitalization. We analyzed the management of 1,204 patients admitted to our Emergency Department for transient loss of consciousness in the period between 1 June 2009 and 1 June 2010, evaluating the following parameters: average age, gender, triage color code at admittance, performed diagnostic tests, diagnosis at discharge from ED and destination ward. We also studied a subgroup of 93 patients admitted to emergency medicine units evaluating their OESIL score at admittance, comorbidities, performed diagnostic tests and diagnosis at discharge from the ward. In the Emergency Department, 45% of patients were discharged with a diagnosis of syncope of unknown origin; in 21% of patients syncope was excluded; 19% of patients received a diagnosis of cardiogenic syncope; 11% were diagnosed with a presyncope; 3% with orthostatic hypotension and 1% with vasovagal syncope. In emergency medicine units, 51% of patients were discharged with a diagnosis of cardiogenic syncope, 11% were diagnosed with vasovagal syncope, 11% with presyncope, 11% with TIA, 8% with loss of consciousness non-syncope and 8% with syncope of unknown origin. Management of patients with syncope, elderly people with important comorbidities in particular, is still a serious problem for the emergency physician. The creation of specialized units for the management of syncope, the so-called syncope units, through the implementation of a shared diagnostic and therapeutic protocol, aims at reducing inappropriate hospitalization and average length of stay.

  14. Midodrine: a role in the management of neurocardiogenic syncope

    OpenAIRE

    Ward, C; Gray, J; Gilroy, J; Kenny, R

    1998-01-01

    Objective—To determine the benefit of midodrine, an α agonist, on symptom frequency and haemodynamic responses during head up tilt in patients with neurocardiogenic syncope.
Setting—Cardiovascular investigation unit (a secondary and tertiary referral centre for the investigation and management of syncope).
Patients—16 outpatients (mean (SD) age 56 (18) years; five men) with frequent hypotensive symptoms (more than two syncopal episodes and fewer than 20 symptom free days per month), and repro...

  15. Dreaming experience as a useful diagnostic clue for syncopal episodes.

    Science.gov (United States)

    Chiesa, V; Terranova, P; Vignoli, A; Canevini, M P

    2011-11-01

    The differential diagnosis between epileptic seizures and syncopes is a common occurrence in clinical practice. The manifestations of seizure and syncope sometimes overlap, and available diagnostic testing often not provides a conclusive answer. Syncope is often preceded by a symptom complex characterized by lightheadedness, generalized muscle weakness, giddiness, visual blurring, tinnitus, and gastrointestinal symptoms. These subjective symptoms are very important in guiding the diagnosis. In our experience, the impression of coming out of a dream after the syncopal episode is a subjective symptom commonly reported by patients, if questioned. To verify the occurrence of dreaming experience after syncope and after generalized tonic-clonic seizures (GTCS) and its diagnostic value in differential diagnosis, we asked 100 patients with GTCS and diagnosis of idiopathic generalized epilepsy (Group 1) and 100 patients with a certain diagnosis of syncope (Group 2) whether they have never felt the impression of coming out of a dream after the loss of consciousness (GTCS or syncope, respectively). In Group 1, nobody referred the dreaming experience, whereas in the syncope group, 19% of patients referred this subjective symptom. Dreaming experience seems to be an additional useful diagnostic clue for syncopal episodes, helping the clinician to differentiate them from seizures. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

  16. Syncope management unit: evolution of the concept and practice implementation.

    Science.gov (United States)

    Shen, Win K; Traub, Stephen J; Decker, Wyatt W

    2013-01-01

    Syncope, a clinical syndrome, has many potential causes. The prognosis of a patient experiencing syncope varies from benign outcome to increased risk of mortality or sudden death, determined by the etiology of syncope and the presence of underlying disease. Because a definitive diagnosis often cannot be established immediately, hospital admission is frequently recommended as the "default" approach to ensure patient's safety and an expedited evaluation. Hospital care is costly while no studies have shown that clinical outcomes are improved by the in-patient practice approach. The syncope unit is an evolving practice model based on the hypothesis that a multidisciplinary team of physicians and allied staff with expertise in syncope management, working together and equipped with standard clinical tools could improve clinical outcomes. Preliminary data have demonstrated that a specialized syncope unit can improve diagnosis in a timely manner, reduce hospital admission and decrease the use of unnecessary diagnostic tests. In this review, models of syncope units in the emergency department, hospital and outpatient clinics from different practices in different countries are discussed. Similarities and differences of these syncope units are compared. Outcomes and endpoints from these studies are summarized. Developing a syncope unit with a standardized protocol applicable to most practice settings would be an ultimate goal for clinicians and investigators who have interest, expertise, and commitment to improve care for this large patient population. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Structural heart disease as the cause of syncope

    Science.gov (United States)

    Guimarães, R.B.; Essebag, V.; Furlanetto, M.; Yanez, J.P.G.; Farina, M.G.; Garcia, D.; Almeida, E.D.; Stephan, L.; Lima, G.G.; Leiria, T.L.L.

    2018-01-01

    We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (Psyncope (HR=2.97, 95%CI=1.94-4.55; Psyncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population. PMID:29513795

  18. A practical approach to evaluating the patient with syncope.

    Science.gov (United States)

    Bentz, Barbara A

    2008-01-01

    Syncope is a significant patient care issue. There are approximately half a million cases annually. Syncope may represent a life-threatening condition or a benign process. Identifying the cause of syncope is often difficult because it occurs sporadically and the cause is usually not obvious. The literature states that as many as 25% to 50% of patients who experience syncope remain undiagnosed. Taking a very practical approach when caring for these patients includes a very detailed health history, electrocardiogram, and a logical approach based on what is known and what was learned from the patient's medical history.

  19. Recurrent Syncope, a Clue in Amyloid Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Julian A. Marin-Acevedo

    2018-01-01

    Full Text Available Infiltrative cardiomyopathies include a variety of disorders that lead to myocardial thickening resulting in a constellation of clinical manifestations and eventually heart failure that could be the first clue to reach the diagnosis. Among the more described infiltrative diseases of the heart is amyloid cardiomyopathy. The disease usually presents with subtle, nonspecific symptoms. Herein, we illustrate a case of recurrent syncope as the initial presenting symptom for systemic amyloid with polyneuropathy and cardiomyopathy as a cause of syncope. The article illustrates the role of advanced cardiac imaging in the diagnosis of the disease with a focused literature review. We also highlight the role of early, shared decision-making between patient, family, and medical team in the management of cardiac amyloidosis.

  20. Syncope Caused by Huge Hiatal Hernia

    Directory of Open Access Journals (Sweden)

    Gabriel Vanerio

    2011-01-01

    Full Text Available A 84-year-old white female had a brief loss of consciousness while playing bridge. A few minutes before the episode she had eaten pizza and significant amount of carbonated soft drinks. After recovery, her friends noticed that she was alert, but pale and sweating. Upon arrival at the emergency room, sitting blood pressure was 160/60 mmHg with a normal sinus rhythm. A chest X-Ray was performed, which was essential to make the diagnosis. The X-Ray showed a large retrocardiac opacity with air and liquid level compatible with a giant hiatus hernia. After a copious snack the hiatal hernia compressed the left atrium, decreasing the left cardiac output, elucidating the mechanism of the syncopal episode. In patients presenting with swallow syncope (particularly after a copious meal, validating the importance of a careful history, a chest X-Ray should be always be performed.

  1. Pathophysiology of Noncardiac Syncope in Athletes.

    Science.gov (United States)

    Christou, Georgios A; Christou, Konstantinos A; Kiortsis, Dimitrios N

    2018-03-31

    The most frequent cause of syncope in young athletes is noncardiac etiology. The mechanism of noncardiac syncope (NCS) in young athletes is neurally-mediated (reflex). NCS in athletes usually occurs either as orthostasis-induced, due to a gravity-mediated reduced venous return to the heart, or in the context of exercise. Exercise-related NCS typically occurs after the cessation of an exercise bout, while syncope occurring during exercise is highly indicative of the existence of a cardiac disorder. Postexercise NCS appears to result from hypotension due to impaired postexercise vasoconstriction, as well as from hypocapnia. The mechanisms of postexercise hypotension can be divided into obligatory (which are always present and include sympathoinhibition, histaminergic vasodilation, and downregulation of cardiovagal baroreflex) and situational (which include dehydration, hyperthermia and gravitational stress). Regarding postexercise hypocapnia, both hyperventilation during recovery from exercise and orthostasis-induced hypocapnia when recovery occurs in an upright posture can produce postexercise cerebral vasoconstriction. Athletes have been shown to exhibit differential orthostatic responses compared with nonathletes, involving augmented stroke volume and increased peripheral vasodilation in the former, with possibly lower propensity to orthostatic intolerance.

  2. Management strategies for recurrent vasovagal syncope.

    Science.gov (United States)

    Vaddadi, G; Corcoran, S J; Esler, M

    2010-08-01

    Vasovagal syncope (VVS) is the commonest cause of recurrent syncope and has a high level of morbidity in both young and elderly patients. Diagnosis and treatment are often unsatisfactory despite the fact that syncope has a lifetime cumulative incidence of 35%. A detailed history can often yield an accurate diagnosis in most young patients. Older patients are more likely to present in an atypical manner and although the yield is low, a more comprehensive diagnostic assessment may be needed. It is important to identify patients with low supine systolic blood pressure who are prone to recurrent VVS. These patients represent a distinct subtype of VVS and may respond to a tailored therapeutic approach. Treatment options for VVS are limited because of a paucity of randomized trials. The backbone of therapy is educating the patient, avoiding precipitating factors, maintaining hydration and the application of physical counter-pressure manoeuvres. Drug therapy is rarely warranted; however, fludrocortisone, alpha-agonists, such as midodrine and dihydroergotamine, and selective serotonin reuptake inhibitors may be helpful in some patients. Permanent cardiac pacing is rarely needed and randomized trials do not support its use.

  3. Epidemiological studies on syncope--a register based approach.

    Science.gov (United States)

    Ruwald, Martin Huth

    2013-08-01

    The epidemiology and prognosis of ‘fainting’ or syncope has puzzled physicians over the years. Is fainting dangerous? This is a question often asked by the patient--and the answer is ‘it depends on a lot of things’. The diverse pathophysiology of syncope and the underlying comorbidites of the patients play an essential role. In epidemiology these factors have major impact on the outcome of the patients. Until recently, even the definition of syncope, differed from one study to another which has made literature reviews difficult. Traditionally the data on epidemiology of syncope has been taken from smaller studies from different clinical settings with wide differences in patient morbidity. Through the extensive Danish registries we examined the characteristics and prognosis of the patients hospitalized due to syncope in a nationwide study. The aims of the present thesis were to investigate: 1) the use, validity and accuracy of the ICD-10 diagnosis of syncope R55.9 in the National Patient Registry for the use of this diagnosis in the epidemiology of syncope, 2) diagnostics used and etiology of a random selection of patients who had a discharge diagnosis of R55.9, 3) the incidence, prevalence and cardiovascular factors associated with the risk of syncope, 4) the prognosis in healthy individuals discharged after syncope, and 5) the prognosis of patients after syncope and evaluation of the CHADS2 score as a tool for short and long-term risk prediction. The first studies of the present thesis demonstrated that the ICD-10 discharge diagnosis could reliably identify a cohort of patients admitted for syncope and that the discharge code carried a high number of unexplained cases despite use of numerous tests. The last studies showed that syncope is a common cause for hospital contact in Denmark and that the risk of syncope is tightly associated with cardiovascular comorbidities and use of pharmacotherapy. Furthermore in patients with no comorbidities (or healthy

  4. Structural heart disease as the cause of syncope

    Directory of Open Access Journals (Sweden)

    R.B. Guimarães

    2018-03-01

    Full Text Available We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16% patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001. Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001. The scores were analyzed for diagnostic performance with area under the curve (AUC and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.

  5. Geriatric Syncope and Cardiovascular Risk in the Emergency Department.

    Science.gov (United States)

    Ali, Nissa J; Grossman, Shamai A

    2017-04-01

    Syncope is a transient loss of consciousness that is caused by a brief loss in generalized cerebral blood flow. This article reviews the background, epidemiology, etiologies, evaluation, and disposition considerations of geriatric patients with syncope, with a focus on cardiovascular risk. Although syncope is one of the most common symptoms in elderly patients presenting to the emergency department, syncope causes in geriatric patients can present differently than in younger populations, and the underlying etiology is often challenging to discern. History, physical examination, and electrocardiography (ECG) have the greatest utility in evaluating syncope. Additional testing should be guided by history and physical examination. There are multiple scoring tools developed to aid in management and these are reviewed in the article. Common predictors that would indicate a need for further work-up include a history of cardiac or valvular disease (i.e., ventricular dysrhythmia, congestive heart failure), abnormal ECG, anemia or severe volume depletion (i.e., from a gastrointestinal bleed), syncope while supine or with effort, report of palpitations or chest pain, persistent abnormal vital signs, or family history of sudden death. With advancing age, cardiovascular morbidity plays a more frequent and important role in the etiology of syncope. The syncope work-up should be tailored to the patient's presentation. Disposition should be based on the results of the initial evaluation and risk factors for adverse outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Stepwise evaluation of unexplained syncope in a large ambulatory population.

    Science.gov (United States)

    Iglesias, Juan F; Graf, Denis; Forclaz, Andrei; Schlaepfer, Juerg; Fromer, Martin; Pruvot, Etienne

    2009-03-01

    Up to 60% of syncopal episodes remain unexplained. We report the results of a standardized, stepwise evaluation of patients referred to an ambulatory clinic for unexplained syncope. We studied 939 consecutive patients referred for unexplained syncope, who underwent a standardized evaluation, including history, physical examination, electrocardiogram, head-up tilt testing (HUTT), carotid sinus massage (CSM) and hyperventilation testing (HYV). Echocardiogram and stress test were performed when underlying heart disease was initially suspected. Electrophysiological study (EPS) and implantable loop recorder (ILR) were used only in patients with underlying structural heart disease or major unexplained syncope. We identified a cause of syncope in 66% of patients, including 27% vasovagal, 14% psychogenic, 6% arrhythmias, and 6% hypotension. Noninvasive testing identified 92% and invasive testing an additional 8% of the causes. HUTT yielded 38%, CSM 28%, HYV 49%, EPS 22%, and ILR 56% of diagnoses. On average, patients with arrhythmic causes were older, had a lower functional capacity, longer P-wave duration, and presented with fewer prodromes than patients with vasovagal or psychogenic syncope. A standardized stepwise evaluation emphasizing noninvasive tests yielded 2/3 of causes in patients referred to an ambulatory clinic for unexplained syncope. Neurally mediated and psychogenic mechanisms were behind >50% of episodes, while cardiac arrhythmias were uncommon. Sudden syncope, particularly in older patients with functional limitations or a prolonged P-wave, suggests an arrhythmic cause.

  7. Usefulness of syncope guidelines in risk stratification of syncope in emergency department.

    Science.gov (United States)

    Sruamsiri, Kamphee; Chenthanakij, Boriboon; Tantiwut, Aphinant; Wittayachamnankul, Borwon

    2014-02-01

    Management of patients with syncope in the Emergency Department now focuses on identifying patients who will be at future risk of serious morbidity. Among the risk stratification scoring systems being used were the San Francisco Syncope Rule (SFSR) and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score. To assess the accuracy of SFSR and OESIL score at predicting short-term serious outcome in Maharaj Nakorn Chiang Mai Hospital. In a prospective descriptive analysis study, adult patients presenting with syncope or near syncope between October 1, 2009 and April 24, 2010 were enrolled. All patients were followed-up at 7-day and 1-month. Statistical analysis included accuracy, sensitivity, specificity, predictive values, and likelihood ratios. One hundred seventy eight patients were enrolled in the present study. Fifty-three patients had a short-term serious outcome on follow-up. SFSR had 74.7% accuracy, 90.6% sensitivity, 68% specificity, 54.5% PPV 94.4% NPV likelihood ratio positive (LR+) of 2.8, and likelihood ratio negative (LR-) of 0.1, whereas OESIL score had 80.9% accuracy, 79.4% sensitivity, 81.6% specificity, 64.6% PPV 90.3% NPV, LR+ of 4.3, and LR- of 0.2. Both scores have good accuracy and sensitivity, but they should not be used as the only device in patient disposition. However, both scores showed a low false negative rate. Therefore, they may help in helping physician discharge low-risk patients.

  8. Sleep syncope: important clinical associations with phobia and vagotonia.

    Science.gov (United States)

    Busweiler, L; Jardine, D L; Frampton, C M; Wieling, W

    2010-10-01

    To compare demographic and clinical data from patients with sleep syncope to those of patients with "classical" vasovagal syncope [VVS] collected over the last 8 years. Retrospective case-controlled study. Syncope unit. Fifty-four patients with a history suggestive of one or more episodes of sleep syncope (group SS) were matched for age and gender to 108 patients with VVS (control group). A syncope questionnaire was completed immediately before tilt-testing and included frequency, age-of-onset and severity of episodes; situations, postures and perceived triggers; lifetime prevalence of specific phobias; and symptoms during syncope. Group SS were mainly women (65%), mean age of 46±2.1 years, with a mean lifetime total of 5.4±0.83 episodes of sleep syncope. Compared to controls, SS episodes were more likely to start in childhood, 26.9% versus 50% (p=0.005), and more severe, score 2.40±0.11 versus 2.81±0.15 (p=0.03). In group SS: syncope onset whilst lying down was more frequent, 4.6% versus 32.7% (p=0.001); the lifelong prevalence of any specific phobia was higher, 32.4% versus 74.5% (p=0.001), in particular blood injection injury (BII) phobia, 19.4% versus 57.4% (p=0.001); and during attacks, distressing vagal symptoms were more frequent, e.g., abdominal discomfort, 13.9% versus 72.2% (p=0.001). Sleep syncope is not rare and is characterised by lifelong, intermittent but severe episodes of vasovagal syncope which may occur in the horizontal position, with distressing abdominal symptoms. BII phobia is strongly associated and may be a predisposing factor or a co-existent disorder in these patients.

  9. Physiological phenomenology of neurally-mediated syncope with management implications.

    Directory of Open Access Journals (Sweden)

    Christoph Schroeder

    Full Text Available BACKGROUND: Due to lack of efficacy in recent trials, current guidelines for the treatment of neurally-mediated (vasovagal syncope do not promote cardiac pacemaker implantation. However, the finding of asystole during head-up tilt -induced (presyncope may lead to excessive cardioinhibitory syncope diagnosis and treatment with cardiac pacemakers as blood pressure is often discontinuously measured. Furthermore, physicians may be more inclined to implant cardiac pacemakers in older patients. We hypothesized that true cardioinhibitory syncope in which the decrease in heart rate precedes the fall in blood pressure is a very rare finding which might explain the lack of efficacy of pacemakers in neurally-mediated syncope. METHODS: We studied 173 consecutive patients referred for unexplained syncope (114 women, 59 men, 42 ± 1 years, 17 ± 2 syncopal episodes. All had experienced (presyncope during head-up tilt testing followed by additional lower body negative suction. We classified hemodynamic responses according to the modified Vasovagal Syncope International Study (VASIS classification as mixed response (VASIS I, cardioinhibitory without (VASIS IIa or with asystole (VASIS IIb, and vasodepressor (VASIS III. Then, we defined the exact temporal relationship between hypotension and bradycardia to identify patients with true cardioinhibitory syncope. RESULTS: Of the (presyncopal events during tilt testing, 63% were classified as VASIS I, 6% as VASIS IIb, 2% as VASIS IIa, and 29% as VASIS III. Cardioinhibitory responses (VASIS class II progressively decreased from the youngest to the oldest age quartile. With more detailed temporal analysis, blood pressure reduction preceded the heart-rate decrease in all but six individuals (97% overall and in 10 out of 11 patients with asystole (VASIS IIb. CONCLUSIONS: Hypotension precedes bradycardia onset during head-up tilt-induced (presyncope in the vast majority of patients, even in those classified as

  10. Characteristics of syncope in patients with dilated cardiomyopathy.

    Science.gov (United States)

    Rami, Abdel-Hadi; Lucian, Muresan; Dana, Pop; Dumitru, Zdrenghea

    2016-04-01

    Syncope carries a poor prognosis among patients with dilated cardiomyopathy (DCM). To assess the prevalence, describe the underlying mechanisms and to identify risk factors for syncope in patients with DCM. One thousand six hundred and ten medical files of 897 patients with a diagnosis of DCM were reviewed. Patients with syncope were identified and their clinical and paraclinical profiles were compared to an equal number of age- and sex-matched patients with DCM without syncope. Thirty patients (27 males) with an average age of 62.5 years were identified, corresponding to a prevalence of syncope of 3.3%. A cardiac origin of syncope was identified in 56% of patients (n=17): ventricular arrhythmias in 33% (n=10), and conduction disorders in 23% (n=7). Other mechanisms of syncope were neurally mediated in 7% (n=2) and orthostatic hypotension in 7% (n=2). In 30% of cases (n=9), the etiology was unidentified. There were no significant differences regarding the etiology of DCM, ejection fraction (35.3% vs 35.3%, p=1.0), NYHA class (mild or advanced, p=0.79) and associated conditions (hypertension, p=0.36; diabetes, p=0.75; atrial fibrillation, p=0.43; and dyslipidemia, p=0.33) between the two groups. However, among patients with syncope, patients with a noncardiac cause were more likely to have hypertension (61.53% vs 23.52%, p=0.08) and diabetes (46.15% vs 5.88%, p=0.03). In patients with DCM, syncope is a relatively rare finding. Cardiac causes (arrhythmias and conduction disorders) are responsible for the majority of cases. Risk factors for syncope in these patients remain to be determined. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  11. Syncope and Epilepsy coexist in 'possible' and 'drug-resistant' epilepsy (Overlap between Epilepsy and Syncope Study - OESYS).

    Science.gov (United States)

    Ungar, Andrea; Ceccofiglio, Alice; Pescini, Francesca; Mussi, Chiara; Tava, Gianni; Rafanelli, Martina; Langellotto, Assunta; Marchionni, Niccolò; van Dijk, J Gert; Galizia, Gianlugi; Bonaduce, Domenico; Abete, Pasquale

    2017-02-28

    Differential diagnosis between syncope and epilepsy in patients with transient loss of consciousness of uncertain etiology is still unclear. Thus, the aim of the present work is to evaluate the prevalence of syncope in patients with "possible" or "drug-resistant" epilepsy. The Overlap between Epilepsy and SYncope Study (OESYS) is a multicenter prospective observational study designed to estimate the prevalence of syncope in patients followed in Epilepsy Centers for "possible" or "drug-resistant" epilepsy and assessed according the European Society of Cardiology (ESC) guidelines of syncope diagnosis. One hundred seven patients were evaluated; 63 (58.9%) had possible and 44 (41.1%) drug-resistant epilepsy. A final diagnosis of isolated syncope was in 45 patients (42.1%), all with possible epilepsy (45/63, 71.4%). Isolated epilepsy was found in 21 patients (19.6%) and it was more frequent in the drug-resistant than in the possible epilepsy group (34.1% vs. 9.5%, p = 0.002). More importantly, syncope and epilepsy coexisted in 37.4% of all patients but the coexistence was more frequent among patients with drug-resistant than possible epilepsy (65.9% vs. 17.5%, p syncope was diagnosed in ≈ 70% of patients with possible epilepsy. Syncope and epilepsy coexisted in ≈ 20% of patients with possible and in ≈ 60% of patients with drug-resistant epilepsy. These findings highlight the need of ESC guidelines of syncope approach in patients with possible and drug-resistant epilepsy.

  12. Etiology of syncope in patients hospitalized with syncope and predictors of mortality and rehospitalization for syncope at 27-month follow-up.

    Science.gov (United States)

    Sule, Sachin; Palaniswamy, Chandrasekar; Aronow, Wilbert S; Ahn, Chul; Peterson, Stephen J; Adapa, Sreedhar; Mudambi, Lakshmi

    2011-01-01

    The authors investigated the etiologies of syncope and risk factors for mortality and rehospitalization for syncope at 27-month follow-up in 325 consecutive patients, mean age 66 years, hospitalized for syncope. The causes of syncope were diagnosed in 241 patients (74%). Of 325 patients, 13 (4%) were rehospitalized for syncope and 38 (12%) died. Stepwise logistic regression analysis showed that significant independent prognostic factors for rehospitalization for syncope were diabetes (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.6-20.4), atrial fibrillation (OR, 4.0; 95% CI, 1.0-15.6), and smoking (OR, 4.6; 95% CI, 1.3-16.8). Stepwise Cox regression analysis showed that significant independent prognostic factors for time to mortality were diabetes (hazard ratio [HR], 2.7; 95% CI, 1.4-5.2), coronary artery bypass graft surgery (HR, 2.9; 95% CI, 1.3-6.5), malignancy history (HR, 2.5; 95% CI, 1.2-5.2), narcotics use (HR, 4.0; 95% CI, 1.7-9.8), smoking (HR, 2.8; 95% CI, 1.4-5.5), atrial fibrillation (HR, 2.4; 95% CI, 1.0-5.4), and volume depletion (HR, 2.8; 95% CI, 1.4-5.8). Copyright © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose. © 2011 Wiley Periodicals, Inc.

  13. Syncopation, body-movement and pleasure in groove music.

    Science.gov (United States)

    Witek, Maria A G; Clarke, Eric F; Wallentin, Mikkel; Kringelbach, Morten L; Vuust, Peter

    2014-01-01

    Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a web-based survey which investigated the relationship between syncopation and ratings of wanting to move and experienced pleasure. Participants heard funk drum-breaks with varying degrees of syncopation and audio entropy, and rated the extent to which the drum-breaks made them want to move and how much pleasure they experienced. While entropy was found to be a poor predictor of wanting to move and pleasure, the results showed that medium degrees of syncopation elicited the most desire to move and the most pleasure, particularly for participants who enjoy dancing to music. Hence, there is an inverted U-shaped relationship between syncopation, body-movement and pleasure, and syncopation seems to be an important structural factor in embodied and affective responses to groove.

  14. Syncopation, body-movement and pleasure in groove music.

    Directory of Open Access Journals (Sweden)

    Maria A G Witek

    Full Text Available Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a web-based survey which investigated the relationship between syncopation and ratings of wanting to move and experienced pleasure. Participants heard funk drum-breaks with varying degrees of syncopation and audio entropy, and rated the extent to which the drum-breaks made them want to move and how much pleasure they experienced. While entropy was found to be a poor predictor of wanting to move and pleasure, the results showed that medium degrees of syncopation elicited the most desire to move and the most pleasure, particularly for participants who enjoy dancing to music. Hence, there is an inverted U-shaped relationship between syncopation, body-movement and pleasure, and syncopation seems to be an important structural factor in embodied and affective responses to groove.

  15. Vascular Causes of Syncope: An Emergency Medicine Review.

    Science.gov (United States)

    Long, Brit; Koyfman, Alex

    2017-09-01

    Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. This review evaluates vascular causes of syncope and their evaluation and management in the ED. Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management. Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope. Published by Elsevier Inc.

  16. Syncope in pediatric patients presenting to an emergency department.

    Science.gov (United States)

    Massin, Martial M; Bourguignont, Astrid; Coremans, Christine; Comté, Laetitia; Lepage, Philippe; Gérard, Paul

    2004-08-01

    To assess the epidemiology of syncope coming to medical attention among unselected children referred to an emergency department in Western Europe. We analyzed the cause of syncope and diagnostic workup of 226 consecutive pediatric patients seen in our emergency department because of a syncopal event. Neurocardiogenic syncope and neurologic disorders were the most common diagnoses (80% and 9%, respectively). Other causes included psychologic, cardiac, respiratory, toxicologic, and metabolic problems. The neurocardiogenic and disease-related syncopes were easily identified or suspected by history and physical examination. Electrocardiography was not performed in 132 cases (58%). Most patients with suspected neurocardiogenic syncope had an electroencephalogram, and 29% were admitted to the hospital. Cardiac disorders represented 5 cases (2%); 2 had been previously misdiagnosed. Syncope in children can result from a wide variety of causes. Consequently, an evaluation that fails to approach this problem in a goal-directed fashion proves to be very expensive, time-consuming, and frustrating to all concerned. Thorough history and physical examination are usually all that are necessary to guide practitioners in choosing the diagnostic tests that apply to a given patient.

  17. Delaying Orthostatic Syncope With Mental Challenge

    Science.gov (United States)

    Goswami, Nandu; Roessler, Andreas; Hinghofer-Szalkay, Helmut; Montani, Jean-Pierre; Steptoe, Andrew

    2012-07-01

    At orthostatic vasovagal syncope there appears to be a sudden withdrawl of sympathetic activity. As mental challenge activates the sympathetic system, we hypothesized that doing mental arithmetic in volunteers driven to the end point of their cardiovascular stability may delay the onset of orthostatic syncope. We investigated this in healthy male subjects. Each subject underwent a head up tilt (HUT) + graded lower body negative pressure (LBNP) up to presyncope session (control) to determine the orthostatic tolerance time, OTT (Time from HUT commencement to development of presyncopal symptoms/signs). Once the tolerance time was known, a randomized crossover protocol was used: either 1) Repeat HUT + LBNP to ensure reproducibility of repeated run or 2) HUT + LBNP run but with added mental challenge (two min before the expected presyncope time). Test protocols were separated by two weeks. Our studies on five male test subjects indicate that mental challenge improves orthostatic tolerance significantly. Additional mental loading could be a useful countermeasure to alleviate the orthostatic responses of persons, particularly in those with histories of dizziness on standing up, or to alleviate hypotension that frequently occurs during hemodialysis or on return to earth from the spaceflight environment of microgravity.

  18. The Etiology of Syncope in an Emergency Hospital.

    Science.gov (United States)

    Bădilă, Elisabeta; Negrea, Claudia; Rîpă, Alina; Weiss, Emma; Bartoş, Daniela; Tîrziu, Cristina

    2016-09-01

    Syncope is a commonly encountered problem in an emergency hospital. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients for whom syncope is a symptom of a potentially life-threatening condition. We identified adult patients presenting with syncope to the Emergency Department of our hospital from January 2012 to June 2014. Of 590 patients found in the hospital database we further selected 217 patients who met our criteria, namely having a positive diagnosis of syncope (being clearly distinguished from other TLOCs) and an etiology of the disease. Thus, definite diagnosis was established retrospectively by reviewing medical records. The demographics of our group shows a slightly different distribution between men and women (49% men and 51% women) and a majority of the urban population (67%). As for the age range, most of our patients were in the age group of 70-80 years (30%), 29% were > 80 years old, and the percentage decreases significantly in the 60-70 years range (17%). The most frequent causes of syncope were cardiac (32%), vasovagal (23%) and due to orthostatic hypotension (12%), but we have also found various cases of mixt or iatrogenic causes. The incidence of syncope increases sharply after 70 years of age and poses special consideration in light of multiple comorbid conditions, age-related changes, atypical presentation, and concomitant medication use. The most common causes of syncope in this population are cardiac causes, orthostatic hypotension and carotid sinus hypersensitivity. Often, root cause of syncope remains undiagnosed, despite exhaustive diagnostic testing.

  19. Approach to the patient with syncope: venues, presentations, diagnoses.

    Science.gov (United States)

    Benditt, David G; Adkisson, Wayne O

    2013-02-01

    Syncope is a frequent cause for presentation to emergency departments and urgent-care clinics. The physician should establish a confident causal diagnosis, assess prognostic implications, and provide appropriate advice to prevent recurrences. An organized approach is needed to the assessment of the patient with syncope, including a careful initial examination as well as application of specialized syncope evaluation units and structured questionnaires for history taking. The initial patient evaluation, particularly a detailed medical history, is the key to identifying the most likely diagnosis. Based on these findings, subsequent diagnostic tests can be chosen to confirm the clinical suspicion. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Adenosine test in the diagnosis of unexplained syncope: marker of conducting tissue disease or neurally mediated syncope?

    Science.gov (United States)

    Parry, Steve W; Nath, Samiran; Bourke, John P; Bexton, Rodney S; Kenny, Rose Anne

    2006-06-01

    Adenosine test (supine administration of a 20 mg intravenous bolus with electrocardiographic and blood pressure monitoring) has been endorsed by the European Society of Cardiology guidelines on syncope management as an 'experimental' test in the diagnosis of unexplained syncope. The test is quick and cheap, but there is no consensus as to what condition, if any, the adenosine test is exposing, with conducting tissue disease and neurally mediated syncope proposed by various authors. In this article, we review the possible mechanisms underlying a positive adenosine test, its safety, and a comprehensive examination of the literature supporting each of the putative causal diagnoses.

  1. Current concepts in the evaluation and management of syncope.

    Science.gov (United States)

    Kuriachan, Vikas; Sheldon, Robert S

    2008-09-01

    Syncope is a very common presentation with a wide differential diagnosis and equally wide prognostic implications. Recent work has highlighted the importance of an accurate history and physical examination as the basis of diagnosis, prognosis, and treatment. Several centers have evaluated the role of structured histories and comprehensive syncope evaluation guidelines and units in managing syncope. Although these do provide comprehensive care, whether they improve overall outcome and reduce costs is far from clear. This is partly because there are few effective treatments for the major cause of fainting, vasovagal syncope. Recent randomized trials have highlighted the roles of physical counterpressure maneuvers and midodrine and the limitations of treatment with beta blockers and permanent cardiac pacing.

  2. Syncope: a review of emergency department management and disposition

    Science.gov (United States)

    Patel, Pranjal R; Quinn, James V

    2015-01-01

    Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion with spontaneous return to baseline function without intervention. It is a common chief complaint of patients presenting to the emergency department. The differential diagnosis for syncope is broad and the management varies significantly depending on the underlying etiology. In the emergency department, determining the cause of a syncopal episode can be difficult. However, a thorough history and certain physical exam findings can assist in evaluating for life-threatening diagnoses. Risk-stratifying patients into low, moderate and high-risk groups can assist in medical decision making and help determine the patient’s disposition. Advancements in ambulatory monitoring have made it possible to obtain prolonged cardiac evaluations of patients in the outpatient setting. This review will focus on the diagnosis and management of the various types of syncope. PMID:27752576

  3. Management of syncope: from evidence to clinical practice

    Directory of Open Access Journals (Sweden)

    Tiziana M. Attardo

    2016-06-01

    Full Text Available Syncope is defined as a transient loss of consciousness due to temporary global cerebral hypoperfusion. It is characterized by rapid onset, short duration, loss of postural tone possibly causing patient fall, and spontaneous full recovery. Syncope has a high prevalence and incidence within the general population with a relevant impact on both quality of life and health care costs. The diagnosis of syncope is often inaccurate and subject to delay, and management is greatly variable. The main objective of this monograph is to discuss a methodological diagnostic approach to signs and symptoms suggestive of syncope, aiming for a management optimization. The present work is based on a systematic review of recent international guidelines.

  4. Approach to syncope in the era of medical technology.

    Science.gov (United States)

    Sakr, Antoine; Sreih, Antoine

    2007-02-01

    Syncope is a common medical condition that continues to challenge residents and specialists. It is responsible for 6% of general medical admissions and imposes a financial burden for unnecessary tests up to $16,000 per patient. Because of its disabling potential and lack of a "gold standard" test, syncope often leads to multiple hospital admissions and to the performance of many tests thought to be useful in diagnosis. Our survey consisted of a series of medical questions aimed at assessing the medical knowledge among nurses, residents and cardiologists. Despite the frequency of syncope, our survey showed a lack of medical knowledge among nurses, residents and cardiologists. It is hoped that improving medical knowledge will allow appropriate tailoring of the workup for syncope and reduce the cost of admissions to the hospital for this condition.

  5. Current investigation and management of patients with syncope

    DEFF Research Database (Denmark)

    Dagres, Nikolaos; Bongiorni, Maria Grazia; Dobreanu, Dan

    2013-01-01

    and indications for tilt table testing in neurally mediated syncope. The majority of centres reported using ECG, echocardiography, and Holter monitoring as their main diagnostic tools in patients with syncope, whereas a smaller proportion of centres applied specific assessment algorithms. Physical manoeuvres were......, electrophysiological study, and implantation of a loop recorder were performed only if there was a specific indication. The use of a tilt table test varied widely: 44% of respondents almost always performed it when neurally mediated syncope was suspected, whereas 37% did not perform it when there was a strong evidence......The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network. Responses were received from 43 centres. The majority of respondents...

  6. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope

    NARCIS (Netherlands)

    Romme, Jacobus J. C. M.; Reitsma, Johannes B.; Black, Catherine N.; Colman, Nancy; Scholten, Rob J. P. M.; Wieling, Wouter; van Dijk, Nynke

    2011-01-01

    Background Neurally mediated reflex syncope is the most common cause of transient loss of consciousness. In patients not responding to nonpharmacological treatment, pharmacological or pacemaker treatment might be considered. Objectives To examine the effects of pharmacological therapy and pacemaker

  7. Syncopation, body-movement and pleasure in groove music.

    OpenAIRE

    Witek, MA; Clarke, EF; Wallentin, M; Kringelbach, ML; Vuust, P

    2014-01-01

    Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a ...

  8. Swallow syncope caused by third-degree atrioventricular block

    DEFF Research Database (Denmark)

    Roust Aaberg, Anne Marie; Eriksson, Anna Elin; Madsen, Per Lav

    2015-01-01

    We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker.......We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker....

  9. A hairy fall: syncope resulting from topical application of minoxidil.

    Science.gov (United States)

    Dubrey, S W; VanGriethuysen, J; Edwards, C M B

    2015-09-07

    We describe the case of a young man who developed syncope after using a high strength formulation of topical minoxidil as a hair growth restorer. Other potential cardiovascular and endocrine causes were excluded, and his symptoms resolved on discontinuation of the product. While syncope is a recognised side effect of using this powerful systemic antihypertensive agent, few cases are documented in the literature, which we illustrate in our discussion. 2015 BMJ Publishing Group Ltd.

  10. Syncopation affects free body-movement in musical groove

    DEFF Research Database (Denmark)

    Witek, Maria A. G.; Popescu, Tudor; Clarke, Eric F

    2016-01-01

    One of the most immediate and overt ways in which people respond to music is by moving their bodies to the beat. However, the extent to which the rhythmic complexity of groove-specifically its syncopation-contributes to how people spontaneously move to music is largely unexplored. Here, we measur...... on the body-part. We demonstrate that while people do not move or synchronise much to rhythms with high syncopation when dancing spontaneously to music, the relationship between rhythmic complexity and synchronisation is less linear than in simple finger-tapping studies.......One of the most immediate and overt ways in which people respond to music is by moving their bodies to the beat. However, the extent to which the rhythmic complexity of groove-specifically its syncopation-contributes to how people spontaneously move to music is largely unexplored. Here, we measured...... free movements in hand and torso while participants listened to drum-breaks with various degrees of syncopation. We found that drum-breaks with medium degrees of syncopation were associated with the same amount of acceleration and synchronisation as low degrees of syncopation. Participants who enjoyed...

  11. Is heart rate recovery index a predictive factor for cardioinhibitory syncope?

    Science.gov (United States)

    Emren, Volkan; Kocabaş, Uğur

    2018-01-01

    Cardioinhibitory syncope is related with excessive bradycardia or asystole due to parasympathetic response. We investigated whether patients with cardioinhibitory syncope have higher heart rate recovery index (HRRi) considered as a parasympathetic system activation in exercise stress testing (EST) than in those with other neurogenic syncope forms. A total of 262 patients who had neurogenic syncope documented by head-up tilt test (HUTT) and 199 healthy control individuals were examined. A maximal EST was applied to all patients after the HUTT. The HRRi was obtained by subtracting the heart rate that was measured at the first (HRRi-1), second (HRRi-2), and third minute (HRRi-3) of the recovery period from the maximal heart rate that was measured during the test. Eighty patients had cardioinhibitory syncope, 118 patients had vasodepressor syncope, and 64 patients had mixed-type syncope. The HRRi-1 was higher in patients with syncope (43.3 ± 7.7) compared to the control group (34.5 ± 4.8; p < 0.001). Post hoc analysis showed that among the syncope groups, there was no difference between patients with vasodepressor syncope (42.2 ± 7.6) and those with mixed type syncope (40.7 ± 4.1) in terms of HRRi-1 (p = 0.420). However, patients with cardioinhibitory syncope (47 ± 8.7) had a higher HRRi-1 than vasodepressor and mixed-type syncope groups (p < 0.05). The threshold value of the HRRi-1, which can be used for the prediction of cardioinhibitory syncope development, was determined to be 41 with 75% sensitivity and 72% specificity. The HRRi-1 was higher in patients with cardioinhibitory syncope compared to the controls. The HRRi-1 has the predictive feature of differentiating cardioinhibitory syncope from other syncope types.

  12. Current approaches to the clinical assessment of syncope in pediatric population.

    Science.gov (United States)

    Bayram, Ayşe Kaçar; Pamukcu, Ozge; Per, Huseyin

    2016-03-01

    Syncope is one of the most common clinical problem in children. This disorder is characterized by transient, spontaneously self-terminating loss of consciousness with brief duration and complete recovery. This situation is usually alarming for the families of patients. The mechanism of syncope is transient global brain hypoperfusion to levels below those tolerated by cerebrovascular autoregulation. Syncope can occur with many different etiologies in the pediatric population. Syncopes are divided into three major categories as neurally mediated syncope, cardiovascular-mediated syncope, and non-cardiovascular syncope. The major challenge in the assessment of children with syncope is that most children are asymptomatic at the time of their presentation, therefore making a careful and detailed history and a comprehensive physical examination essential in all patients. A trigger stimulus is detected in some cases, and this is an important clinical clue for the diagnosis. Cardiac causes of syncope in children are rare but can be life threatening and have the highest risk of morbidity and mortality. Misdiagnosis of epilepsy is common in patients presenting with syncope; therefore, the differential diagnosis between epileptic seizures and syncope is very important. It should be remembered that the evaluation of syncope in children is costly and diagnostic workup has a limited diagnostic yield. The aim of this article is to present different types of syncope and to provide new practical clinical approaches to the diagnosis, investigation, and management in the pediatric population.

  13. Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Ranya A Hegazy

    2008-02-01

    Full Text Available Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16 years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65 and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3% while 10.7% (n=25 had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2% were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope.

  14. Managing patients affected by syncope in ER: differential diagnosis and risk stratification

    OpenAIRE

    Elena Vitale; Roberto Maggi; Giuseppe Demarchi; Ivo Casagranda; Michele Brignole

    2009-01-01

    Syncope is a common presentation to the emergency department that account to about 1% . The efforts of the emergency physician in evaluating the patient with syncope should be directed to determine a specific diagnosis of syncope type and to make the risk stratification. The first objective can be achieved utilizing with strict adherence the guidelines on management of syncope of the European Society of Cardiology. To achieve the second objective it is necessary to evaluate the risk factors f...

  15. Tilt-table testing of patients with pacemaker and recurrent syncope

    DEFF Research Database (Denmark)

    Nielsen, Christian E. Haarmark; Kanters, Jørgen K; Mehlsen, Jesper

    2016-01-01

    The diagnosis of recurrent syncope in patients with pacemakers (PM) is quite challenging and the etiology of syncope is often multifactorial. To portray the mechanism of syncope in PM patients, we report the results of head-up tilt table testing (HUT) in a series of patients with PM, originally...... with pacemakers has a high diagnostic yield. Although, the majority of patients had a vasodepressor or orthostatic hypotensive response, cardioinhibitory response leading to syncope was also seen....

  16. The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth; Hansen, Morten Lock; Lamberts, Morten

    2012-01-01

    Syncope is a common cause for hospitalization and may be related to comorbidity and concurrent medication. The objective of this study was to determine the incidence, comorbidity, and pharmacotherapy in a nationwide cohort of patients hospitalized with syncope.......Syncope is a common cause for hospitalization and may be related to comorbidity and concurrent medication. The objective of this study was to determine the incidence, comorbidity, and pharmacotherapy in a nationwide cohort of patients hospitalized with syncope....

  17. Use of implantable and external loop recorders in syncope with unknown causes

    OpenAIRE

    Kaoru Tanno

    2017-01-01

    The gold standard for diagnosing syncope is to elucidate the symptom-electrocardiogram (ECG) correlation. The ECG recordings during syncope allow physicians to either confirm or exclude an arrhythmia as the mechanism of syncope. Many studies have investigated the use of internal loop recorder (ILR), while few studies have used external loop recorder (ELR) for patients with unexplained syncope. The aim of this review is to clarify the clinical usefulness of ILR and ELR in the diagnosis and man...

  18. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention

    OpenAIRE

    Koene, Ryan J.; Adkisson, Wayne O.; Benditt, David G.

    2017-01-01

    Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC) caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., re...

  19. The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units.

    Science.gov (United States)

    Croci, F; Brignole, M; Alboni, P; Menozzi, C; Raviele, A; Del Rosso, A; Dinelli, M; Solano, A; Bottoni, N; Donateo, P

    2002-10-01

    The appropriate diagnostic work-up of patients with syncope is not well defined. We applied the guidelines of Italian 'Associazione Nazionale Medici Cardiologi Ospedalieri' to a group of consecutive patients with syncope referred to three Syncope Units. The aim of the study was to evaluate the applicability of those guidelines in the 'real world' and their impact on the use of the tests. We evaluated 308 consecutive patients with syncope (mean age 61 +/- 20 years; median of three syncopal episodes per patient). The hierarchy and appropriateness of diagnostic tests and the definitions of the final diagnosis followed standardized predefined criteria. In brief, all patients underwent initial evaluation consisting of history, physical examination, supine and upright blood pressure measurement and standard electrocardiogram (ECG) (only in patients > 45 years or with history of heart disease). Any subsequent investigations were based on the findings of the initial evaluation. Priority was given to cardiological tests (prolonged ECG monitoring, exercise test, electrophysiological study), or to neurally mediated tests (carotid sinus massage, tilt test, ATP test), or to neuro-psychiatric tests, as appropriate. The initial evaluation alone was diagnostic in 72 patients (23%). One further test was necessary for diagnosis in 65 patients (21%), > or = 2 tests in 64 (21%) and > or = 3 tests in 50 (16%). The diagnostic yield was 10% for ECG, 3% for echocardiogram, 16% for Holter, 5% for exercise test, 27% for electrophysiological study, 57% for carotid sinus massage, 52% for tilt testing and 15% for ATP test. At the end of the work-up the mechanism of syncope remained unexplained in 57 patients (18%). When standardized criteria based on the appropriateness of indications are used, few simple tests are usually needed for diagnosis of syncope.

  20. The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes

    NARCIS (Netherlands)

    van Dijk, J Gert; Thijs, Roland D; van Zwet, Erik; Tannemaat, M; van Niekerk, Julius; Benditt, David G; Wieling, Wouter

    Syncope is defined as transient loss of consciousness as a result of cerebral hypoperfusion. Electroencephalography during syncope shows either a 'slow-flat-slow' or a 'slow' pattern. The first is believed to denote more severe hypoperfusion. Although the diagnosis of vasovagal syncope relies

  1. The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes

    NARCIS (Netherlands)

    van Dijk, J. Gert; Thijs, Roland D.; van Zwet, Erik; Tannemaat, Martijn R.; van Niekerk, Julius; Benditt, David G.; Wieling, Wouter

    2014-01-01

    Syncope is defined as transient loss of consciousness as a result of cerebral hypoperfusion. Electroencephalography during syncope shows either a 'slow-flat-slow' or a 'slow' pattern. The first is believed to denote more severe hypoperfusion. Although the diagnosis of vasovagal syncope relies

  2. Sympatho-vagal responses in patients with sleep and typical vasovagal syncope

    NARCIS (Netherlands)

    Jardine, D. L.; Krediet, C. T. P.; Cortelli, P.; Frampton, C. M.; Wieling, W.

    2009-01-01

    Sleep syncope is a recently described form of vasovagal syncope that interrupts sleep. The pathophysiology of this condition is uncertain but a 'central' non-baroreflex-mediated trigger has been suggested. In the present study, we tested the hypothesis that patients with sleep syncope have abnormal

  3. Syncopation affects free body-movement in musical groove.

    Science.gov (United States)

    Witek, Maria A G; Popescu, Tudor; Clarke, Eric F; Hansen, Mads; Konvalinka, Ivana; Kringelbach, Morten L; Vuust, Peter

    2017-04-01

    One of the most immediate and overt ways in which people respond to music is by moving their bodies to the beat. However, the extent to which the rhythmic complexity of groove-specifically its syncopation-contributes to how people spontaneously move to music is largely unexplored. Here, we measured free movements in hand and torso while participants listened to drum-breaks with various degrees of syncopation. We found that drum-breaks with medium degrees of syncopation were associated with the same amount of acceleration and synchronisation as low degrees of syncopation. Participants who enjoyed dancing made more complex movements than those who did not enjoy dancing. While for all participants hand movements accelerated more and were more complex, torso movements were more synchronised to the beat. Overall, movements were mostly synchronised to the main beat and half-beat level, depending on the body-part. We demonstrate that while people do not move or synchronise much to rhythms with high syncopation when dancing spontaneously to music, the relationship between rhythmic complexity and synchronisation is less linear than in simple finger-tapping studies.

  4. Syncope risk assessment in the emergency department and clinic.

    Science.gov (United States)

    Benditt, David G

    2013-01-01

    The initial assessment of patients who present with presumed syncope is challenging. Syncope has many possible causes ranging from relatively benign to potentially life-threatening, and sorting through the possibilities may not be feasible given time limitations in an urgent care setting. Therefore, the physician almost always must determine whether the affected individual needs in-hospital evaluation or can be safely referred to an outpatient syncope evaluation clinic. In instances when the etiology of syncope has been diagnosed with confidence at the initial clinical evaluation, the hospitalization question is readily addressed and the appropriateness of hospitalization versus timely outpatient evaluation (preferably in a dedicated syncope management clinic) is clear. In those cases in which the diagnosis is uncertain, risk stratification schemes such as those summarized in this communication become more essential. However, at present no single risk assessment protocol appears to be satisfactory for universal application. The development of a consensus recommendation is an essential next step. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Clinical manifestations of syncope in children depending on the type of cardiovascular disease

    Directory of Open Access Journals (Sweden)

    N. A. Tonkikh

    2013-08-01

    Full Text Available Syncope in children is a topical multidisciplinary medical and social problem all over the world. Syncope occurrence in children population is about 15%. Despite modern equipment of European clinics it is not possible to determine the cause of syncope in about 1/3 of cases. Our objective was to determine special features in clinical presentation of cardiovascular syncope in children. The study was conducted on 144 children (80 females, 64 males from 2 to 18 years with diagnosed syncope of cardiovascular origin. Methods of vibrational and alternative statistics were used to perform research data analysis using licensed program package “MedStat” (serial number MS 000065 Structure of cardiovascular syncope causes was the following: prevalence of vasovagal syncope was 72,9±3,7 %, prevalence of heart rate and conduction abnormalities was 22,2±3,5 %, prevalence of structural heart pathology was 4,9±1,8%. In all patients cardiovascular disease was diagnosed first time in their life. This indicates insufficient awareness level of physicians about differential diagnostic algorithm of pathology which cause syncope in children. The length of syncopal anamnesis in children was varied from 1 month to 6 years. Only 16,7±3,1 % of cardiovascular pathology was diagnosed within first 6 months after first syncope episode, 47,9±4,2 % of cardiovascular pathology was diagnosed after 3 and more years. In 82,6±3,2 % of patients cause of syncope was established after few years. Prevalent cause of late diagnosed syncope in children with cardiovascular pathology was vasovagal syncope: in 55,2±4,9 % of patients after 3 years and more from the first syncope episode. Nonetheless, according to European cardiologist association (2009 year guidelines vasovagal syncope has benign prognosis, our analysis demonstrate that in 16,0±3,1 % of cases vasovagal syncope occurs during swimming, bicycle ride, road crossing, standing near open sewer manhole, that means, in this

  6. Comparison of existing syncope rules and newly proposed anatolian syncope rule to predict short-term serious outcomes after syncope in the Turkish population.

    Science.gov (United States)

    Kayayurt, Kamil; Akoglu, Haldun; Limon, Onder; Ergene, Asım Oktay; Yavasi, Ozcan; Bayata, Serdar; Berk, Nergiz Vanden; Unluer, Erden Erol

    2012-04-20

    We wished to compare the San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in Syncope Study (EGSYS) and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk scores and to assess their efficacy in recognising patients with syncope at high risk for short-term adverse events (death, the need for major therapeutic procedures, and early readmission to the hospital). We also wanted to test those variables to designate a local risk score, the Anatolian Syncope Rule (ASR). This prospective, cohort study was conducted at the emergency department of a tertiary care centre. Between December 1 2009 and December 31 2010, we prospectively collected data on patients of ages 18 and over who presented to the emergency department with syncope. We enrolled 231 patients to the study. A univariate analysis found 23 variables that predicted syncope with adverse events. Dyspnoea, orthostatic hypotension, precipitating cause of syncope, age over 58 years, congestive heart failure, and electrocardiogram abnormality (termed DO-PACE) were found to predict short-term serious outcomes by logistic regression analysis and these were used to compose the ASR. The sensitivity of ASR, OESIL, EGSYS and SFSR for mortality were 100% (0.66 to 1.00); 90% (0.54 to 0.99), 80% (0.44 to 0.97) and 100% (0.66 to 1.00), respectively. The specificity of ASR, OESIL, EGSYS and SFSR for mortality were 78% (0.72 to 0.83); 76% (0.70 to 0.82); 80% (0.74 to 0.85) and 70% (0.63 to 0.76). The sensitivity of ASR, OESIL, EGSYS and SFSR for any adverse event were 97% (0.85 to 1.00); 70% (0.52 to 0.82); 56% (0.40 to 0.72) and 87% (0.72 to 0.95). The specificity of ASR, OESIL, EGSYS and SFSR for any adverse event were 72% (0.64 to 0.78); 82% (0.76 to 0.87); 84% (0.78 to 0.89); 78% (0.71 to 0.83), respectively. The newly proposed ASR appears to be highly sensitive for identifying patients at risk for short-term serious outcomes, with scores at least as good as those provided by existing diagnostic

  7. Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope.

    Science.gov (United States)

    Thiruganasambandamoorthy, Venkatesh; Kwong, Kenneth; Wells, George A; Sivilotti, Marco L A; Mukarram, Muhammad; Rowe, Brian H; Lang, Eddy; Perry, Jeffrey J; Sheldon, Robert; Stiell, Ian G; Taljaard, Monica

    2016-09-06

    Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department. We sought to develop a clinical decision tool to identify adult patients with syncope who are at risk of a serious adverse event within 30 days after disposition from the emergency department. We prospectively enrolled adults (age ≥ 16 yr) with syncope who presented within 24 hours after the event to 1 of 6 large emergency departments from Sept. 29, 2010, to Feb. 27, 2014. We collected standardized variables at index presentation from clinical evaluation and investigations. Adjudicated serious adverse events included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, serious hemorrhage and procedural interventions within 30 days. We enrolled 4030 patients with syncope; the mean age was 53.6 years, 55.5% were women, and 9.5% were admitted to hospital. Serious adverse events occurred in 147 (3.6%) of the patients within 30 days after disposition from the emergency department. Of 43 candidate predictors examined, we included 9 in the final model: predisposition to vasovagal syncope, heart disease, any systolic pressure reading in the emergency department 180 mm Hg, troponin level above 99th percentile for the normal population, abnormal QRS axis ( 100°), QRS duration longer than 130 ms, QTc interval longer than 480 ms, emergency department diagnosis of cardiac syncope and emergency department diagnosis of vasovagal syncope (C statistic 0.88, 95% confidence interval [CI] 0.85-0.90; optimism 0.015; goodness-of-fit p = 0.11). The risk of a serious adverse event within 30 days ranged from 0.4% for a score of -3 to 83.6% for a score of 11. The sensitivity was 99.2% (95% CI 95.9%-100%) for a threshold score of -2 or higher and 97.7% (95% CI 93.5%-99.5%) for a threshold score of -1 or higher. The Canadian Syncope Risk Score showed good

  8. Recognizing cardiac syncope in patients presenting to the emergency department with trauma.

    Science.gov (United States)

    Bhat, Pradeep K; Pantham, Ganesh; Laskey, Sara; Como, John J; Rosenbaum, David S

    2014-01-01

    Cardiac syncope is associated with poor outcomes and may result in traumatic injuries. In patients presenting to the emergency department (ED) with trauma, recognizing the cause of syncope is particularly challenging. Also, clinical markers to identify cardiac syncope are not well established. We sought to evaluate clinical markers that could identify cardiac syncope in patients with traumatic falls derived from a large urban trauma database. All patients presenting to the ED during a 10-year study period with a traumatic fall were identified retrospectively. The subset of patients with syncope was ascertained by chart review and defined as cardiac syncope (e.g., presence of dysrhythmia, valvular abnormality), non-cardiac syncope (e.g., vasovagal, neurological), or syncope of unknown cause. Of the 5420 patients with traumatic falls, 180 (3.3%) patients with syncope were identified. Among the 180 patients with syncope, the cause was identified as cardiac in 24 (13%), noncardiac in 58 (32%), and unknown in 98 (54%). Three independent predictors (i.e., risk factors) of cardiac syncope were identified: age >65 years, presence of coronary artery disease, and pathological Q waves. Presence of at least one risk factor accurately predicted cardiac syncope in this population, with a sensitivity of 100%, a specificity of 43%, and a negative predictive value of 100% (area under the receiver operating characteristic curve: 0.80 ± 0.04). In patients with traumatic falls and syncope, simple clinical and electrocardiographical variables may identify patients with cardiac causes of syncope. Proper identification of cardiac syncope in this population can potentially prevent recurrence of life-threatening traumatic injury. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Clinical evaluation and risk stratification in patients with syncope.

    Science.gov (United States)

    Koenig, T; Duncker, D; Hohmann, S; Schroeder, C; Oswald, H; Veltmann, C

    2014-06-01

    Syncope accounts for approximately 1 % of visits to emergency departments. The first diagnostic step is to rule out nonsyncopal conditions as a cause of the transient loss of consciousness. Next, the basic clinical evaluation should identify patients at high risk for potentially life-threatening events. These patients should be admitted and monitored until a diagnosis is made and definitive treatment can be offered. Guided by the basic evaluation findings, specific tests should be performed to prove or rule out the suspected diagnosis. In low-risk patients, this should preferably be done in an outpatient setting. To date, there is no consensus on a structured algorithm for the evaluation of patients with syncope. Therefore, it seems beneficial to formulate an algorithm based on the current guidelines for the management of syncope for use in the clinical setting.

  10. [Technical options of electrotherapy in patients with vasovagal syncope].

    Science.gov (United States)

    Bałczewska, Daria; Kaczmarek, Krzysztof; Ptaszyński, Paweł; Wranicz, Jerzy Krzysztof; Cygankiewicz, Iwona

    2016-10-19

    Syncope is a symptom of the disease with diverse etiology and can be evidence of both benign and very serious life-threatening conditions. Vasovagal syncope(VVS), with prevalence about 35% of the general population, is most frequent causes of transient loss of consciousness (T-LOC). Most cases of vasovagal syncope requires conservative treatment. Although cardioinhibitory type of VVS characterized by a significant bradycardia or pause of the heart rate and can be treated with continuous electrotherapy. This article discuss cardiac pacing and technical solutions for the treatment of VVS. Available cardiac pacing methods used to detect and break VVS such as Rate Drop Response (RDR), Closed Loop Stimulation (CLS) and rate response driven by variations of myocardial contractility like Peak Endocardial Acceleration (PEA), has been presented.

  11. Cardiovascular causes of syncope. Identifying and controlling trigger mechanisms

    International Nuclear Information System (INIS)

    Akhtar, M.; Jazayeri, M.; Sra, J.

    1991-01-01

    Syncope usually has a cardiovascular source, so neurologic evaluation has a low diagnostic yield in these patients. Cardiac arrhythmias in persons with or without structural heart disease can produce syncope. Neurocardiogenic dysfunction that results in diminished venous return and hypercontractility is another frequent cause. Postural hypotension or left ventricular outflow obstruction may also be to blame. Careful history taking and physical examination, head-up tilt testing, echocardiography or radionuclide isotope imaging, and electrophysiologic study are often diagnostic. However, syncope remains undiagnosed in some patients, and they may require periodic reassessment. Treatment options are available for most cardiovascular disorders, among them use of pharmacologic agents; catheter, surgical, or radio-frequency modification of certain tachycardias; and permanent pacing. 33 references

  12. Strenuous Exercise Induced Syncope Due to Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Veysel Yavuz

    2014-09-01

    Full Text Available Coronary artery anomalies are among the neglected topics in cardiology. Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients. During exercise, the distended aorta and pulmonary artery with increased blood flow may squeeze the Left Main Coronary Artery (LMCA between them. Even though arrhythmias are common causes of syncope, one should also think about aberrant coronary artery in the patients with syncope of unexplained origin. Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers should be referred to diagnostic coronary angiography.

  13. Cardiovascular causes of syncope. Identifying and controlling trigger mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Akhtar, M.; Jazayeri, M.; Sra, J. (Sinai Samaritan Medical Center, Milwaukee, WI (USA))

    1991-08-01

    Syncope usually has a cardiovascular source, so neurologic evaluation has a low diagnostic yield in these patients. Cardiac arrhythmias in persons with or without structural heart disease can produce syncope. Neurocardiogenic dysfunction that results in diminished venous return and hypercontractility is another frequent cause. Postural hypotension or left ventricular outflow obstruction may also be to blame. Careful history taking and physical examination, head-up tilt testing, echocardiography or radionuclide isotope imaging, and electrophysiologic study are often diagnostic. However, syncope remains undiagnosed in some patients, and they may require periodic reassessment. Treatment options are available for most cardiovascular disorders, among them use of pharmacologic agents; catheter, surgical, or radio-frequency modification of certain tachycardias; and permanent pacing. 33 references.

  14. Psychogenic pseudo-syncope: Not always a diagnosis of exclusion.

    Science.gov (United States)

    Walsh, Kathleen E; Baneck, Trisha; Page, Richard L; Brignole, Michele; Hamdan, Mohamed H

    2018-02-24

    Psychogenic pseudo-syncope (PPS) frequently mimics syncope. The aim of this study was to assess the prevalence and clinical features of PPS and its relationship to vasovagal syncope (VVS). We examined retrospectively the medical records of 1401 consecutive patients referred to a syncope unit. We identified patients who had the final diagnosis of PPS. In these patients, we retrieved the initial diagnosis made during their first visit and the subsequent tests performed leading to the final diagnosis. Fourteen (1.0%) patients (mean age 35±14; 11 females) were diagnosed as having PPS: 7 had a diagnosis of PPS alone and 7 had both VVS and PPS. High frequency of attacks (53±35 attacks during the previous year), prolonged loss of consciousness (LOC)(minutes to > 1 hour), and a history of psychiatric disorders characterized PPS patients. Tilt test reproduced a PPS attack in the presence of normal blood pressure and heart rate in 7 patients (50%), and induced VVS in another 3 patients who had the final diagnosis of both PPS and VVS. In 2 patients, one or more events occurred during the clinic visits and were directly witnessed by the clinic personnel. We have shown that 1% of referrals to a syncope unit have the final diagnosis of PPS and that 50% of cases presented with a different initial diagnosis, namely VVS. Our findings suggest that causality between syncope and psychiatric disorders is likely bi-directional. The presence of a multidisciplinary team is important to address this often unrecognized relationship. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Validation of EGSYS Score in Prediction of Cardiogenic Syncope

    Directory of Open Access Journals (Sweden)

    Hamid Kariman

    2015-01-01

    Full Text Available Introduction. Evaluation of Guidelines in Syncope Study (EGSYS is designed to differentiate between cardiac and noncardiac causes of syncope. The present study aimed to evaluate the accuracy of this predictive model. Methods. In this prospective cross-sectional study, screening performance characteristics of EGSYS-U (univariate and EGSYS-M (multivariate in prediction of cardiac syncope were calculated for syncope patients who were referred to the emergency department (ED. Results. 198 patients with mean age of 59.26 ± 19.5 years were evaluated (62.3% male. 115 (58.4% patients were diagnosed with cardiac syncope. Area under the ROC curve was 0.818 (95% CI: 0.75–0.87 for EGSYS-U and 0.805 (CI 95%: 0.74–0.86 for EGSYS-M (p=0.53. Best cut-off point for both models was ≥3. Sensitivity and specificity were 86.08% (95% CI: 78.09–91.59 and 68.29% (95% CI: 56.97–77.86 for EGSYS-U and 91.30% (95% CI: 84.20–95.52 and 57.32% (95% CI: 45.92–68.02 for EGSYS-M, respectively. Conclusion. The results of this study demonstrated the acceptable accuracy of EGSYS score in predicting cardiogenic causes of syncope at the ≥3 cut-off point. It seems that using this model in daily practice can help physicians select at risk patients and properly triage them.

  16. Syncope as a Warning Symptom of Sudden Cardiac Death in Athletes.

    Science.gov (United States)

    Vettor, Giulia; Zorzi, Alessandro; Basso, Cristina; Thiene, Gaetano; Corrado, Domenico

    2015-08-01

    Clinical evaluation of syncope in the athlete remains a challenge. Although benign mechanisms predominate, syncope may be arrhythmic and precede SCD. Exercise-induced syncope should be regarded as an important alarming symptom of an underlying cardiac disease predisposing to arrhythmic cardiac arrest. All athletes with syncope require a focused and detailed workup for underlying cardiac causes, either structural or electrical. Major aim is to identify athletes at risk and to protect them from SCD. Athletes with potentially life-threatening etiologies of syncope should be restricted from competitive sports. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. [Flatus gone astray and other causes of syncope ].

    Science.gov (United States)

    Hekkala, Anna-Mari; Parikka, Hannu

    2014-01-01

    Loss of consciousness i.e. syncope is a common cause of getting to emergency call service. We describe two patients, in whom fainting was caused by reflexogenic syncope. The diagnosis is quickly solved if there is patience to review the patient history as thoroughly as possible. Registration of the conventional 12-lead electrocardiography and clinical examination usually suffice as basic investigations, without the need for expensive equipment. Careful scrutiny of the medical history will not only reveal the cause of fainting but also the predisposing factors, whereby recurrence of the event can easily be avoided by recognizing a threatening situation early enough.

  18. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention

    Directory of Open Access Journals (Sweden)

    Ryan J. Koene, MD

    2017-12-01

    Full Text Available Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies; in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD. Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death, and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk. Keywords: Syncope, Sudden cardiac death, Risk assessment

  19. Diagnostic yield of device interrogation in the evaluation of syncope in an elderly population.

    Science.gov (United States)

    D'Angelo, Robert N; Pickett, Christopher C

    2017-06-01

    Device interrogation has become a standard part of the syncope evaluation for patients admitted with permanent pacemakers (PPM) or implantable cardiac defibrillators (ICD), although few studies have shown interrogation yields clinically useful data. The purpose of this study is to determine the diagnostic yield of device interrogation as well as other commonly performed tests in the workup of unexplained syncope in patients with previously implanted PPMs or ICDs. We retrospectively reviewed records of 88 patients admitted to our medical center for syncope with previously implanted pacemakers between January 1, 2005 and January 1, 2015 using ICD-9 billing data. Pacemaker interrogation demonstrated an arrhythmia as the cause for syncope in 4 patients (4%) and evidence of device failure secondary to perforation in 1 patient (1%). The cause of syncope was unknown in 34 patients (39%). Orthostatic hypotension was the most commonly identified cause of syncope (26%), followed by vasovagal syncope (13%), autonomic dysfunction (5%), ventricular arrhythmia (3%), atrial arrhythmia (2%), congestive heart failure (2%), stroke (2%), and other less common causes (8%). History was the most important determinant of syncope (36%), followed by orthostatic vital signs (14%), device interrogations (4%), head CT (2%), and transthoracic echocardiogram (1%). Device interrogation is rarely useful for elucidating a cause of syncope without concerning physical exam, telemetry, or EKG findings. Interrogation may occasionally yield paroxysmal arrhythmias responsible for syncopal episode, but these rarely alter clinical outcomes. Interrogation appears to be more useful in patients with syncope after recent device placement. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  20. Multidisciplinary approach for diagnosing syncope: a retrospective study on 521 outpatients.

    Science.gov (United States)

    Strano, S; Colosimo, C; Sparagna, A; Mazzei, A; Fattouch, J; Giallonardo, A T; Calcagnini, G; Bagnato, F

    2005-11-01

    To describe causes of syncope in outpatients in whom structural heart disease was ruled out as a cause, and to analyse the role of a multidisciplinary approach in a syncope unit for the diagnosis of patients with syncope of unknown origin. Cardiovascular autonomic nervous system (ANS) function was evaluated extensively in 521 outpatients by careful history, physical examination including orthostatic blood pressure measurement and standard ECG, and tilt testing. Causes of syncope remained unknown in 29.2% of cases. ANS dysfunction was found in 58.6% of those presenting with either neurally mediated syncope (53.6%) or chronic autonomic failure (5%); 3.8% of the patients suffered from syncope of cardiogenic origin (2.5%) or non-neurogenic hypotension (1.3%), and 8.4% had loss of consciousness of non-syncopal origin. Loss of consciousness was confirmed as being related to seizures in under 30% of patients initially diagnosed as having epilepsy. Neurally mediated syncope represents the commonest type of syncope. ANS evaluation including tilt testing should be considered as preliminary screening in patients with syncope in the absence of definite heart abnormalities. Neurologists should consider syncope from ANS failure as a comorbid factor in patients with seizures where the clinical characteristics are not straightforward.

  1. [Syncope and occupational risk survey: the role of continuing education and multidisciplinary approach].

    Science.gov (United States)

    Barbic, F; Angaroni, L; Orlandi, M; Costantino, G; Dipaola, E; Borleri, D; Borchini, R; D'Adda, F; Perego, F; Borella, M; Galli, A; Solbiati, M; Casazza, G; Furlan, R; Seghizzi, P

    2011-01-01

    Syncope is a common disorder characterized most of the times by a positive clinical outcome. However, it may turn to a life threatening event even for working colleagues and third party when occurring during an high risk job. We have recently found that, out of 670 patients admitted to the Emergency Department (ED) for syncope, about 50% were potential workers, being their age between 18 and 65 years. Also, we found that in this group of patients syncope recurrence was as high as 11% at 6 months. It is unknown how physicians address the problem of the occupational risk in patients suffering from syncope and how occupational aspects are taken into account in the clinical judgment before work readmission. One hundred eighty five doctors (149 occupational physicians, OP), participating in a work-shop on syncope, were asked to fulfill a questionnaire about their clinical experience and their attention to the occupational aspects in patients after syncope. Despite long lasting clinical experience, 41% of OP did not scrutinize syncope as a relevant symptom in their daily activity. 65% of the other specialists were used to address the occupational risk aspects in their syncope patients. A multidisciplinary approach involving continuing education on safety at work might reduce work accidents due to syncope relapse and promote a safe and suitable re-employment of patients with syncope. scrutinize syncope as a relevant symptom in their daily activity. 65% of the other specialists were used to address the occupational risk aspects in their syncope patients. A multidisciplinary approach involving continuing education on safety at work might reduce work accidents due to syncope relapse and promote a safe and suitable re-employment of patients with syncope.

  2. The Risk stratification Of Syncope in the Emergency department (ROSE) pilot study: a comparison of existing syncope guidelines.

    Science.gov (United States)

    Reed, Matthew J; Newby, David E; Coull, Andrew J; Jacques, Keith G; Prescott, Robin J; Gray, Alasdair J

    2007-04-01

    This study was conducted as a feasibility pilot for the Risk stratification Of Syncope in the Emergency department (ROSE) study. The secondary aim was to compare the performance of our existing emergency department (ED) guidelines with existing clinical decision rules (Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) Score and San Francisco Syncope Rule; SFSR) at predicting short-term (1 week and 1 month) and medium-term (3 months) serious outcomes for patients with syncope presenting to the ED. This was a prospective cohort study. All patients presenting with syncope aged > or = 16 years between 7 November 2005 and 7 February 2006 were prospectively enrolled. 99 patients were recruited over a 3-month period. 44 patients were admitted and 55 discharged from the ED. 11 patients had a serious outcome: 8 by 7 days and a further 3 by 3 months. Five patients died by 3 months and six others had an alternative serious outcome. All 11 patients had been admitted from the ED, 7 were at high risk, 4 were at medium risk and none were at low risk according to our existing ED guidelines. Percentages of serious outcomes were 0%, 2.9%, 8.0%, 22.7% and 37.5% for OESIL scores of 0, 1, 2, 3 and 4 respectively. 40 patients had none of the 5 SFSR high-risk factors (0 serious outcomes = 0%) and 59 patients had an SFSR high-risk factor (11 serious outcomes = 18.6%). The risk of serious outcome at 7 days, 1 month and 3 months was 8.1%, 8.1% and 11.1%, respectively. A study to derive and validate a UK ED syncope clinical decision rule is feasible. This pilot study has evaluated the OESIL score, the SFSR and our existing ED guidelines, and has shown that each is able to identify an increased probability of medium-term serious outcome in patients with syncope. The SFSR shows good sensitivity at the expense of an increase in admissions to hospital; however, our existing ED syncope guidelines and the OESIL Score, although being able to successfully risk stratify patients, are not

  3. Syncope workup: Greater yield in select trauma population.

    Science.gov (United States)

    Harfouche, Melike; Cline, Michael; Mazzei, Michael; Santora, Thomas

    2017-08-01

    There is great variation in practice regarding the assessment of trauma patients who present with syncope. The purpose of this study was to determine the yield of screening studies (electrocardiogram, echocardiogram, and carotid duplex) and define characteristics to identify groups that may benefit from these investigations. We conducted a retrospective cohort study of all trauma patients from 2003 to 2015 who received a carotid duplex as part of a syncope evaluation at our urban Level 1 Trauma Center. Demographics, clinical findings as well as interventions undertaken (ie: placement of defibrillators/pacemakers) as a result of the syncope evaluation were collected. Data analysis was performed with STATA 14 and relationships between comorbidities, positive findings and interventions were assessed. Significance was assumed for p 70%) requiring intervention. The screening studies used in a syncope evaluation have low yield in the general trauma population. Carotid duplex should not be routinely performed. Cardiac evaluation should be tailored to individuals with cardiac comorbidities, older age and elevated ISS. An ECG should be used as initial screening in this patient cohort. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. NMR - finding in a case of Morquio's syndrome with syncope

    International Nuclear Information System (INIS)

    Treig, T.; Huk, W.; Nusslein, B.

    1987-01-01

    Acute or chronic cervical myelopathies are well known neurological complications of mucopolysaccharidoses This paper deals with a case of a mild form of Morquio's disease which appeared with syncope. NMR-imaging of the cranio-spinal region demonstrated a high intensity echo in the medulla oblongata before and after spinal decompression

  5. Corpus-Based Rhythmic Pattern Analysis of Ragtime Syncopation

    NARCIS (Netherlands)

    Koops, Hendrik Vincent; Volk, A.; de Haas, W.B.

    2015-01-01

    This paper presents a corpus-based study on rhythmic patterns in the RAG-collection of approximately 11.000 symbolically encoded ragtime pieces. While characteristic musical features that define ragtime as a genre have been debated since its inception, musicologists argue that specific syncopation

  6. Accuracy of the ICD-10 discharge diagnosis for syncope

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth; Hansen, Morten Lock; Lamberts, Morten

    2013-01-01

    .METHODS AND RESULTS: Two samples were investigated. One sample consisted of 5262 randomly selected medical patients. The other sample consisted of 750 patients admitted or seen in the emergency department (ED) for syncope (ICD-10: R55.9) in three hospitals in Denmark. All charts were reviewed for baseline...

  7. Cardiac Monitoring in Patients with Syncope: Making that Elusive Diagnosis

    Science.gov (United States)

    Subbiah, Rajesh; Chia, Pow-Li; Gula, Lorne J.; Klein, George J.; Skanes, Allan C.; Yee, Raymond; Krahn, Andrew D.

    2013-01-01

    Elucidating the cause of syncope is often a diagnostic challenge. At present, there is a myriad of ambulatory cardiac monitoring modalities available for recording cardiac rhythm during spontaneous symptoms. We provide a comprehensive review of these devices and discuss strategies on how to reach the elusive diagnosis based on current evidencebased recommendations. PMID:23228074

  8. Carbon monoxide poisoning mimicking long-QT induced syncope

    NARCIS (Netherlands)

    I.M. Onvlee-Dekker (Irene); A.C.H. de Vries (Andrica); A.D.J. ten Harkel (Arend)

    2007-01-01

    textabstractCarbon monoxide (CO)poisoning is a rare cause of QT prolongation, and is therefore easily missed. The case of a patient with unexplained syncope and QT prologation on the electrocardiogram that turned out to be related to CO poisoning is reported here. In patients with QT prolongation,

  9. Diagnostic Yield of Echocardiography in Syncope Patients with Normal ECG

    Directory of Open Access Journals (Sweden)

    Nai-Lun Chang

    2016-01-01

    Full Text Available Aim. This study aimed to assess the role of echocardiography as a diagnostic tool in evaluating syncope patients with normal versus abnormal electrocardiogram. Methods. We conducted a retrospective study of 468 patients who were admitted with syncope in 2011 at St. Joseph’s Regional Medical Center, Paterson, NJ. Hospital records and patient charts, including initial emergency room history and physical, were carefully reviewed. Patients were separated into normal versus abnormal electrocardiogram groups and then further divided as normal versus abnormal echocardiogram groups. Causes of syncope were extrapolated after reviewing all test results and records of consultations. Results. Three hundred twelve of the total patients (68.6% had normal ECG. Two-thirds of those patients had echocardiograms; 11 patients (5.7% had abnormal echo results. Of the aforementioned patients, three patients had previous documented history of severe aortic stenosis on prior echocardiograms. The remaining eight had abnormal but nondiagnostic echocardiographic findings. Echocardiography was done in 93 of 147 patients with abnormal ECG (63.2%. Echo was abnormal in 27 patients (29%, and the findings were diagnostic in 6.5% patients. Conclusions. This study demonstrates that echocardiogram was not helpful in establishing a diagnosis of syncope in patients with normal ECG and normal physical examination.

  10. Optimizing squatting as a physical maneuver to prevent vasovagal syncope

    NARCIS (Netherlands)

    Krediet, C. T. Paul; Go-Schön, Ingeborg K.; van Lieshout, Johannes J.; Wieling, Wouter

    2008-01-01

    OBJECTIVES: Squatting is a potent physical maneuver to prevent syncope; however, a major drawback is that standing up from squatting is a large hemodynamic stressor that often causes new presyncopal symptoms. We tested the hypothesis that lower body skeletal muscle tensing (LBMT) attenuates the

  11. New monitoring techniques to diagnose the cause of syncope.

    Science.gov (United States)

    Mittal, Suneet

    2014-01-01

    Syncope is a very common clinical problem. Given the extensive differential diagnosis, we have developed a structured approach for the evaluation and management of patients with unexplained syncope. Patients with overt cardiac, neurologic, or metabolic disturbances are identified and treated accordingly. However, the remaining patients with high-risk characteristics are hospitalized for risk stratification. After excluding patients who can benefit from pacemaker or implantable cardioverter-defibrillator implantation, an implantable loop recorder (ILR) appears to be a very effective diagnostic tool. The recent availability of a small ILR that can be implanted within minutes and provides daily data wirelessly for over 3 years appears to have elevated the ILR over short-term external electrocardiography (ECG) monitoring techniques in patients with unexplained syncope. Herein, using specific case examples, we review how we use a structural pathway at our institution to guide the evaluation and management of patients presenting with unexplained syncope, identify the types of patients who benefit from long-term ECG monitoring, and show how this strategy has positively affected clinical care in these patients.

  12. Brain Computed Tomography evaluation of patients with syncopal ...

    African Journals Online (AJOL)

    Objective: The aim of our study is to determine the value of using brain computerized tomography as a routine investigation in patients presenting with syncope to the emergency department at King Hussein Medical Center Amman Jordon. Methods: In the time period between March 2006 and April 2008, a total of 254 ...

  13. Midodrine: a role in the management of neurocardiogenic syncope

    Science.gov (United States)

    Ward, C; Gray, J; Gilroy, J; Kenny, R

    1998-01-01

    Objective—To determine the benefit of midodrine, an α agonist, on symptom frequency and haemodynamic responses during head up tilt in patients with neurocardiogenic syncope.
Setting—Cardiovascular investigation unit (a secondary and tertiary referral centre for the investigation and management of syncope).
Patients—16 outpatients (mean (SD) age 56 (18) years; five men) with frequent hypotensive symptoms (more than two syncopal episodes and fewer than 20 symptom free days per month), and reproducible syncope with glyceryl trinitrate (GTN) during head up tilt.
Design and intervention—Randomised double blind placebo controlled study. Patients were randomised to receive either placebo or midodrine for one month. Symptom events were recorded during each study month. At the end of each study month patients completed a quality of life scoring scale (Short Form 36) and a global assessment of therapeutic response. They received GTN with head up tilt for measurement of heart rate (electrocardiography), phasic blood pressure (digital photoplethysmography), and thoracic fluid index (transthoracic impedance plethysmography) during symptom provocation.
Results—Patients administered midodrine had an average of 7.3 more symptom free days than those who received placebo (95% confidence interval (CI) 4.6 to 9; p midodrine (p = 0.002). All domains of quality of life showed improvement with midodrine, in particular physical function (8.1; 95% CI 3.7 to 12.2), energy and vitality (14.6; 95% CI 7.3 to 22.1), and change in health status (22.2; 95% CI 11 to 33.4 ). Fourteen patients who were given placebo had tilt induced syncope compared with six given midodrine (p = 0.01). Baseline supine systolic blood pressure was higher and heart rate lower in patients who received midodrine than in those who were given placebo ( p midodrine indicates increased venous return when supine and during head up tilt. There were no serious adverse effects

  14. An approach to the clinical assessment and management of syncope in adults.

    Science.gov (United States)

    Ntusi, N A B; Coccia, C B I; Cupido, B J; Chin, A

    2015-08-01

    Syncope, defined as a brief loss of consciousness due to an abrupt fall in cerebral perfusion, remains a frequent reason for medical presentation. The goals of the clinical assessment of a patient with syncope are twofold: (i) to identify the precise cause in order to implement a mechanism-specific and effective therapeutic strategy; and (ii) to quantify the risk to the patient, which depends on the underlying disease,rather than the mechanism of the syncope. Hence, a structured approach to the patient with syncope is required. History-taking remains the most important aspect of the clinical assessment. The classification of syncope is based on the underlying pathophysiological mechanism causing the event, and includes cardiac, orthostatic and reflex (neurally mediated) mechanisms. Reflex syncope can be categorised into vasovagal syncope (from emotional or orthostatic stress), situational syncope (due to specific situational stressors), carotid sinus syncope(from pressure on the carotid sinus, e.g. shaving or a tight collar), and atypical reflex syncope (episodes of syncope or reflex syncope that cannot be attributed to a specific trigger or syncope with an atypical presentation). Cardiovascular causes of syncope may be structural(mechanical) or electrical. Orthostatic hypotension is caused by an abnormal drop in systolic blood pressure upon standing, and is defined asa decrease of >20 mmHg in systolic blood pressure or a reflex tachycardia of >20 beats/minute within 3 minutes of standing. The main causes of orthostatic hypotension are autonomic nervous system failure and hypovolaemia. Patients with life-threatening causes of syncope should be managed urgently and appropriately. In patients with reflex or orthostatic syncope it is important to address any exacerbating medication and provide general measures to increase blood pressure, such as physical counter-pressure manoeuvres. Where heart disease is found to bet he cause of the syncope, a specialist opinion is

  15. The changing face of orthostatic and neurocardiogenic syncope with age.

    Science.gov (United States)

    Cooke, J; Carew, S; Costelloe, A; Sheehy, T; Quinn, C; Lyons, D

    2011-08-01

    Reports of the outcomes of syncope assessment across a broad spectrum of ages in a single population are scarce. It is our objective to chart the varying prevalence of orthostatic and neurocardiogenic syncope (NCS) as a patient ages. This was a retrospective study. All consecutive patients referred to a tertiary referral syncope unit over a decade were included. Patients were referred with recurrent falls or orthostatic intolerance. Tilt tests and carotid sinus massage (CSM) were performed in accordance with best practice guidelines. A total of 3002 patients were included (1451 short tilt, 127 active stand, 1042 CSM and 382 prolonged tilt). Ages ranged from 11 to 91 years with a median (IQR) of 75 (62-81) years. There were 1914 females; 1088 males. Orthostatic hypotension (OH) was the most commonly observed abnormality (test positivity of 60.3%). Those with OH had a median (IQR) age of 78 (71-83) years. Symptomatic patients were significantly younger than asymptomatic (P = 0.03). NCS demonstrated a bimodal age distribution. Of 194 patients with carotid sinus hypersensitivity, the median age (IQR) was 77 (68-82) years. Those with vasovagal syncope (n = 80) had a median (IQR) age of 30 (19-44) years. There were 57 patients with isolated postural orthostatic tachycardia syndrome. Of the total patients, 75% were female. They had a median (IQR) age of 23 (17-29) years. We have confirmed, in a single population, a changing pattern in the aetiology of syncope as a person ages. The burden of disease is greatest in the elderly.

  16. The changing face of orthostatic and neurocardiogenic syncope with age.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    AIM: Reports of the outcomes of syncope assessment across a broad spectrum of ages in a single population are scarce. It is our objective to chart the varying prevalence of orthostatic and neurocardiogenic syncope (NCS) as a patient ages. METHODS: This was a retrospective study. All consecutive patients referred to a tertiary referral syncope unit over a decade were included. Patients were referred with recurrent falls or orthostatic intolerance. Tilt tests and carotid sinus massage (CSM) were performed in accordance with best practice guidelines. RESULTS: A total of 3002 patients were included (1451 short tilt, 127 active stand, 1042 CSM and 382 prolonged tilt). Ages ranged from 11 to 91 years with a median (IQR) of 75 (62-81) years. There were 1914 females; 1088 males. Orthostatic hypotension (OH) was the most commonly observed abnormality (test positivity of 60.3%). Those with OH had a median (IQR) age of 78 (71-83) years. Symptomatic patients were significantly younger than asymptomatic (P = 0.03). NCS demonstrated a bimodal age distribution. Of 194 patients with carotid sinus hypersensitivity, the median age (IQR) was 77 (68-82) years. Those with vasovagal syncope (n = 80) had a median (IQR) age of 30 (19-44) years. There were 57 patients with isolated postural orthostatic tachycardia syndrome. Of the total patients, 75% were female. They had a median (IQR) age of 23 (17-29) years. CONCLUSION: We have confirmed, in a single population, a changing pattern in the aetiology of syncope as a person ages. The burden of disease is greatest in the elderly.

  17. Clinical Mimics: An Emergency Medicine-Focused Review of Syncope Mimics.

    Science.gov (United States)

    Coleman, Diana K; Long, Brit; Koyfman, Alex

    2018-01-01

    Syncope is an event that causes a transient loss of consciousness (LOC) secondary to global cerebral hypoperfusion. The transient nature of the event can make diagnosis in the emergency department (ED) difficult, as symptoms have often resolved by time of initial presentation. The symptoms and presentation of syncope are similar to many other conditions, which can lead to difficulty in establishing a diagnosis in the ED. This review evaluates patients presenting with a history concerning for possible syncope, mimics of syncope, and approach to managing syncope mimics. Syncope is caused by transient LOC secondary to global cerebral hypoperfusion. Many conditions can present similarly to syncope, making diagnosis in the ED difficult. Some of the most emergent conditions include seizures, stroke, metabolic disorders, and head trauma. Other nonemergent conditions include cataplexy, pseudosyncope, or deconditioning. Many laboratory studies and imaging can be nondiagnostic during ED evaluation. For patients presenting with apparent syncope, immediate treatment should focus on identifying and treating life-threatening conditions. History and physical examination can help guide further diagnostic evaluation and management. Patients with apparent syncope should be evaluated for potential immediate life-threatening conditions. A thorough history and physical examination can aid in distinguishing syncope from common mimics and help identify and subsequently treat life-threatening conditions. Published by Elsevier Inc.

  18. Diagnostic and prognostic value of high-sensitivity cardiac troponin T in patients with syncope.

    Science.gov (United States)

    Christ, Michael; Geier, Felicitas; Popp, Steffen; Singler, Katrin; Smolarsky, Alexander; Bertsch, Thomas; Müller, Christian; Greve, Yvonne

    2015-02-01

    We examined the diagnostic and predictive value of high-sensitivity cardiac troponin T (cTnThs) in patients with syncope. We performed an analysis of consecutive patients with syncope presenting to the emergency department. The primary end point was the accuracy to diagnose a cardiac syncope. In addition, the study explored the prognostic relevance of cTnThs in patients with cardiac and noncardiac syncope. A total of 360 patients were enrolled (median age, 70.5 years; male, 55.8%; 23.9% aged >80 years). Cardiac syncope was present in 22% of patients, reflex syncope was present in 40% of patients, syncope due to orthostatic hypotension was present in 20% of patients, and unexplained syncope was present in 17.5% of patients. A total of 148 patients (41%) had cTnThs levels above the 99% confidence interval (CI) (cutoff point). The diagnostic accuracy for cTnThs levels to determine the diagnosis of cardiac syncope was quantified by the area under the curve (0.77; CI, 0.72-0.83; P value of cTnThs levels within 30 days: Patients with increased cTnThs levels had a 52% likelihood for adverse events, patients with cTnThs levels below the cutoff point had a low risk (negative predictive value, 83.5%). Increased cTnThs levels indicate adverse prognosis in patients with noncardiac causes of syncope, but not in patients with cardiac syncope being a risk factor for adverse outcome by itself. Patients with syncope presenting to the emergency department have a high proportion of life-threatening conditions. cTnThs levels show a limited diagnostic and predictive accuracy for the identification of patients with syncope at high risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. International study on syncope of uncertain aetiology 3 (ISSUE 3): pacemaker therapy for patients with asystolic neurally-mediated syncope: rationale and study design

    NARCIS (Netherlands)

    Brignole, M.; Andresen, Dietrich; Benditt, David; Blanc, Jean Jacques; Garcia-Civera, Roberto; Khran, Andrew; Menozzi, Carlo; Moya, Angel; Sutton, Richard; Vardas, Panos; Wieling, Wouter

    2007-01-01

    Aim To assess the effectiveness of pacing therapy for preventing syncope recurrence in patients with a high probability of cardio-inhibitory neurally-mediated syncope (NMS). Methods Study design: Multi-centre, prospective, double-blind, randomized placebo-controlled study. Inclusion criteria:

  20. International Study on Syncope of Uncertain Etiology 2: the management of patients with suspected or certain neurally mediated syncope after the initial evaluation Rationale and study design

    NARCIS (Netherlands)

    Brignole, M.; Sutton, R.; Menozzi, C.; Moya, A.; Garcia-Civera, R.; Benditt, D.; Vardas, P.; Wieling, W.; Andresen, D.; Migliorini, R.; Hollinworth, D.

    2003-01-01

    Study design Multi-centre, prospective observational study Objectives Main objective is to verify the value of implantable loop recorder (ILR) in assessing the mechanism of syncope and the efficacy of the ILR-guided therapy after syncope recurrence. Inclusion criteria Patients who met the following

  1. How well are European Society of Cardiology (ESC) guidelines adhered to in patients with syncope?

    Science.gov (United States)

    O'Dwyer, C; Hade, D; Fan, C W; Cunningham, C; Kenny, R A

    2010-01-01

    The ESC guidelines on syncope were published in 2001 and updated in 2004. Adherence to the recommendations enables early stratification of low and high risk patients and prevents unnecessary investigations and admissions. Vasovagal syncope (VVS) is the commonest cause of syncope in all age groups and a low risk condition. The study objective was to determine whether the ESC guidelines were adhered to prior to referral to a syncope unit; 100 consecutive patients with unexplained syncope (52 +/- 23 (15-91) years); 53 female. Sixty-six patients had VVS. Forty nine (75%) of patients with VVS had undergone unnecessary investigations prior to diagnosis and 31 (47%) were admitted to hospital for investigation. Research from other countries confirms that adherence to the ESC guidelines expediates accurate diagnosis, improves resource utilization and reduces health care cost. Greater awareness amongst Irish practitioners of guidelines may improve syncope management and reduce costs.

  2. How well are European Society of Cardiology (ESC) guidelines adhered to in patients with syncope?

    LENUS (Irish Health Repository)

    O'Dwyer, C

    2010-01-01

    The ESC guidelines on syncope were published in 2001 and updated in 2004. Adherence to the recommendations enables early stratification of low and high risk patients and prevents unnecessary investigations and admissions. Vasovagal syncope (VVS) is the commonest cause of syncope in all age groups and a low risk condition. The study objective was to determine whether the ESC guidelines were adhered to prior to referral to a syncope unit; 100 consecutive patients with unexplained syncope (52 +\\/- 23 (15-91) years); 53 female. Sixty-six patients had VVS. Forty nine (75%) of patients with VVS had undergone unnecessary investigations prior to diagnosis and 31 (47%) were admitted to hospital for investigation. Research from other countries confirms that adherence to the ESC guidelines expediates accurate diagnosis, improves resource utilization and reduces health care cost. Greater awareness amongst Irish practitioners of guidelines may improve syncope management and reduce costs.

  3. [Evaluation of "complex syncope: what are the indications for second-level investigations?].

    Science.gov (United States)

    Ungar, Andrea; Morrione, Alessandro; Rafanelli, Martina; Maraviglia, Alice; Landi, Annalisa; Caldi, Francesca; Chisciotti, Valentina Maddalena; Ruffolo, Emilia; Marchionni, Niccolò; Del Rosso, Attilio

    2009-01-01

    Syncope is a common symptom accounting for 1.1% of all admissions to the emergency department in Italy. Diagnostic and therapeutic management of patients with syncope may be complex and with a major impact on health expenditure. A standardized approach to syncope may reduce diagnostic tests, hospitalizations and health costs. After the initial "gold standard" evaluation, which includes history, physical examination, orthostatic hypotension test and ECG, several diagnostic pathways can be followed. It has been shown that a correct initial evaluation and a thorough knowledge of syncope can reduce needless testing and increase diagnostic yield, optimizing resource management. In this review we aim to underscore the key points of the management of patients with syncope and the main indications for specific second-level examinations, such as those for neuroautonomic evaluation (tilt table test, carotid sinus massage) and implantable loop recorder. The role of Syncope Units in the management of patients with temporary loss of consciousness is also described.

  4. Influence of climate on emergency department visits for syncope: role of air temperature variability.

    Directory of Open Access Journals (Sweden)

    Andrea Galli

    Full Text Available BACKGROUND: Syncope is a clinical event characterized by a transient loss of consciousness, estimated to affect 6.2/1000 person-years, resulting in remarkable health care and social costs. Human pathophysiology suggests that heat may promote syncope during standing. We tested the hypothesis that the increase of air temperatures from January to July would be accompanied by an increased rate of syncope resulting in a higher frequency of Emergency Department (ED visits. We also evaluated the role of maximal temperature variability in affecting ED visits for syncope. METHODOLOGY/PRINCIPAL FINDINGS: We included 770 of 2775 consecutive subjects who were seen for syncope at four EDs between January and July 2004. This period was subdivided into three epochs of similar length: 23 January-31 March, 1 April-31 May and 1 June-31 July. Spectral techniques were used to analyze oscillatory components of day by day maximal temperature and syncope variability and assess their linear relationship. There was no correlation between daily maximum temperatures and number of syncope. ED visits for syncope were lower in June and July when maximal temperature variability declined although the maximal temperatures themselves were higher. Frequency analysis of day by day maximal temperature variability showed a major non-random fluctuation characterized by a ∼23-day period and two minor oscillations with ∼3- and ∼7-day periods. This latter oscillation was correlated with a similar ∼7-day fluctuation in ED visits for syncope. CONCLUSIONS/SIGNIFICANCE: We conclude that ED visits for syncope were not predicted by daily maximal temperature but were associated with increased temperature variability. A ∼7-day rhythm characterized both maximal temperatures and ED visits for syncope variability suggesting that climate changes may have a significant effect on the mode of syncope occurrence.

  5. Syncope in the Pediatric Emergency Department - Can We Predict Cardiac Disease Based on History Alone?

    Science.gov (United States)

    Hurst, David; Hirsh, Daniel A; Oster, Matthew E; Ehrlich, Alexandra; Campbell, Robert; Mahle, William T; Mallory, Michael; Phelps, Heather

    2015-07-01

    The American Heart Association recommends a "meticulous history" when evaluating patients with an initial episode of syncope. However, little is known about which historical features are most helpful in identifying children with undiagnosed cardiac syncope. Our objectives were 1) to describe the cardiac disease burden in Emergency Department (ED) syncope presentations, and 2) to identify which historical features are associated with a cardiac diagnosis. Using syncope presentations in our ED between May 1, 2009 and February 28, 2013, we 1) performed a cross-sectional study describing the burden of cardiac syncope, and 2) determined the sensitivity and specificity of four historical features identifying cardiac syncope. Of 3445 patients, 44.5% were male presenting at 11.5 ± 4.5 years of age. Of patients with a cardiac diagnosis (68, ~2%), only 3 (0.09%) were noted to have a previously undiagnosed cardiac cause of syncope: 2 with supraventricular tachycardia and 1 with myocarditis. Among the three cases and 100 randomly selected controls, the respective sensitivity and specificity of the historical features were 67% and 100% for syncope with exercise, 100% and 98% for syncope preceded by palpitations, and 67% and 70% for syncope without prodrome. The presence of at least two features yielded a sensitivity of 100% and specificity of 100%. Our study, which represents the largest published series of pediatric syncope presenting to the ED, confirms that newly diagnosed cardiac causes of syncope are rare. Using a few specific historical features on initial interview can help guide further work-up more precisely. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Etiology of faint in children with recurrent syncope and syncope‘ hemodynamic patterns

    OpenAIRE

    Kinčinienė, Odeta

    2010-01-01

    Object of dissertation: new practice of orthostatic test for prognostication mechanism of syncope in children. There is no published studies in Lithuania where researched causes and mechanisms of children syncope. Trying to find published studies about pediatric syncope or orthostatic test’s mechanism prediction was failed despite of presence such trials in adults. Research was performed in two steps. The first step: detail anamnesis, objective physical examination, basic laboratory ex...

  7. Pediatric syncope: is detailed medical history the key point for differential diagnosis?

    Science.gov (United States)

    Ikiz, Mehmet Alper; Cetin, Ibrahim Ilker; Ekici, Filiz; Güven, Alev; Değerliyurt, Aydan; Köse, Gülşen

    2014-05-01

    Syncope is a transient loss of consciousness as a result of global cerebral hypoperfusion. It is generally benign but may be a sign of pathology. The purpose of this study was to analyze the frequency of syncope due to cardiac, neurocardiogenic, neurologic, situational, psychiatric, and other causes and make a differential diagnosis of syncope types according to detailed medical history and further investigations. We examined prospectively 268 children presented to pediatric polyclinics as well as cardiology and neurology departments (age range, 1-18 years) with a primary complaint of syncope for the study. Cardiac syncope was diagnosed in 12 patients, neurocardiogenic syncope in 232, neurologic syncope in 9, psychiatric syncope in 9, situational in 4, and benign paroxysmal positional vertigo in 2. The neurologic syncope group consists of patients diagnosed with epilepsy after evaluation. Eight patients in the cardiac syncope group were found to have diseases such as long QT syndrome, and the remaining patients had hypertrophic cardiomyopathy, atrioventricular nodal reentry tachycardia, ventricular tachycardia, and a second-degree heart block that can cause sudden death. In conclusion, syncope is a common problem in childhood that requires hospitalization. Because it may be the first finding of an underlying malignant cardiac or neurologic disease, clinicians must be very careful during medical evaluation. An electrocardiogram and a medical history including the details of the event, chronic diseases, and familial diseases are among the most important steps for the right diagnosis and prognosis. Instead of a routine procedure, further diagnostic workup should be directed according to medical history for high yield. Convulsive movements may be defined in all types of syncope related with cerebral hypoxia, and this may lead to a misdiagnosis of seizure by the clinician.

  8. Syncope in old people. The importance of multiparametric monitor in OBI evaluation

    OpenAIRE

    Alessandro Riccardi; Laura Pastorino; Bruno Chiarbonello; Luca Beatini; Luca Corti; Marina Castelli; Roberto Lerza

    2006-01-01

    Syncope is a common clinical entity, and it causes up to 3% of admission in the Emergency Department. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography, with a correct identification of etiology at the presentation in up to 50% of cases. Moreover, the underlying cause of syncope remains unidentified in a elevated percentage of patients. The application of Standard Guidelines and the institution of the Observation Unit (OBI) with continuous ...

  9. Diagnostic Patterns in the Evaluation of Patients Presenting with Syncope at the Emergency or Outpatient Department

    OpenAIRE

    Kang, Gu Hyun; Oh, Ju Hyeon; Kim, June Soo; On, Young Keun; Song, Hyoung Gon; Jo, Ik Joon; Kim, Su Jin; Bae, Su-Jin; Shin, Tae Gun

    2012-01-01

    Purpose Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results The ED group had fewer episodes of ...

  10. Use of implantable and external loop recorders in syncope with unknown causes

    Directory of Open Access Journals (Sweden)

    Kaoru Tanno

    2017-12-01

    Full Text Available The gold standard for diagnosing syncope is to elucidate the symptom-electrocardiogram (ECG correlation. The ECG recordings during syncope allow physicians to either confirm or exclude an arrhythmia as the mechanism of syncope. Many studies have investigated the use of internal loop recorder (ILR, while few studies have used external loop recorder (ELR for patients with unexplained syncope. The aim of this review is to clarify the clinical usefulness of ILR and ELR in the diagnosis and management of patients with unexplained syncope. Many observational and four randomized control studies have shown that ILR for patients with unknown syncope is a useful tool for early diagnosis and improving diagnosis rate. ILR also provides important information on the mechanism of syncope and treatment strategy. However, there is no evidence of total mortality or quality of life improvements with ILR. The diagnostic yield of ELR in patients with syncope was similar to that with ILR within the same timeframe. Therefore, ELR could be considered for long-term ECG monitoring before a patient switches to using ILR. A systematic approach and selection of ECG monitoring tools reduces health care costs and improves the selection of patients for optimal treatment possibilities. Keywords: Internal loop recorder, External loop recorder, Unknown Syncope

  11. The emergency department approach to syncope: evidence-based guidelines and prediction rules.

    Science.gov (United States)

    Kessler, Chad; Tristano, Jenny M; De Lorenzo, Robert

    2010-08-01

    Syncope is a sudden, transient loss of consciousness associated with inability to maintain postural tone followed by spontaneous recovery and return to baseline neurologic status. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients whose syncope is a symptom of a potentially life-threatening condition. This article reviews the current status of syncope from the emergency department perspective, focusing on the current evidence behind the various clinical decision rules derived during the past decade. Published by Elsevier Inc.

  12. Autonomic syncope in pediatrics: a practice-oriented approach to classification, pathophysiology, diagnosis, and management.

    Science.gov (United States)

    Sapin, Samuel O

    2004-01-01

    This paper presents a practice-oriented approach to the problem of syncope in pediatrics. Autonomic syncope is the major etiologic category in pediatrics and consists of 2 types: reflex and dysautonomic. The latter type is rare in pediatrics. Reflex syncope has 4 subtypes: neurocardiogenic, central, situational, and cerebral. Neurocardiogenic syncope, the most common subtype, is easily diagnosed by taking a careful, detailed history; identifying diagnostic red flags; performing a complete physical examination; and ordering a minimum of laboratory tests. Patient and parent education is essential, and usually, without medication, outcomes are good.

  13. Cor triatriatum sinistrum: presentation of syncope and atrial tachycardia.

    Science.gov (United States)

    Avari, Malcolm; Nair, Sunil; Kozlowska, Zofia; Nashef, Samer

    2017-02-14

    We present a rather unusual cause for syncope associated with atrial tachycardia. A man aged 39 years presented with an episode of syncope and narrow complex tachycardia. Further investigations, including transoesophageal echocardiography, identified cor triatriatum sinistrum (CTS), a rare congenital abnormality characterised by the atrium being divided by a fibrous membrane. Although it is rare, there has been an increase in diagnosis due to developments in diagnostic imaging techniques. Symptoms are related to the size of fenestrations within the fibrous membrane. Presenting symptoms can mimic those seen in mitral stenosis. It is a condition that can occur in isolation, but it can also be associated with other cardiac abnormalities such as an atrial septal defect (ASD) (as in this case). Surgery is the definitive treatment (this man had surgical repair of CTS and closure of ASD) and should be considered at any age if there are any associated symptoms or complications. 2017 BMJ Publishing Group Ltd.

  14. Intermittent Brugada Syndrome Presenting with Syncope in an Adult Female

    Directory of Open Access Journals (Sweden)

    Patricia Chavez

    2014-01-01

    Full Text Available Background. Brugada syndrome accounts for 4–12% of all sudden deaths worldwide and at least 20% of sudden deaths in patients with structurally normal hearts. Case Report. A 48-year-old female presented to the emergency department after two witnessed syncopal episodes. While awaiting discharge had a third collapse followed by cardiac arrest with shockable rhythm. Initial electrocardiogram showed wide QRS complex with left axis deviation, ST-segment elevation of 2 mm followed by a negative T wave with no isoelectric separation, suggestive of spontaneous intermittent Brugada type 1 pattern. Cardiac magnetic resonance imaging demonstrated neither structural heart disease nor abnormal myocardium. After placement of an implantable cardioverter defibrillator the patient was discharged. Why should an emergency physician be aware of this? Brugada syndrome is an infrequently encountered clinical entity which may have a fatal outcome. This syndrome primarily presents with syncope. It should be considered as a component of differential diagnosis in patients with family history of syncope and sudden cardiac death.

  15. Epileptic Seizures Versus Syncope: Pathophysiology and Clinical Approach

    Directory of Open Access Journals (Sweden)

    Marios Charalambous

    2017-02-01

    Full Text Available Generalised epileptic seizures and syncope are two syndromes with similar clinical manifestation and their differentiation can be quite challenging. The aim of this review is to use an evidence-based approach in differentiating these two syndromes through the comprehension of the pathophysiological mechanisms involved and their clinical signs. Both syndromes affect regions of the forebrain and consciousness level, although, different mechanisms are involved. Syncope is a paroxysmal event secondary to a short-term decrease in cerebral perfusion, oxygenation or essential nutrients delivery. Generalised epileptic seizure activity is defined as the clinical manifestation of transient paroxysmal disturbances in brain function secondary to an imbalance between excitatory and inhibitory neurotransmitters. Clinical criteria, including precipitating events, clinical signs preceding, during and following the episodes and event duration, can be used to differentiate the two syndromes. Although these criteria might be useful for the practitioner, definite conclusions should be precluded due to the lack of original research articles and weak evidence on this specific field.Application: The review might be a useful tool for the general practitioner and clinical scientist as it will aid towards the differentiation of two syndromes, i.e. generalised epileptic seizures and syncope, with similar clinical presentation.

  16. Jugular venous reflux and plasma endothelin-1 are associated with cough syncope: a case control pilot study

    Science.gov (United States)

    2013-01-01

    Background Jugular venous reflux (JVR) has been reported to cause cough syncope via retrograde-transmitted venous hypertension and consequently decreased cerebral blood flow (CBF). Unmatched frequencies of JVR and cough syncope led us to postulate that there should be additional factors combined with JVR to exaggerate CBF decrement during cough, leading to syncope. The present pilot study tested the hypothesis that JVR, in addition to an increased level of plasma endothelin-1 (ET-1), a potent vasoconstrictor, is involved in the pathophysiology of cough syncope. Methods Seventeen patients with cough syncope or pre-syncope (Mean[SD] = 74.63(12.37) years; 15 males) and 51 age/gender-matched controls received color-coded duplex ultrasonography for JVR determination and plasma ET-1 level measurements. Results Multivariate logistic analysis showed that the presence of both-side JVR (odds ratio [OR] = 10.77, 95% confident interval [CI] = 2.40-48.35, p = 0.0019) and plasma ET-1 > 3.43 pg/ml (OR = 14.57, 95% CI = 2.95-71.59, p = 0.001) were independently associated with the presence of cough syncope/ pre-syncope respectively. There was less incidence of cough syncope/ pre-syncope in subjects with the absence of both-side JVR and a plasma ET-1 ≦3.43 pg/ml. Presence of both side JVR and plasma ET-1 level of > 3.43 pg/ml, increased risk for cough syncope/pre-syncope (p syncope/ pre-syncope. Although sample size of this study was small, we showed a synergistic effect between JVR and plasma ET-1 levels on the occurrence of cough syncope/pre-syncope. Future studies should confirm our pilot findings. PMID:23324129

  17. Self-reported cardiovascular conditions are associated with falls and syncope in community-dwelling older adults.

    OpenAIRE

    KENNY, ROSE

    2015-01-01

    PUBLISHED Background: with increasing age, causes of syncope are more often of cardiac origin. Syncope in older persons is often mistaken for falls. Data regarding the association between specific cardiovascular conditions, falls and syncope are limited. Methods: cross-sectional analyses within a population sample aged 50+ (n = 8,173). Syncope and falls in the past year, cardiovascular conditions and co-variates were gathered through personal interviews. Associations between cardiovasc...

  18. The egsys and oesil risk scores for classification of cardiac etiology of syncope: comparison, revaluation, and clinical Implications

    Czech Academy of Sciences Publication Activity Database

    Plášek, J.; Doupal, V.; Fürstová, Jana; Martínek, A.

    2010-01-01

    Roč. 154, č. 2 (2010), s. 169-173 ISSN 1213-8118 Institutional research plan: CEZ:AV0Z10300504 Keywords : Syncope * Cardiac Syncope * EGSYS * OESIL * Emergency Department * Decision-Making * Syncope Management Unit Subject RIV: IN - Informatics, Computer Science Impact factor: 0.716, year: 2010

  19. Edward P. Sharpey-Schafer was right: evidence for systemic vasodilatation as a mechanism of hypotension in cough syncope

    NARCIS (Netherlands)

    Krediet, C. T. Paul; Wieling, Wouter

    2008-01-01

    Cough syncope typically occurs in middle aged and senior, muscularly built males with a history of chronic obstructive lung disease. Originally, cough syncope was thought to be a form of epilepsy and only in the 1940s it was recognized to be of syncopal nature. The circulatory pathophysiology is,

  20. Self-reported cardiovascular conditions are associated with falls and syncope in community-dwelling older adults

    NARCIS (Netherlands)

    Jansen, Sofie; Kenny, Rose Anne; de Rooij, Sophia E.; van der Velde, Nathalie

    2015-01-01

    with increasing age, causes of syncope are more often of cardiac origin. Syncope in older persons is often mistaken for falls. Data regarding the association between specific cardiovascular conditions, falls and syncope are limited. cross-sectional analyses within a population sample aged 50+ (n =

  1. Syncope in Brugada syndrome: prevalence, clinical significance, and clues from history taking to distinguish arrhythmic from nonarrhythmic causes

    NARCIS (Netherlands)

    Olde Nordkamp, Louise R. A.; Vink, Arja S.; Wilde, Arthur A. M.; de Lange, Freek J.; de Jong, Jonas S. S. G.; Wieling, Wouter; van Dijk, Nynke; Tan, Hanno L.

    2015-01-01

    Syncope in Brugada syndrome (BrS) patients is a sign of increased risk for sudden cardiac death and usually is ascribed to cardiac arrhythmias. However, syncope often occurs in the general population, mostly from nonarrhythmic causes (eg, reflex syncope). The purpose of this study was to distinguish

  2. Standardized approaches to the investigation of syncope: Canadian Cardiovascular Society position paper.

    Science.gov (United States)

    Sheldon, Robert S; Morillo, Carlos A; Krahn, Andrew D; O'Neill, Blair; Thiruganasambandamoorthy, Venkatesh; Parkash, Ratika; Talajic, Mario; Tu, Jack V; Seifer, Colette; Johnstone, David; Leather, Richard

    2011-01-01

    Syncope is a very common presentation in the emergency department, and the combination of a wide differential diagnosis, a range of prognoses, and infrequent documentation of the faint leads to a high proportion of patients being admitted. These problems are mirrored in the investigation of inpatients with syncope, for which the high proportion of patients with benign outcomes and the profound risk aversion of health care providers make for expensive and inefficient assessment. Difficulties such as this in health services delivery can be improved by standardized approaches, such as guidelines, pathways, and checklists. Accordingly, emergency department decision rules, specialized syncope-monitoring units, and formal diagnostic algorithms have been developed to provide standardized approaches to the investigation of syncope. To provide guidance in the management of syncope, the Canadian Cardiovascular Society commissioned a position paper on standardized approaches to syncope investigation in adults. A primary panel first reviewed the literature systematically, then undertook iterative syntheses of data, and finally took positions with specific recommendations according to the GRADE framework. This paper summarizes the evidence and its quality and makes recommendations on the specific approaches meriting adoption. The position paper was then reviewed by a secondary panel, which provided suggestions for revisions leading to the final document as presented here. Overall, the position group concluded that there is little persuasive evidence that emergency department syncope rules and diagnostic syncope units provide efficient care and improved outcomes but that formal diagnostic algorithms with specialist support show promise. Copyright © 2011. Published by Elsevier Inc.

  3. Use of implantable and external loop recorders in syncope with unknown causes.

    Science.gov (United States)

    Tanno, Kaoru

    2017-12-01

    The gold standard for diagnosing syncope is to elucidate the symptom-electrocardiogram (ECG) correlation. The ECG recordings during syncope allow physicians to either confirm or exclude an arrhythmia as the mechanism of syncope. Many studies have investigated the use of internal loop recorder (ILR), while few studies have used external loop recorder (ELR) for patients with unexplained syncope. The aim of this review is to clarify the clinical usefulness of ILR and ELR in the diagnosis and management of patients with unexplained syncope. Many observational and four randomized control studies have shown that ILR for patients with unknown syncope is a useful tool for early diagnosis and improving diagnosis rate. ILR also provides important information on the mechanism of syncope and treatment strategy. However, there is no evidence of total mortality or quality of life improvements with ILR. The diagnostic yield of ELR in patients with syncope was similar to that with ILR within the same timeframe. Therefore, ELR could be considered for long-term ECG monitoring before a patient switches to using ILR. A systematic approach and selection of ECG monitoring tools reduces health care costs and improves the selection of patients for optimal treatment possibilities.

  4. Predicting neurally mediated syncope based on pulse arrival time: algorithm development and preliminary results.

    Science.gov (United States)

    Meyer, Christian; Morren, Geert; Muehlsteff, Jens; Heiss, Christian; Lauer, Thomas; Schauerte, Patrick; Rassaf, Tienush; Purerfellner, Helmut; Kelm, Malte

    2011-09-01

    Neurally mediated syncope (NMS) is a common disorder that is triggered by orthostatic stress. The circulatory adjustments to orthostatic stress occur just prior to a sudden loss of consciousness. NMS prediction would protect patients from falls or accidents. Based on simultaneously recorded heart rate (HR) and pulse wave during 70° head-up tilt (HUT) table testing we investigated a syncope warning system. In 14 patients with a history of suspected NMS we tested 2 algorithms based on HR and/or pulse arrival time (PAT). When the cumulative risk exceeded the threshold, which was calculated during the first 2 minutes following the posture change to upright position, a syncope prediction alarm was triggered. All syncopes (n = 7) were detected more than 16 seconds before the onset of dizziness or unconsciousness by using a prediction alarm based on HR and PAT (syncope prediction algorithm 2). No false alarm was generated in patients with negative HUT (n = 7). Syncope prediction was improved by detecting the slope of HR changes as compared with monitoring PAT changes alone (syncope prediction algorithm 1). The duration between the prediction alarm and the occurrence of syncope was 99 ± 108 seconds. Predicting NMS is feasible by monitoring HR and the onset of the pulse wave at the periphery. This approach might improve NMS management.  © 2011 Wiley Periodicals, Inc.

  5. Prevalence and clinical outcomes of patients with multiple potential causes of syncope

    NARCIS (Netherlands)

    Chen, Lin Y.; Gersh, Bernard J.; Hodge, David O.; Wieling, Wouter; Hammill, Stephen C.; Shen, Win-Kuang

    2003-01-01

    Objective: To determine the prevalence, predictors, and prognosis of patients with multiple potential causes of syncope. Patients and Methods: This is a retrospective cohort study with prospective follow-up of consecutive patients with syncope of uncertain cause who were referred to the

  6. Managing patients affected by syncope in ER: differential diagnosis and risk stratification

    Directory of Open Access Journals (Sweden)

    Elena Vitale

    2009-02-01

    Full Text Available Syncope is a common presentation to the emergency department that account to about 1% . The efforts of the emergency physician in evaluating the patient with syncope should be directed to determine a specific diagnosis of syncope type and to make the risk stratification. The first objective can be achieved utilizing with strict adherence the guidelines on management of syncope of the European Society of Cardiology. To achieve the second objective it is necessary to evaluate the risk factors for short- and long-term outcomes. Furthermore, in case of unexplained syncope, it is necessary to determine the probability of cardiac cause. On this subject, the EGSYS score seems to be a reliable tool.

  7. Syncope In Pediatric Patients: A Practical Approach To Differential Diagnosis And Management In The Emergency Department.

    Science.gov (United States)

    Fant, Collen; Cohen, Arl

    2017-04-01

    Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope.

  8. Short-term Prognosis and Current Management of Syncopal Patients at Intermediate Risk: Results from the IRiS (Intermediate-Risk Syncope) Study.

    Science.gov (United States)

    Numeroso, Filippo; Mossini, Gianluigi; Giovanelli, Michela; Lippi, Giuseppe; Cervellin, Gianfranco

    2016-08-01

    Despite guidelines, admission rates and expenditures for syncope remain high. This may be caused by an imprecise definition of cardiovascular disease considered at risk and an overestimation of the role of comorbidities and advanced age. In a cohort of patients with undetermined syncope, we prospectively compared the short-term prognosis of patients at intermediate risk (i.e., with stable heart diseases or comorbidities, of any age) versus those at high risk for cardiogenic syncope and identified factors associated with serious events. Secondarily, we analyzed the current management of intermediate-risk patients. In a cohort of patients with undetermined syncope, we analyzed personal data, the presence of stable heart diseases or comorbidities, destination, length of hospitalization, incidence of serious events at 30 days, and costs. In a 6-month period, 347 patients (185 male and 162 female, age 72.8 years) with undetermined syncope were enrolled, 250 at intermediate risk and 97 at high risk. Intermediate-risk patients were younger, with less frequent comorbidities and with a drastically lower incidence of serious events (0.8% vs. 27.8%, p Risk factors for cardiogenic syncope were the unique variable associated with serious events. Intermediate-risk patients were mostly admitted (62.8%) in an ordinary ward or into an emergency department observation unit; in the case of ordinary admission we observed a mean prolonged hospitalization (8.8 days), elevated costs ($270,183), and a high rate of unexplained syncope (51%). According to the results of this study, the authors believe that intermediate-risk patients could be safely discharged, with potentially significant costs saving. In prognostic stratification, priority is to seek risk factors for cardiogenic syncope while advanced age, stable heart diseases, or comorbidities likely lead to inappropriate hospitalization. © 2016 by the Society for Academic Emergency Medicine.

  9. Predicting the outcome in patients with unexplained syncope and suspected cardiac cause: role of electrophysiologic studies.

    Science.gov (United States)

    Assadian Rad, Mohammad; Farahani, Mohammad; Emkanjoo, Zahra; Moladoust, Hassan; Alizadeh, Abolfath

    2015-03-01

    Unexplained syncope is a challenge facing electrophysiologists. The prognosis varies widely depending on underlying causes, specially, cardiac ones. We sought to determine the abnormal electrophysiolgic (EP) study results as predictors of prognosis in syncope patients with suspected cardiac cause and risk factors associated with mortality. A total of 227 consecutive patients with unexplained syncope were prospectively enrolled in this study. EP study was performed in 177 patients in base of inclusion criteria. These patients, in whom a cardiac cause of syncope was suspected, underwent EP study and if negative, head-up tilts test (HUTT). Complete follow-up was obtained for 132 patients for 20.0±10.8 months. A cardiac cause of syncope was established in 35%, a neurally mediated syncope in 35.6%, and in the rest 29.4% the cause of syncope remained unexplained despite a throughout neurologic and cardiologic evaluation. Logistic analysis revealed that the significant predictors of a cardiac cause of syncope were the absence of prodromal symptoms, left bundle branch block (LBBB), sever left ventricle (LV) dysfunction and male gender. At logistic analysis, the presence of LBBB (OR=6.63; 95% CI: 1.09-40) was significantly associated with outcome of death. The present study provides evidence that presence of LBBB, abnormal EP study result and structural heart disease (SHD) have prognostic value in patients with suspected cardiac cause of syncope. The patients with SHD and unexplained syncope who had a negative EP study have a good long-term prognosis even in the presence of LV dysfunction.

  10. A cross sectional study on prevalence and etiology of syncope in Tehran.

    Science.gov (United States)

    Saedi, Sedigheh; Oraii, Saied; Hajsheikholeslami, Farhad

    2013-01-01

    Recurrent syncope of obscure etiology, particularly in those with structural heart diseases, is associated with higher mortality rates. There are insufficient and conflicting data on prevalence and etiology of syncope in the urban Middle Eastern population. Evaluating the etiologic basis of syncope can be an effective step in prevention of morbidities and sudden cardiac death in susceptible populations. The aim of our study was to determine the prevalence and etiology of syncope in an outpatient cardiology clinic in Tehran the capital of Iran. In this cross sectional study data was collected from patients' records whose first visits were from March 2006 to September 2007 and had undergone thorough examination for syncope (ECG, Holter monitoring, echocardiography, Tilt table testing, Electrophysiological study). All efforts were done to determine underlying heart diseases, physical exam and test abnormalities, final diagnosis and treatment in all selected patients. Overall prevalence of syncope was estimated to be 9%. The age-specific prevalence rates were 5-14 years:  4.14%, 15-44 years: 44.8%, 45-64 years: 31%, 65 years and Older: 20%. The most frequently identified cause (60%) was neurally-mediated (vasovagal) syncope. Mean age of patients was 44.9 years with a minimum of 5 years and maximum of 85 years. In our study, coronary heart disease had a high prevalence among participants (12.4%). Syncope is a common clinical problem. In this study prevalence rates peaked in 15-44 years age group. Considering that recurrent syncope is often disabling and may cause injury and the fact that heart diseases are more common in people affected by syncope, especial cautions should be taken while evaluating this group of patients.

  11. Rationale for the prevention of syncope trial IV: assessment of midodrine.

    Science.gov (United States)

    Raj, Satish R; Faris, Peter D; McRae, Maureen; Sheldon, Robert S

    2012-12-01

    Vasovagal syncope is a common problem associated with a poor quality of life, which improves when the frequency of syncope is reduced. Effective pharmacological therapies for vasovagal syncope have been elusive. Midodrine is a pro-drug whose primary metabolite is an alpha-1 adrenoreceptor agonist. A few studies have suggested that it may be beneficial in syncope, but all have had significant methodological limitations. A placebo-controlled clinical trial of midodrine for the prevention of vasovagal syncope is needed. The prevention of syncope trial IV (POST 4) is a multicenter, international, randomized, placebo-controlled study of midodrine in the prevention of vasovagal syncope. The primary end point is the time to first recurrence of syncope. Patients will be randomized 1:1 to receive midodrine 10-30 mg/day or matching placebo, and followed for 1 year. Secondary end points include syncope frequency, presyncope, and quality of life. Primary analysis will be performed with an intention-to-treat approach, with a secondary on-treatment analysis. A total sample size of 112, split equally between the two groups, achieves 85 % power to detect a 50 % relative risk reduction when the event rates are 55 and 27.5 % in the placebo and midodrine arms. Allowing for 20 % dropout, we propose to enroll 140 patients. POST 4 is registered with http://www.clinicaltrials.gov (NCT01456481). This study will be the first adequately powered trial to determine whether midodrine is effective in preventing vasovagal syncope. If it is effective, then midodrine may become the first-line pharmacological therapy for this condition.

  12. Cost-effectiveness of diagnostic approaches to vasovagal syncope.

    Science.gov (United States)

    Li, Ya-wen; Chen, Li; Du, Jun-bao; Yang, Yuan-yuan; Jin, Hong-fang

    2010-10-01

    Syncope is a common clinical problem with multiple causes. Vasovagal syncope (VVS) is by far the most frequent cause of syncope in children and adolescents. The traditional diagnostic approach to VVS of children and adolescents is based on a series of tests to exclude all other causes, which is complex and time and medical resource consuming. Attempts have been made to develop a new cost-effective diagnostic approach to avoid these problems. This study aimed to compare the economic effectiveness and diagnostic value of the traditional diagnostic approach to VVS of children with a new diagnostic approach. One hundred and eighteen children diagnosed as VVS were divided into two groups according to the different diagnostic approaches. The diagnostic value of the two diagnostic approaches was then analyzed. Meanwhile, the costs of hospitalization, diagnostic testing and hospital stay were determined. Data were evaluated by the cost-minimization analysis. The diagnostic value of the new diagnostic approach was similar to that of the traditional diagnostic approach (56.57% vs. 53.91%, P = 0.697). However, the cost of hospitalization per patient by the new diagnostic approach was (1507.08 ± 144.63) Yuan (RMB) which was less than that of the traditional diagnostic approach (2603.64 ± 208.19) Yuan. The costs of diagnostic tests per patient by the new diagnostic approach was (1256.04 ± 109.14) Yuan and by the traditional approach (2175.22 ± 153.32) Yuan. Compared to the traditional diagnostic approach to diagnose VVS in children and adolescents, the new diagnostic approach is of a good economic value, and it should be popularized in clinical practice.

  13. Recurrent Syncope in Patients with Carotid Sinus Hypersensitivity

    OpenAIRE

    Alfonso Lagi; Sergio Cerisano; Simone Cencetti

    2012-01-01

    Syncope recurrence in pacemaker-implanted subjects for the cardio-inhibitory response to sinus carotid massage (SCM) was investigated. The study-hypothesis was that recurrences had significant vasodepressor responses that could justify the loss of consciousness. Forty-six patients were enrolled (16 patients and 30 controls), followed and revaluated after 5–7 years. At the end of follow-up, significant differences were found between patients and controls in mean SCM SAP (87 versus 106 mmHg) an...

  14. Syncope Associated with Carbon Monoxide Poisoning due to Narghile Smoking

    Directory of Open Access Journals (Sweden)

    Seda Ozkan

    2013-01-01

    Full Text Available Narghile smoking is a traditional method of tobacco use, and it has been practiced extensively for 400 years. Traditionally, narghile smoking is a matter of culture mainly in Middle East, Asia, and Africa. In recent years, its use as a social activity has increased worldwide, especially among young people. Narghile smoking is an unusual cause of carbon monoxide poisoning. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide. We present an acute syncope case of a 19-year-old male patient who had carbon monoxide poisoning after narghile smoking.

  15. Left Atrial Thrombus Causing Stroke and Syncope: Does Size Matters?

    Directory of Open Access Journals (Sweden)

    Surender Deora

    2014-01-01

    Full Text Available Left atrium thrombus is seen in patients with rheumatic heart disease, severe mitral stenosis and/or atrial fibrillation, but is usually immobile and located in left atrial appendage. Freely mobile thrombus is rarely seen, and the size may vary from few millimeters to centimeters. The clinical presentation varies from presyncope or syncope in a small well organized thrombus to transient ischemic attacks or stroke in large poorly organized thrombus. Management includes urgent surgical removal of thrombus with underlying valvular correction and anticoagulation.

  16. Pacing system malfunction is a rare cause of hospital admission for syncope in patients with a permanent pacemaker.

    Science.gov (United States)

    Ofman, Peter; Rahilly-Tierney, Catherine; Djousse, Luc; Peralta, Adelqui; Hoffmeister, Peter; Gaziano, J Michael; Weiss, Alexey; Lotan, Chaim; Rosenheck, Shimon

    2013-01-01

    Few studies have examined the prevalence of permanent pacemaker (PPM) malfunction among patients with a previously implanted pacemaker admitted to the hospital with syncope. This study sought to examine causes of syncope in patients with a previously implanted pacemaker admitted to our hospital with syncope. We retrospectively reviewed our hospital admission database for patients who had both keywords "syncope" and "pacemaker" as their diagnoses from January 1, 1995 until June 1, 2012. One hundred and sixty-two patients who were admitted to the hospital because of syncope and had a PPM implanted prior to the index syncopal episode were included. All patients had pacemakers interrogated during the admission. Two independent physicians examined the discharge summary of each patient and determined the cause of syncope in each case. Of the 162 patients studied, eight (4.9%) were found to have pacemaker system malfunction as a cause of syncope. In 96 patients (59.2%), the cause of syncope could not be determined prior to hospital discharge. Among the identifiable causes of syncope, orthostatic hypotension was most prevalent (16%) followed by vasovagal (6%), severe aortic stenosis (4.3%), atrial arrhythmia (3.1%), acute and subacute infection (3.1%), and other less prevalent causes (3.1%). In this study, PPM system malfunction was rarely a cause of syncope in patients admitted to the hospital with a previously implanted device. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  17. Syncope in Brugada syndrome: prevalence, clinical significance, and clues from history taking to distinguish arrhythmic from nonarrhythmic causes.

    Science.gov (United States)

    Olde Nordkamp, Louise R A; Vink, Arja S; Wilde, Arthur A M; de Lange, Freek J; de Jong, Jonas S S G; Wieling, Wouter; van Dijk, Nynke; Tan, Hanno L

    2015-02-01

    Syncope in Brugada syndrome (BrS) patients is a sign of increased risk for sudden cardiac death and usually is ascribed to cardiac arrhythmias. However, syncope often occurs in the general population, mostly from nonarrhythmic causes (eg, reflex syncope). The purpose of this study was to distinguish arrhythmic events from nonarrhythmic syncope in BrS and to establish the clinical relevance of nonarrhythmic syncope. We reviewed the patient records of 342 consecutively included BrS patients and conducted systematic interviews in 141 patients with aborted cardiac arrest (ACA) or syncope. In total, 23 patients (7%) experienced ECG-documented ACA and 118 (34%) syncope; of these 118, 67 (57%) were diagnosed with suspected nonarrhythmic syncope. Compared to suspected nonarrhythmic syncope patients, ACA patients were older at first event (45 vs 20 years), were more likely to be male (relative risk 2.1) and to have urinary incontinence (relative risk 4.6), and were less likely to report prodromes. ACA was never triggered by hot/crowded surroundings, pain or other emotional stress, seeing blood, or prolonged standing. During follow-up (median 54 months), ACA rate was 8.7% per year among ACA patients and 0% per year among suspected nonarrhythmic syncope patients. Syncope, especially nonarrhythmic syncope, often occurs in BrS. The high incidence of nonarrhythmic syncope must be taken into account during risk stratification. Arrhythmic events and nonarrhythmic syncope may be distinguished by clinical characteristics (absence of prodromes and, particularly, specific triggers), demonstrating the importance of systematic history taking. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Self-reported cardiovascular conditions are associated with falls and syncope in community-dwelling older adults.

    Science.gov (United States)

    Jansen, Sofie; Kenny, Rose Anne; de Rooij, Sophia E; van der Velde, Nathalie

    2015-05-01

    with increasing age, causes of syncope are more often of cardiac origin. Syncope in older persons is often mistaken for falls. Data regarding the association between specific cardiovascular conditions, falls and syncope are limited. cross-sectional analyses within a population sample aged 50+ (n = 8,173). Syncope and falls in the past year, cardiovascular conditions and co-variates were gathered through personal interviews. Associations between cardiovascular conditions and (recurrent) falls and syncope were studied through multivariable logistic regression. mean age was 64 years (range: 51-105); 54% was female. Four per cent reported syncope, 19% falls and 23% cardiovascular morbidity. Abnormal heart rhythm was associated with falls (odds ratio (OR) 1.3 [95% confidence interval (CI) 1.0-1.5]), syncope (OR 1.6 [1.2-2.3]) and recurrent syncope (OR 2.2 [1.3-3.6]). Heart murmur was associated with falls (OR 1.4 [1.1-1.8]), recurrent falls (OR 1.5 [1.0-2.0]) and syncope (OR 1.9 [1.3-2.7]). Angina was associated with recurrent falls (OR 1.4 [1.0-1.9]), syncope (OR 1.8 [1.2-2.6]) and recurrent syncope (OR 2.7 [1.6-4.6]). Heart failure was associated with recurrent falls (OR 1.9 [1.0-3.4]) and myocardial infarction with syncope (OR 1.5 [1.0-2.3]). self-reported cardiovascular conditions are associated with falls and syncope in a general population cohort. This warrants additional cardiovascular evaluation in older patients with unexplained falls and syncope. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. A dedicated investigation unit improves management of syncopal attacks (Syncope Study of Unselected Population in Malmo--SYSTEMA I).

    Science.gov (United States)

    Fedorowski, Artur; Burri, Philippe; Juul-Möller, Steen; Melander, Olle

    2010-09-01

    To investigate whether a systematic approach to unexplained syncopal attacks based on the European Society of Cardiology guidelines would improve the diagnostic and therapeutic outcomes. Patients presenting with transient loss of consciousness to the Emergency Department of Skåne University Hospital in Malmö were registered by triage staff. Those with established cardiac, neurological, or other definite aetiology and those with advanced dementia were excluded. The remaining patients were offered evaluation based on an expanded head-up tilt test protocol, which included carotid sinus massage, and nitroglycerine challenge if needed. Out of 201 patients registered over a period of 6 months, 129 (64.2%) were found to be eligible; of these, 101 (38.6% men, mean age 66.3 +/- 18.4 years) decided to participate in the study. Head-up tilt test allowed diagnoses in 91 cases (90.1%). Vasovagal syncope (VVS) was detected in 45, carotid sinus hypersensitivity (CSH) in 27, and orthostatic hypotension (OH) in 51 patients. Twelve patients with VVS and 15 with CSH also had OH, whereas 25 were diagnosed with OH only. In a multivariate logistic regression, OH was independently associated with age [OR (per year): 1.05, 95% CI 1.02-1.08, P = 0.001], history of hypertension (2.73, 1.05-7.09, P = 0.039), lowered estimated glomerular filtration rate (per 10 mL/min/1.73 m(2): 1.17, 1.01-1.33, P = 0.032), use of loop diuretics (10.44, 1.22-89.08, P = 0.032), and calcium-channel blockers (5.29, 1.03-27.14, P = 0.046), while CSH with age [(per year) 1.12, 1.05-1.19, P approach to patients presenting with unexplained syncopal attacks considerably increased diagnostic efficacy and accuracy. Potential syncope diagnoses have a tendency to overlap and show diversity in demographic, anamnestic, and pharmacological determinants.

  20. Collapse query cause: the management of adult syncope in the emergency department.

    Science.gov (United States)

    Reed, M J; Gray, A

    2006-08-01

    Syncope is a commonly encountered problem in the emergency department (ED). Its causes are many and varied, some of which are potentially life threatening. A review was carried out of relevant papers in the available literature, and this article attempts to assimilate current evidence relating to ED management. While the cause of syncope can be identified in many patients, and life threatening conditions subsequently treated, a risk stratification approach should be taken for those in whom a cause is not identified in the ED. Aspects of the history and examination that may help identify high risk patients are explored and the role of investigations to aid this stratification is discussed. Identifying a cardiac cause for syncope is a poor prognostic indicator. Patients with unexplained syncope who have significant cardiac disease should therefore be investigated thoroughly to determine the nature of the underlying heart disease and the cause of syncope, although presently there is little evidence that this improves their dismal prognosis. This risk stratification approach has led to the development of several clinical decision rules, which are discussed along with current international guidelines on syncope management. This review suggests that presently the American College of Emergency Physicians guidelines are the most useful aids specific to the management of syncope in the ED; however, the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score may also be a useful ED risk stratification tool.

  1. The Effects of Parkinson's Disease and Age on Syncopated Finger Movements

    Science.gov (United States)

    Stegemöller, Elizabeth L.; Simuni, Tanya; MacKinnon, Colum

    2009-01-01

    In young healthy adults, syncopated finger movements (movements between consecutive beats) are characterized by a frequency-dependent change in phase at movement rates near 2 Hz. A similar frequency-dependent phase transition is observed during bimanual anti-phase (asymmetric) tasks in healthy young adults, but this transition frequency is significantly lowered in both patients with Parkinson's disease (PD) and older adults. To date, no study has examined the transition frequency associated with unimanual syncopated movements in patients with PD or older adults. This study examined the effects of movement frequency on the performance of unconstrained syncopated index finger flexion movements in patients with PD, older adult subjects matched to patients with PD, and young adult subjects. Syncopated movements were paced by an acoustic tone that increased in frequency from 1 to 3 Hz in 0.25 Hz increments. Movement phase was quantified and the movement frequency where subjects transitioned from syncopation to synchronization was compared between groups. The principal finding was a marked impairment in the ability of patients with PD to perform syncopated movements when off medication. Medication did not significantly improve performance. In addition, the transition frequency for older adult subjects was lower than young adult subjects. These findings demonstrate that, similar to bimanual tasks, the coordination dynamics associated with unimanual syncopated finger movements transition from a stable to an unstable pattern at significantly lower frequencies in patients with PD and older adults compared to young adults. PMID:19596277

  2. Diagnostic patterns in the evaluation of patients presenting with syncope at the emergency or outpatient department.

    Science.gov (United States)

    Kang, Gu Hyun; Oh, Ju Hyeon; Kim, June Soo; On, Young Keun; Song, Hyoung Gon; Jo, Ik Joon; Kim, Su Jin; Bae, Su-Jin; Shin, Tae Gun

    2012-05-01

    Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823,000 (440,000-1,408,000) won vs. 420,000 (186,000-766,000) won, ppatients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.

  3. Reflex vasovagal syncope--is there a benefit in pacemaker therapy?

    Science.gov (United States)

    Sousa, Pedro Alexandre; Candeias, Rui; Marques, Nuno; Jesus, Ilídio

    2014-05-01

    Reflex vasovagal syncope often affects young populations and is associated with a benign prognosis in terms of mortality. However, a minority of patients have recurrent episodes, with a considerable impact on their quality of life. Pacemaker therapy has been an option in these patients since the 1990s if a conservative strategy fails. Initially, non-randomized and open-label randomized trials showed promising results, but these studies were associated with a significant placebo effect. Recently, an approach based on the use of implantable loop recorders has shown that some patients with reflex vasovagal syncope could benefit from implantation with dual-chamber pacemakers, particularly patients aged >40 years, with recurrent syncopal episodes resulting in frequent injuries, in whom a long asystole (≥3 s asystole with syncope or ≥6 s asystole without syncope) has been documented with an implantable loop recorder. The authors present a literature review on the role of cardiac pacing in reflex vasovagal syncope and propose a diagnostic and therapeutic decision flowchart for patients with syncope of probable reflex etiology. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Manual compression and reflex syncope in native renal biopsy.

    Science.gov (United States)

    Takeuchi, Yoichi; Ojima, Yoshie; Kagaya, Saeko; Aoki, Satoshi; Nagasawa, Tasuku

    2018-03-14

    Complications associated with diagnostic native percutaneous renal biopsy (PRB) must be minimized. While life threatening major complications has been extensively investigated, there is little discussion regarding minor bleeding complications, such as a transient hypotension, which directly affect patients' quality of life. There is also little evidence supporting the need for conventional manual compression following PRB. Therefore, this study evaluated the relationship between minor and major complications incidence in patients following PRB with or without compression. This single-center, retrospective study included 456 patients (compression group: n = 71; observation group: n = 385). The compression group completed 15 min of manual compression and 4 h of subsequent strict bed rest with abdominal bandage. The observation group completed 2 h of strict bed rest only. The primary outcome of interest was transient symptomatic hypotension (minor event). Of the 456 patients, 26 patients encountered intraoperative and postoperative transient hypotension, which were considered reflex syncope without tachycardia. Univariate analysis showed that symptomatic transient hypotension was significantly associated with compression. This association remained significant, even after adjustment of covariates using multivariate logistic regression analysis (adjusted odds ratio 3.27; 95% confidential interval 1.36-7.82; P = 0.0078). Manual compression and abdominal bandage significantly increased the frequency of reflex syncope during native PRB. It is necessary to consider the potential benefit and risk of compression maneuvers for each patient undergoing this procedure.

  5. Recurrent syncope in patients with carotid sinus hypersensitivity.

    Science.gov (United States)

    Lagi, Alfonso; Cerisano, Sergio; Cencetti, Simone

    2012-01-01

    Syncope recurrence in pacemaker-implanted subjects for the cardio-inhibitory response to sinus carotid massage (SCM) was investigated. The study-hypothesis was that recurrences had significant vasodepressor responses that could justify the loss of consciousness. Forty-six patients were enrolled (16 patients and 30 controls), followed and revaluated after 5-7 years. At the end of follow-up, significant differences were found between patients and controls in mean SCM SAP (87 versus 106 mmHg) and reduction in mean SCM SAP (59 versus 38 mmHg); in the number of symptomatic subjects soon after SCM (5 versus 1); and in the number of subjects suffering from orthostatic hypotension. A subgroup of 13 patients showed significantly different hypotensive responses to SCM compared with the values observed at study recruitment. The data showed that some subjects with a defined hemodynamic pattern in response to SCM may change their characteristics and have spontaneous and/or provocative symptoms. These data explain the syncopal relapses, and suggest the presence of autonomic dysregulation in individuals with carotid sinus hypersensitivity.

  6. Long-Term Outcome of Patients with Bifascicular Block and Unexplained Syncope Following Cardiac Pacing.

    Science.gov (United States)

    Kalscheur, Matthew M; Donateo, Paolo; Wenzke, Kevin E; Aste, Milena; Oddone, Daniele; Solano, Alberto; Maggi, Roberto; Croci, Francesco; Page, Richard L; Brignole, Michele; Hamdan, Mohamed H

    2016-10-01

    According to the ACC/AHA/HRS guidelines, cardiac pacing is reasonable in patients with bifascicular block (BF-B) and syncope when other causes have been excluded. The purpose of this study was to assess the long-term outcome of patients with BF-B and unexplained syncope following cardiac pacing. Between 2009 and 2015, we identified 43 consecutive patients (mean age of 78 ± 12 years, 64% males) who presented with syncope and BF-B and had received a pacemaker (PM). During a mean follow-up period of 31 ± 21 months, syncope recurred in seven patients (16%): 7% (95% standard error [SE] ± 3%) at 1 year and 18% (95% SE ± 7%) at 5 years. At univariable analysis, the only predictor of syncope recurrence was empiric pacing (P = 0.03). There were no syncope recurrences in the 12 patients who received a PM following a positive electrophysiological study (EPS) and the five patients with documentation of paroxysmal atrioventricular block (AVB) during cardiac monitoring (insertable loop recorder [ILR]), (EPS/ILR Group, n = 17) compared to seven of 26 (27%) patients who received empiric pacing (Empiric Group, n = 26; P = 0.02). Progression to high-degree AVB was documented during follow-up in 16 (37%) patients: nine of 17 (53%) patients in the EPS/ILR Group and seven of 26 (27%) patients in the Empiric Group (P = 0.11). There were no injuries reported during ILR monitoring. We have shown that syncope recurs not infrequently in patients with BF-B who received pacing for syncope. Nearly one in four patients who had empiric pacing suffered syncope recurrence compared to no recurrences in patients who received a PM following a positive EPS or documentation of transient AVB. © 2016 Wiley Periodicals, Inc.

  7. Association Between Baseline Blood Pressures, Heart Rates, and Vasovagal Syncope in Children and Adolescents.

    Science.gov (United States)

    Adlakha, Himanshu; Gupta, Ruchi; Hassan, Romana; Kern, Jeffrey H

    2018-01-28

    Vasovagal syncope is the most common cause of syncope in children and adults, accounting for 50-66% of unexplained syncope. There are no studies establishing the relationship between syncope, baseline heart rate, and blood pressure. To identify a possible association between baseline blood pressure and heart rate with syncope. We conducted a questionnaire-based chart review study. A questionnaire was distributed to the guardian of children between eight and 18 years of age who attended the Pediatric Ambulatory Care Clinic at Flushing Hospital Medical Center. Based on the responses in the questionnaire, subjects were classified either as cases (positive for syncope) or controls (negative for syncope). Children and adolescents with neurological, cardiac, or any medical condition that can cause syncopal episodes were excluded from the study. Data collected from the questionnaire included age, gender, ethnicity, medical history, family history of syncope, and the amount of salt used in food. Anthropometric and vital signs for the current visit (height, weight, BMI, blood pressure, and heart rate) and vital signs from two previous visits were collected from electronic medical records. The data was analyzed using t-test and chi-square test with Microsoft Excel software (Microsoft Office Standard, v. 14, Microsoft; 2010); p<0.05 was considered significant. A total of 197 subjects were included in this study. There were 18 cases and 179 controls. Of the cases, (4/18) 22.2% were more likely to have a systolic blood pressure lower than the 10th percentile for their gender, age, and height as compared with controls (7/179) 3.9%, p = 0.003. The subjects with a history of syncope were more likely to add salt to their food (p = 0.004). There were no significant differences between cases and controls for age, gender, ethnicity between cases and controls for systolic blood pressure. No significant difference was observed between the heart rates of cases and controls. Children

  8. Use of Implantable Loop Recorders to Unravel the Cause of Unexplained Syncope

    Directory of Open Access Journals (Sweden)

    Dr. Aniket Puri, DM, FACC, FAPSIC, FSCAI

    2013-03-01

    Full Text Available Syncope is a symptom of many underlying disease states, which range from the relatively benign to the life threatening. There are numerous investigations done for patients with recurrent unexplained syncope which may have very low yield when it comes to making a definitive diagnosis. Recently, the implantable loop recorder (ILR for continuous monitoring of the cardiac rhythm has been launched in India. This review will briefly discuss these current availabel strategies and focus on the usefulness of an ILR in the definitive diagnosis and treatment of patients with a recurrent unexplained syncope.

  9. Role of head-up tilt table testing in patients with syncope or transient loss of consciousness

    Directory of Open Access Journals (Sweden)

    Toshiyuki Furukawa, MD, PhD

    2017-12-01

    Full Text Available The tilt table test (TTT is a useful method for the management of reflex syncope. However, the TTT is incomplete and has several problems. The indications for this test are established using guidelines. The TTT is not suitable for all syncopal patients. It is currently unclear (1 When should the TTT be used, (2 for which types of patients TTT should be performed, and (3 does the TTT provide useful information to guide indication for pacing therapy for reflex syncope. The answers to these questions appear in recent reports from two guidelines published by the European Society of Cardiology and the Japan Circulation Society. The indications for TTT do not apply to all syncopal patients, but selected patients. For patients with low risks and rare syncopal events, the TTT is not necessary, even when diagnoses are unconfirmed. The TTT is used not only for diagnosis of reflex syncope, but also for many clinical management of several conditions (i.e., exclusion of cardiac syncope. Positive TTT results cannot predict the effects of pacing therapy for reflex syncope. The decision to use pacing therapy should be based on documented electrocardiograms and other findings, including TTT results. Keywords: Tilt table testing, Reflex syncope, Pacemaker, Italian protocol, Management of syncope

  10. Mechanisms of lower body negative pressure-induced syncope

    Science.gov (United States)

    Davrath, Linda Ruble

    Although extensively investigated, the mechanisms of post-spaceflight orthostatic intolerance have not been elucidated. The working hypothesis was that a markedly reduced left ventricular end-systolic volume (LVESV) would be achieved during progressive, presyncopal-limited LBNP and would cause bradycardia and a fall in blood pressure, thus triggering syncope. Eight healthy men, age 25.1 ± 1.3 years, volunteered for the study. Subjects were exposed to graded levels of LBNP on two separate occasions. Changes in left ventricular end-diastolic volume and LVESV were measured, using two-dimensional echocardiography, at each stage of LBNP from rest to presyncope. Plasma venous blood samples were withdrawn at the end of each stage of the LBNP protocol for the measurement of plasma venous catecholamines and plasma renin activity (PRA). Catecholamines were analyzed by HPLC with electro-chemical detection, and PRA was determined by radioimmunoassay. All subjects reached presyncope during the LBNP. LVESV decreased by 28% at presyncope with no evidence of ventricular cavity obliteration. Norepinephrine (NE) increased by 44% from rest to presyncope, but no epinephrine surge was detected (35% increase from rest to presyncope). These data indicate that it is possible to initiate syncope with only a 28% decrease in LVESV, and that sympatho-inhibition and bradycardia are not required elements for syncope to occur. To investigate the effect of moderate sodium restriction on cardiovascular hemodynamics and orthostatic tolerance, presyncopal LBNP testing was performed. Urinary sodium excretion was significantly higher on the normal-sodium diet when compared with the sodium-restricted diet, but urinary potassium was not different. Cumulative stress index (655 ± 460 on normal-sodium diet vs. 639 ± 388 on sodium-restricted diet) scores were not different. Cardiac volumes, blood pressure and total peripheral resistance were not different at any stage of the LBNP between the diets, nor

  11. Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Leite

    2001-01-01

    Full Text Available Syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and cathecolaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.

  12. Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

    DEFF Research Database (Denmark)

    Brinth, Louise Schouborg; Latif, Tabassam; Pors, Kirsten

    2014-01-01

    Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflex control - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorly understood. Methods: We studied the hemodynamic response to carotid sinus massage (CSM......) and compared this to other measurements of autonomic cardiovascular control in patients suspected of syncope-related falls. One hundred patients (≥80 years-old) referred to our syncope unit due to recurrent falls or possible syncope participated. CSM was performed in the supine and head-up tilted (HUT....... Conclusions: The hemodynamic response to CSM has a well-defined pattern and differs both with respect to the stimulus site and patient position. We suggest that CSS is not a distinct pathophysiological process or disease entity but rather an acquired cardiovascular instability due to age-related degeneration...

  13. Non-Linear Coupling Among Cardiovascular Variability Signals in Neuromediate Syncope

    National Research Council Canada - National Science Library

    Censi, F

    2001-01-01

    Aim of this study is to evaluate the degree of coupling among the cardiovascular variability series and the respiration in subjects susceptible to neurally mediated syncope, in comparison to normal subjects...

  14. What is The Utility of Electrophysiological Study in Elderly Patients with Syncope and Heart Disease?

    Directory of Open Access Journals (Sweden)

    Rumas Aslam

    2015-01-01

    Conclusion: Complete EPS allows the identification of treatable causes in a high proportion of elderly patients with syncope and heart disease. Yet, the prognosis of these patients is mainly related to LVEF and age.

  15. Relative utility of serum troponin and the OESIL score in syncope.

    Science.gov (United States)

    Hing, Rosslyn; Harris, Roger

    2005-02-01

    To investigate the utility of both a random troponin T level taken greater than 4 h after a syncopal event and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score in predicting outcome post syncope. We prospectively enrolled 113 adult patients who presented to our ED after a syncopal event. Each patient had a troponin T level taken at least 4 h after the event. The relevant history of the syncope, background medical history and ECG were collected at presentation. Patients were followed up via telephone after 3-6 months and medical records were also examined. The OESIL risk score was calculated for each patient and the predictive value of both the troponin T and OESIL score were analysed for their utility post syncope. Data were analysed for 100 patients. Twenty percent were believed to have a cardiac cause for their syncope. An elevated troponin T level was found to be highly specific (0.99, 95% confidence interval [CI] 0.96-1.0) for adverse cardiac outcome, but with a very low sensitivity (0.13, 95% CI 0-0.3). The OESIL risk score was found to be predictive of an adverse cardiac outcome (receiver-operating characteristic [ROC] 0.73, 95% CI 0.63-0.84) and return to normal function (ROC 0.74, 95% CI 0.63-0.86). A normal serum troponin T has a poor negative predictive value for adverse cardiac outcomes following syncope. A simple risk stratification system, such as the OESIL score, can predict those patients most at risk after a syncopal episode.

  16. Paroxysmal atrial fibrillation in seven dogs with presumed neurally-mediated syncope.

    Science.gov (United States)

    Porteiro Vázquez, D M; Perego, M; Santos, L; Gerou-Ferriani, M; Martin, M W S; Santilli, R A

    2016-03-01

    To document the electrocardiographic findings of vagally-induced paroxysmal atrial fibrillation following a presumed reflex syncopal episode in the dog. Seven dogs with a syncopal episode followed by a paroxysm of atrial fibrillation recorded on a 24-hour Holter. Twenty-four hour Holter monitors were retrospectively reviewed, analysing the cardiac rhythm associated with syncopal events. Each recording was analysed from 10 min before the syncopal episode to until 10 min after a normal sinus rhythm had returned. Nine episodes were recorded in seven dogs, with one patient experiencing three events during one Holter recording. Five of the seven dogs presented with underlying structural heart disease. In two the syncopal episodes occurred following exercise, two associated with coughing and three were during a period of rest. All dogs had documented on the Holter recording a rhythm abnormality during syncope. The most common finding leading up to the syncopal event was development of a progressive sinus bradycardia, followed by sinus arrest interrupted by a ventricular escape rhythm and then ventricular arrest. This was then followed by an atrial fibrillation. The atrial fibrillation was paroxysmal in seven recordings and persistent in two. In two dogs, the atrial fibrillation reorganised into self-limiting runs of atypical atrial flutter. This combination of electrocardiographic arrhythmias are probably caused by an inappropriate parasympathetic stimulation initiating a reflex or neurally-mediated syncope, with abnormal automaticity of the sinus node and of the subsidiary pacemaker cells and changes in the electrophysiological properties of the atrial muscle, which promoted the paroxysmal atrial fibrillation. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing.

    Science.gov (United States)

    Giannopoulos, Georgios; Kossyvakis, Charalampos; Panagopoulou, Vasiliki; Tsiachris, Dimitrios; Doudoumis, Konstantinos; Mavri, Maria; Vrachatis, Dimitrios; Letsas, Konstantinos; Efremidis, Michael; Katsivas, Apostolos; Lekakis, John; Deftereos, Spyridon

    2017-05-01

    Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly. The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT). This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms. Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P cause death was 41% vs 56% (P = .023), respectively. The multivariable odds ratio was 0.25 (95% confidence interval 0.15-0.40) after adjustment for potential confounders. In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause). Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Syncope and risk of sudden cardiac arrest in coronary artery disease.

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    Aro, Aapo L; Rusinaru, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Phan, Derek; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S

    2017-03-15

    Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community. All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records. 2119 SCA cases (68.4±13.8years, 66.9% male) and 746 controls (66.7±11.7years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were >5years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF ≥50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79). Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large sub-group without any current means of SCA risk stratification. Copyright © 2016. Published by Elsevier B.V.

  19. San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review

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    Saccilotto, Ramon T.; Nickel, Christian H.; Bucher, Heiner C.; Steyerberg, Ewout W.; Bingisser, Roland; Koller, Michael T.

    2011-01-01

    Background: The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been validated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes. Methods: We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics. Results: We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79–0.93), and the pooled estimate of specificity was 0.52 (95% CI 0.43–0.62). There was substantial between-study heterogeneity (resulting in a 95% prediction interval for sensitivity of 0.55–0.98). The probability of a serious outcome given a negative score with the San Francisco Syncope Rule was 5% or lower, and the probability was 2% or lower when the rule was applied only to patients for whom no cause of syncope was identified after initial evaluation in the emergency department. The most common cause of false-negative classification for a serious outcome was cardiac arrhythmia. Interpretation: The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department. Consideration of all available electrocardiograms, as well as arrhythmia monitoring, should be included in application of the San Francisco Syncope Rule. Between-study heterogeneity was likely due to inconsistent classification of arrhythmia. PMID:21948723

  20. History of syncope predicts loss of consciousness after head trauma: Retrospective study.

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    Zyśko, Dorota; Sutton, Richard; Timler, Dariusz; Furtan, Stanisław; Melander, Olle; Fedorowski, Artur

    2014-01-01

    Head trauma may present as transient loss of consciousness (TLOC) currently classified as traumatic in origin, in contrast to non-traumatic forms, such as syncope. Whether past history of syncope predisposes to loss of consciousness after head injury has been poorly studied. A retrospective analysis of data obtained from 818 consecutive patients admitted to Emergency Departments was conducted. Face-to-face semi-structured interviews were performed, where patients' past history of syncope and head injury were explored. Head injury events were stratified as high- or low-energy trauma. Data regarding past syncopal events were explored in regard to number, age at the first occurrence, and syncope circumstances. Multivariate logistic regression model was applied to assess the relationship between loss of consciousness during head injury and past history of syncope. Both past history of non-traumatic TLOC (odds ratio [OR] 3.78; 95% confidence interval [CI] 2.13-6.68, p consciousness after head injury. The clinical importance of this finding merits further investigation.

  1. Cognitive Impairment Is Very Common in Elderly Patients With Syncope and Unexplained Falls.

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    de Ruiter, Susanne C; de Jonghe, Jos F M; Germans, Tjeerd; Ruiter, Jaap H; Jansen, René W M M

    2017-05-01

    To evaluate the prevalence of cognitive impairment (CI), including mild CI and dementia, in elderly patients with syncope and unexplained falls. In this population, we compared the use of the Mini-Mental State Examination (MMSE) with a cognitive screening test that assesses executive dysfunction typical of subcortical (vascular) CI, that is, the Montreal Cognitive Assessment (MoCA). Observational cohort study. Outpatient fall and syncope clinic. Consecutive patients aged ≥65 years with syncope and unexplained falls without loss of consciousness. Baseline characteristics, functional status, MMSE, MoCA, and magnetic resonance imaging scans of the brain. prevalence of CI, comparing the MMSE with the MoCA. CI was defined as an MMSE/MoCA score Fall Group: n = 99). Prevalence of CI was 16.8% (MMSE) versus 60.4% (MoCA) in the Syncope Group (P Fall Group (P Fall Group with either method. Executive dysfunction was present in both groups. CI is as common in elderly patients with syncope as it is in patients with unexplained falls, with an overall prevalence of 58%. The MMSE fails as a screening instrument for CI in these patients, because it does not assess executive function. Therefore, we recommend the MoCA for cognitive screening in older patients with syncope and unexplained falls. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  2. Operating theatre related syncope in medical students: a cross sectional study

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    Fitzgerald JEF

    2009-03-01

    Full Text Available Abstract Background Observing surgical procedures is a beneficial educational experience for medical students during their surgical placements. Anecdotal evidence suggests that operating theatre related syncope may have detrimental effects on students' views of this. Our study examines the frequency and causes of such syncope, together with effects on career intentions, and practical steps to avoid its occurrence. Methods All penultimate and final year students at a large UK medical school were surveyed using the University IT system supplemented by personal approach. A 20-item anonymous questionnaire was distributed and results were analysed using the Statistical Package for Social Sciences, version 15.0 (Chicago, Illinois, USA. Results Of the 630 clinical students surveyed, 77 responded with details of at least one near or actual operating theatre syncope (12%. A statistically significant gender difference existed for syncopal/near-syncopal episodes (male 12%; female 88%, p Conclusion Our study shows that operating theatre related syncope among medical students is common, and we establish useful risk factors and practical steps that have been used to prevent its occurrence. Our study also highlights the detrimental effect of this on the career intentions of medical students interested in surgery. Based on these findings, we recommend that dedicated time should be set aside in surgical teaching to address this issue prior to students attending the operating theatre.

  3. Syncope in children and adolescents living in north-eastern Poland - scope of causes.

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    Baran, M; Szczepanski, W; Bossowski, A

    2013-01-01

    To investigate the diagnostic yield of different tests and asses the scope of causes in children referring to the hospital with a syncope in north-eastern Poland. A review of 386 consecutive patients (age 2-18 years) living in north-eastern Poland presenting to the cardiology department with a new onset syncope (which appeared to be neurally mediated by history) was undertaken. The patients underwent physical examination, laboratory tests, electrocardiography, 24-holter monitoring, head-up tilt-test, exercise test, echocardiography and electroencephalography. All the tests were performed in most of the patients, without ending the diagnostics after finding the first probable cause of loss of consciousness. 229 potential causes of syncope were found in 191 patients (49.4%), with 2 possible causes in 32 patients and 3 potential causes in 3 patients. The top 3 tests with the highest diagnostic yield were: head-up tilt test (41.4%), 24-holter monitoring (14.5%) and echocardiography (8.4%). Electroencephalography was useful in 3 patients (1.5%) and exercise test did not help in any patient. In some children more than one potential cause of syncope was diagnosed. That might confirm multiple factors' causality of syncope. Head-up tilt-test has the highest diagnostic yield in children with syncope. If the diagnostic protocol is not very strict, one might find some crucial conditions in about 8.3% of patients.

  4. Syncope in the young athlete: Assessment of prognosis in subjects with hypertrophic cardiomyopathy.

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    Magalhães-Ribeiro, Carlos; Freitas, João

    2016-01-01

    Syncope is a common but concerning event in young athletes. Although mostly due to benign reflex causes, syncope may be arrhythmic and precede sudden cardiac death. Efforts must therefore be made to distinguish post-exertional syncope from syncope during exercise, which can be an ominous sign of a possible underlying heart disease, such as hypertrophic cardiomyopathy. Prevention requires cooperation between physician and athlete, in order to identify individuals at risk and to protect them from sudden death. Solving this diagnostic dilemma may lead to recommendations for athletes to be cleared to play or disqualified from competitive sports, and presents challenging and controversial decisions to the health care provider that can prove difficult to implement. Although exercise contributes to physical and psychological well-being, there are insufficient data to indicate whether an athlete with hypertrophic cardiomyopathy diagnosed after a syncopal episode can safely resume competitive physical activity. The purpose of this study was to review the literature on syncope in young athletes and its relationship to individuals with hypertrophic cardiomyopathy, in order to enable accurate assessment of prognosis and the possibility of resuming competitive sports. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Recurrent Syncope Due to Carotid Sinus Hypersensitivity and Sick Sinus Syndrome

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    Feng-Yu Kuo

    2008-10-01

    Full Text Available Syncope is a sudden and brief loss of consciousness with postural tone. Its recovery is usually spontaneous. There are various causes of syncope including cardiac, vascular, neurologic, metabolic and miscellaneous origins. The tracing is usually time-consuming and costly. The diagnosis of carotid sinus syncope may sometimes be difficult since the symptoms are nonspecific, especially in older persons. Here, we report the case of a 72-year-old woman who sought medical attention at our hospital due to repeated syncope episodes over the previous 5 years. Neurologic examinations showed negative results (including brain computed tomography. Twenty-four-hour ambulatory electrocardiogram monitoring showed atrial and ventricular premature contractions only. Electrophysiologic study disclosed prolonged corrected sinus node recovery time (1,737 ms with poor atrioventricular conduction. Drop of blood pressure together with sinus bradycardia developed after left side carotid sinus massage. Both carotid sinus hypersensitivity with sick sinus syndrome contributed to this patient's syncope, and after pacemaker placement together with selective serotonin reuptake inhibitor treatment, she was free from syncope thereafter.

  6. Selected problems that may be thecause of cardiogenic syncope in children and adolescents. Useful information for family doctor and paediatrician

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    Aleksandra Morka

    2014-12-01

    Full Text Available Children with syncope are common patients in paediatric and family doctor clinics as well as emergency departments. The current guidelines of the European Society of Cardiology (2009 distinguish between three types of syncope: reflex, orthostatic hypotension and cardiac syncope. The essence of any syncope is the reduction of cerebral blood flow, loss of consciousness and a subsequent fall. The most common and the mildest form of syncope is reflex syncope, usually preceded by prodromal symptoms, while the rarest but also the most dangerous form is cardiac syncope. Cardiac syncopes are generally organic in origin and it is usually possible to determine their cause. In some cases it is possible to treat the cause of cardiac syncopes. They differ from reflex syncopes in the mechanism of origin: they usually do not have prodromal symptoms, and sometimes the first symptom of an ongoing disease can be syncope and even sudden cardiac death. Cardiac syncope affects patients with cardiac arrhythmias – tachy- or bradyarrhythmias, patients who suffer from malfunction of a previously implanted pacemaker, patients with defects that cause disturbed outflow from the right or the left ventricle, patients with defects and diseases of the heart muscle and/or coronary vessels as well as abnormalities causing impediment to the flow of blood within the heart or vessels (e.g. tumours. Some of these diseases such as, for example, hypertrophic cardiomyopathy or long QT syndrome are genetic abnormalities. In cardiac syncope, as in other types of syncope it is important to obtain a detailed family history and perform specialised tests. In recent years tilt tests have been increasingly less used and emphasis has been put on a very detailed diagnosis of cardiac arrhythmias as a potential cause of syncope and sudden cardiac death. Every patient with a suspected cardiac syncope should be referred to a specialist centre for

  7. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score.

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    Del Rosso, A; Ungar, A; Maggi, R; Giada, F; Petix, N R; De Santo, T; Menozzi, C; Brignole, M

    2008-12-01

    To develop, in patients referred for syncope to an emergency department (ED), a diagnostic score to identify those patients likely to have a cardiac cause. Prospective cohort study. ED of 14 general hospitals. 516 consecutive patients with unexplained syncope. Subjects underwent a diagnostic evaluation on adherence to Guidelines of the European Society of Cardiology. The clinical features of syncope were analysed using a standard 52-item form. In a validation cohort of 260 patients the predictive value of symptoms/signs was evaluated, a point score was developed and then validated in a cohort of 256 other patients. Diagnosis of cardiac syncope, mortality. Abnormal ECG and/or heart disease, palpitations before syncope, syncope during effort or in supine position, absence of autonomic prodromes and absence of predisposing and/or precipitating factors were found to be predictors of cardiac syncope. To each variable a score from +4 to -1 was assigned to the magnitude of regression coefficient. A score >or=3 identified cardiac syncope with a sensitivity of 95%/92% and a specificity of 61%/69% in the derivation and validation cohorts, respectively. During follow-up (mean (SD) 614 (73) days) patients with score >or=3 had a higher total mortality than patients with a score management of patients with syncope in an ED.

  8. Diagnostic accuracy of ICD-9 code 780.2 for the identification of patients with syncope in the emergency department.

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    Furlan, Ludovico; Solbiati, Monica; Pacetti, Veronica; Dipaola, Franca; Meda, Martino; Bonzi, Mattia; Fiorelli, Elisa; Cernuschi, Giulia; Alberio, Daniele; Casazza, Giovanni; Montano, Nicola; Furlan, Raffaello; Costantino, Giorgio

    2018-02-12

    Syncope is a common condition that affects individuals of all ages and is responsible for 1-3% of all emergency department (ED) visits. Prospective studies on syncope are often limited by the exiguous number of subjects enrolled. A possible alternative approach would be to use of hospital discharge diagnoses from administrative databases to identify syncope subjects in epidemiological observational studies. We assessed the accuracy of the International Classification of Diseases, Ninth Revision (ICD-9) code 780.2 "syncope and collapse" to identify patients with syncope. Patients in two teaching hospitals in Milan, Italy with a triage assessment for ED access that was possibly related to syncope were recruited in this study. We considered the index test to be the attribution of the ICD-9 code 780.2 at ED discharge and the reference standard to be the diagnosis of syncope by the ED physician. The sensitivity, specificity, positive and negative predictive values of the ICD-9 code 780.2 to identify patients with syncope were 0.63 (95% confidence interval [CI] 0.58-0.67), 0.98 (95% CI 0.98-0.99), 0.83 (95% CI 0.79-0.87) and 0.95 (95% CI 0.94-0.95), respectively. The moderate sensitivity of ICD-9 code 780.2 should be considered when the code is used to identify patients with syncope through administrative databases.

  9. Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly

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    Rafanelli M

    2014-02-01

    Full Text Available Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Background: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT, carotid sinus massage (CSM, or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. Methods: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. Results: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was

  10. [Evaluation of the effects of diverse therapeutic treatments versus no treatment of patients with neurocardiogenic syncope].

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    Di Girolamo, E; Di Iorio, C; Sabatini, P; Leonzio, L; Barsotti, A

    1998-08-01

    Head-up tilt test was introduced in clinical practice to assess vasovagal syncope and its use has further been extended to evaluate the efficacy of drug administration in these patients. Nevertheless, the effects of tilt test on vasovagal syncope have never been compared with those obtained by ethylephrine or propranolol administration. One hundred and sixty-nine consecutive patients with vasovagal syncope and positive baseline or nitrate-potentiated tilt test (60 degrees upright position for 45 min, or until syncope occurred; 5 mg sublingual isosorbide dinitrate administration if no symptoms occurred) were randomly distributed among three groups: Group A (57 control patients discharged without medical therapy); Group B (56 patients discharged with 75 mg/die ethylephrine); Group C (56 patients discharged with 80 mg/die propranolol). Tilt test was repeated after 1 month, while clinical outcome was evaluated monthly for a mean follow-up of 37.1 +/- 15.6 months. No significant differences in acute tilt-induced syncope recurrence rates were obtained among groups at test repetition since 70.2% of Group A, 69.6% of Group B and 62.5% of Group C experienced syncope. At 3-year follow-up 82.4% of Group A, 83.9% of Group B and 87.5% of Group C (NS among groups) remained symptom free, the most important clinical result being obtained in untreated patients. These data suggest that tilt test execution may prevent syncope recurrence as ethylephrine or propranolol administration. Irrespective of the therapeutical choice, the "controlled reproduction" of symptoms and some psychophysical training of patients to avoid precipitating circumstances, to recognize early symptoms promptly to be reverted by Trendelemburg position, may produce the same clinical improvement as (empiric) ethylephrine or propranolol therapy.

  11. Syncope risk stratification tools vs clinical judgment: an individual patient data meta-analysis.

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    Costantino, Giorgio; Casazza, Giovanni; Reed, Matthew; Bossi, Ilaria; Sun, Benjamin; Del Rosso, Attilio; Ungar, Andrea; Grossman, Shamai; D'Ascenzo, Fabrizio; Quinn, James; McDermott, Daniel; Sheldon, Robert; Furlan, Raffaello

    2014-11-01

    There have been several attempts to derive syncope prediction tools to guide clinician decision-making. However, they have not been largely adopted, possibly because of their lack of sensitivity and specificity. We sought to externally validate the existing tools and to compare them with clinical judgment, using an individual patient data meta-analysis approach. Electronic databases, bibliographies, and experts in the field were screened to find all prospective studies enrolling consecutive subjects presenting with syncope to the emergency department. Prediction tools and clinical judgment were applied to all patients in each dataset. Serious outcomes and death were considered separately during emergency department stay and at 10 and 30 days after presenting syncope. Pooled sensitivities, specificities, likelihood ratios, and diagnostic odds ratios, with 95% confidence intervals, were calculated. Thirteen potentially relevant papers were retrieved (11 authors). Six authors agreed to share individual patient data. In total, 3681 patients were included. Three prediction tools (Osservatorio Epidemiologico sulla Sincope del Lazio [OESIL], San Francisco Syncope Rule [SFSR], Evaluation of Guidelines in Syncope Study [EGSYS]) could be assessed by the available datasets. None of the evaluated prediction tools performed better than clinical judgment in identifying serious outcomes during emergency department stay, and at 10 and 30 days after syncope. Despite the use of an individual patient data approach to reduce heterogeneity among studies, a large variability was still present. Current prediction tools did not show better sensitivity, specificity, or prognostic yield compared with clinical judgment in predicting short-term serious outcome after syncope. Our systematic review strengthens the evidence that current prediction tools should not be strictly used in clinical practice. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Witnessing loss of consciousness during TMS – Syncope in contrast to seizure

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    Philipp Riedel

    Full Text Available Objective: Transient loss of consciousness (T-LOC can occur during transcranial magnetic stimulation (TMS. T-LOC during TMS can be caused by syncope or seizure. TMS operators explicitly screen participants and are also able to witness clinical manifestations of T-LOC during stimulation. Therefore they have direct access to information necessary to tell the two etiologies apart, if they are well trained on the clinical differences and not only sensitive to the potential risk of seizure induction. We here present a typical case of vasovagal syncope during TMS to contrast its clinical manifestations to that of seizures. Method: We describe an event of T-LOC in a 21 year old healthy woman during single-pulse TMS. Screening, setting, clinical manifestations and advanced diagnostics are reported. Discussion: Based on the detailed description of the case, we discuss why syncope is the most parsimonious etiology for the clinical picture observed in this participant. We provide information on typical clinical features of seizure that were particularly not observed. We also address potential benefits of further diagnostic tools. Additionally, we go into more parameters that can be useful to distinguish syncope from seizure. Conclusion: TMS operators should be well aware of the differentiation of T-LOC in syncopal or ictal in etiology, because they witness T-LOC during TMS. By presenting a typical case of vasovagal syncope during TMS the report in hand provides necessary information and literature to do so. Keywords: TMS, Seizure, Syncope, Adverse-event, T-LOC, Case-report

  13. Predictors of hospitalization in patients with syncope assisted in specialized cardiology hospital.

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    Fischer, Leonardo Marques; Dutra, João Pedro Passos; Mantovani, Augusto; Lima, Gustavo Glotz de; Leiria, Tiago Luiz Luz

    2013-12-01

    Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely set home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. In comparison with those not admitted OESIL scores of 0-1 were associated with a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score > 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.

  14. The role of psychological factors in response to treatment in neurocardiogenic (vasovagal) syncope.

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    Gracie, Jennifer; Newton, Julia L; Norton, Michael; Baker, Christine; Freeston, Mark

    2006-08-01

    Studies have established a link between vasovagal syncope (VVS) and anxiety, depression, and functional impairment. This study examines the prevalence of psychological problems in patients with VVS and whether non-responders are psychologically different from those whose symptoms respond to conservative treatment. Subjects with tilt-confirmed VVS completed the hospital anxiety and depression scale (HADS) (measures current levels of anxiety and depression) and the syncope functional status questionnaire (SFSQ) (syncope-specific quality-of-life measure) and participated in a semi-structured interview to ascertain potential triggers, thought content, and coping strategies. In this study, 41 subjects participated. There was no difference in gender and age duration of symptoms between responders (n=21) and non-responders (n=20). Non-responders were significantly more anxious (P=0.003) and depressed (P=0.003) and had a higher level of state (P=0.008) and trait (P=0.004) anxiety than responders. Non-responders reported more fear/worry (P=0.02), a significantly higher degree of impairment owing to syncope (P=0.01), and a greater number of perceived triggers (P=0.039); on average, participants reported eight negative thoughts about the consequences of VVS, with particular emphasis on threats of physical harm or death. Non-responders had higher levels of avoidance/protection coping and rumination. This study has confirmed that patients with VVS have a significant degree of psychological distress, which is worthy of consideration in its own right, out with management purely aimed at reducing syncopal or pre-syncopal symptoms. Further, this distress may actually influence the natural history of what is a chronic relapsing condition and may in fact be more relevant to the patient than the number of syncopal episodes that they are experiencing.

  15. The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes.

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    van Dijk, J Gert; Thijs, Roland D; van Zwet, Erik; Tannemaat, Martijn R; van Niekerk, Julius; Benditt, David G; Wieling, Wouter

    2014-02-01

    Syncope is defined as transient loss of consciousness as a result of cerebral hypoperfusion. Electroencephalography during syncope shows either a 'slow-flat-slow' or a 'slow' pattern. The first is believed to denote more severe hypoperfusion. Although the diagnosis of vasovagal syncope relies primarily on history taking, there is limited evidence regarding the relative importance of various clinical features, and none that relate them to the severity of electroencephalographic changes. The aim of this investigation was to study symptoms, signs and electroencephalographic changes with a 1 s resolution using electroencephalography and video data in 69 cases of tilt-induced vasovagal syncope. The main finding was that flattening of the electroencephalograph indicated more profound circulatory changes: the 'slow-flat-slow' group had a lower minimum blood pressure, longer maximum RR-interval, contained more cases with asystole and had a longer duration of loss of consciousness than the 'slow' group. Second, we describe a range of signs, including some that have rarely been reported in syncope, e.g. oral automatisms. Third, signs occurred at different rates depending on electroencephalographic flattening, suggesting a classification of syncopal signs. Type A signs (e.g. loss of consciousness, eye opening and general stiffening) develop during the first slow phase, stay present during flattening and stop in the second slow phase. Type B (particularly myoclonic jerks) occur when the electroencephalograph is slow but not flat: their abolition with electroencephalographic flattening suggests dependence on cortical activity. Type C signs (making sounds, roving eye movements and stertorous breathing) occur only in the flat phase, whereas type D (dropping the jaw and snoring) may occur either in slow or flat phases. In conclusion, our findings provide a detailed assessment of clinical symptoms in relation to electroencephalographic (EEG) changes during tilt-induced syncope.

  16. Syncope unit in the paediatric population: A single-centre experience.

    Science.gov (United States)

    Courtheix, Mathieu; Jalal, Zakaria; Bordachar, Pierre; Iriart, Xavier; Pillois, Xavier; Escobedo, Cécile; Rabot, Catherine; Tribout, Laetitia; Thambo, Jean-Benoit

    2016-03-01

    Syncopes are frequent in the paediatric population. Most are benign, but rare cases are caused by cardiac life-threatening diseases. Syncope units developed in the adult population have demonstrated improvement in evaluation and treatment, with a reduction in hospitalization. We report our experience of paediatric syncope management in a dedicated unit, and analyse the value of different elements in the identification of cardiac causes. This prospective study included 97 consecutive patients (mean age: 12.1±3.3 years) referred between January 2011 and June 2013 to a syncope unit with a paediatric cardiologist, a nurse, a physiotherapist and a psychologist. Patients were classified into diagnostic categories after an initial evaluation that included history, physical examination, electrocardiography, echocardiography and Holter monitoring. The most common diagnosis was neurocardiogenic syncope (n=69, 70.4%). Fifty-two cases (81.3%) had no or less recurrence after specific management that included physiotherapy and psychological support (follow-up: 11.5±5.4 months). Psychogenic pseudosyncopes affected 20 children (20.6%). Two patients had epileptic seizures. There were five cases of cardiac syncope (5.1%): two long QT syndromes and a catecholaminergic polymorphic ventricular tachycardia received beta-blockers; two atrioventricular complete blocks required pacemakers. One case was of indeterminate cause and received an insertable loop recorder after exhaustive investigations. Exercise-induced syncopes were significantly associated with cardiac origins (P=0.003), such as electrocardiographic abnormalities (PSyncope units in the paediatric population may be useful in the diagnostic process, to help identify rare cardiac aetiologies, and could decrease recurrence through specific management. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Syncope in old people. The importance of multiparametric monitor in OBI evaluation

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    Alessandro Riccardi

    2006-10-01

    Full Text Available Syncope is a common clinical entity, and it causes up to 3% of admission in the Emergency Department. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography, with a correct identification of etiology at the presentation in up to 50% of cases. Moreover, the underlying cause of syncope remains unidentified in a elevated percentage of patients. The application of Standard Guidelines and the institution of the Observation Unit (OBI with continuous monitoring improves patients management, chiefly in the geriatric population (> 65 years old. In older patients the clinical features of syncope are less defined, and the medical history has a limited value. The management in the OBI of this group of patient with continuous monitoring could become the best approach. The ECG monitoring can detect life-threatening arrhythmias in older patients with apparent non cardiac syncope. In the firs six months of 2005 the Emergency Department of the Ospedale San Paolo (Savona evaluated 164 patients > 65 years old with diagnosis of syncope/pre-syncope. During monitoring we detected events of arrhythmia in 12 patients (7,3%, including ventricular tachycardia in 2, atrial fibrillation in 4, paroxysmal atrial flutter in 2, paroxysmal supraventricular tachycardia in 1, asystole in 1 and third-degree atrioventricular block in 2 patients. We briefly describe 2 of this case: in both cases the first suggestion indicates a possible non cardiac etiology, but the subsequent monitoring shows episodes of potentially fatal arrhythmia. Both an early discharge and an in non-monitorized bed admission wouldn’t have preserved the two patient by a sudden cardiac death.

  18. Prospective evaluation of diagnostic work-up in syncope patients: results of the PL-US registry.

    Science.gov (United States)

    Kulakowski, Piotr; Lelonek, Malgorzata; Krynski, Tomasz; Bacior, Bogumila; Kowalczyk, Jacek; Malkowska, Beata; Tokarczyk, Monika; Stypula, Pawel; Pawlik, Tomasz; Stec, Sebastian M

    2010-02-01

    Syncope is a common problem. Demographic and clinical characteristics of patients admitted to different types of centres may vary, physician's adherence to the guidelines has been examined only in a few studies, and the requirements for implantable loop recorders (ILR) have not been well defined. The aim of this study was to (i) compare demographic and clinical characteristics of patients with syncope diagnosed and treated in tertiary electrophysiology cardiac centres and those attending syncope units or general hospitals, (ii) assess how physicians adhere to the published guidelines, and (iii) calculate the requirement for ILR insertion. In total, 669 consecutive patients with syncope, admitted to 18 electrophysiological cardiac tertiary centres over a mean of 3 months (range 1-10 months), entered a special Internet database called the PL-US (Polish patients with Unexplained Syncope) registry. Detailed demographic and clinical characteristics of the patients, including the results of all diagnostic tests performed, were analysed. Adherence to the guidelines was assessed, based on the published recommendations. The ILR implantation was indicated when (i) all other tests were inconclusive (unexplained syncope) and (ii) syncope associated with injury or presence of organic heart disease or past medical history and ECG suggesting arrhythmic syncope. Syncope of cardiac/arrhythmic origin was the most frequent diagnosis (53%), followed by reflex syncope (33%). Adherence to the guidelines was less than satisfactory-measurement of blood pressure in an upright position, carotid sinus massage, exercise testing, and electrophysiological study were underused, whereas prolonged ECG monitoring and neurological consultations were overused. Unexplained syncope had 58 (9%) patients, and 42 (72%) of them had indication for ILR which accounts for 6% of the whole study population. The calculated need for ILR was 222 implants/million inhabitants/year. Patients with syncope admitted to

  19. Effectiveness of midodrine treatment in patients with recurrent vasovagal syncope not responding to non-pharmacological treatment (STAND-trial).

    Science.gov (United States)

    Romme, Jacobus J C M; van Dijk, Nynke; Go-Schön, Ingeborg K; Reitsma, Johannes B; Wieling, Wouter

    2011-11-01

    Initial treatment of vasovagal syncope (VVS) consists of advising adequate fluid and salt intake, regular exercise, and physical counterpressure manoeuvres. Despite this treatment, up to 30% of patients continue to experience regular episodes of VVS. We investigated whether additional Midodrine treatment is effective in these patients. In our study, patients with at least three syncopal and/or severe pre-syncopal recurrences during non-pharmacological treatment were eligible to receive double-blind cross-over treatment starting either with Midodrine or placebo. Treatment periods lasted for 3 months with a wash-out period of 1 week in-between. At baseline and after each treatment period, we collected data about the recurrence of syncope and pre-syncope, side effects, and quality of life (QoL). Twenty-three patients (17% male, mean age 32) included in the cross-over trial received both Midodrine and placebo treatment. The proportion of patients who experienced syncopal and pre-syncopal recurrences did not differ significantly between Midodrine and placebo treatment (syncope: 48 vs. 65%, P= 0.22; pre-syncope: 74 vs. 78%, P> 0.99). The median number of syncopes and pre-syncopes per 3 months were also not significantly different during Midodrine and placebo treatment (0 vs. 1; P= 0.57; and 6 vs. 8; P= 0.90). The occurrence of side effects was similar during Midodrine and placebo treatment (48 vs. 57%; P= 0.75). Also, QoL did not differ significantly. Our findings indicate that additional Midodrine treatment is less effective in patients with VVS not responding to non-pharmacological treatment than reported as first-line treatment.

  20. Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. The ECSIT study (epidemiology and costs of syncope in Trento).

    Science.gov (United States)

    Del Greco, Maurizio; Cozzio, Susanna; Scillieri, Marco; Caprari, Francesca; Scivales, Alessandro; Disertori, Marcello

    2003-02-01

    The ECSIT study was aimed at evaluating the hospital management of syncope patients, at comparing the appropriateness and costs of the hospital diagnostic pathway before (phase 1) and after (phase 2) the introduction of new guidelines and at analyzing the physicians' compliance to the guidelines. All syncope patients admitted to the emergency room between August 1 and October 31, 1999 (phase 1) and between March 1 and May 31, 2000 (phase 2) were enrolled and their clinical records were analyzed in a blind fashion. During the study 538 consecutive patients came to the emergency room for syncope with a hospitalization rate of 53% in phase 1 (n = 151) and of 42% in phase 2 (n = 107). The in-hospital stay increased from 9 days in phase 1 to 11.3 days in phase 2 and diagnostic tests from 2.6 per patient (phase 1) to 2.9 per patient (phase 2) with total costs that rose from [symbol: see text] 3,474 to [symbol: see text] 3,647. Patients with no diagnosis decreased from 51 to 45.8% and the principal causes were identified as vascular brain disease (36.1 vs 33.7%) and neurally-mediated mechanisms (35.3 vs 42.2%). Despite the high costs of syncope management, the appropriateness and efficacy of the hospital diagnostic pathway remains far from ideal and simply introducing new guidelines seems unable to modify clinical practice.

  1. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio risk score, and clinical judgment in the assessment of short-term outcome of syncope.

    Science.gov (United States)

    Dipaola, Franca; Costantino, Giorgio; Perego, Francesca; Borella, Marta; Galli, Andrea; Cantoni, Giulia; Barbic, Franca; Casella, Francesco; Duca, Pier Giorgio; Furlan, Raffaello

    2010-05-01

    The study aimed to compare the efficacy of the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score, San Francisco Syncope Rule, and clinical judgment in assessing the short-term prognosis of syncope. We studied 488 patients consecutively seen for syncope at the emergency department of 2 general hospitals between January and July 2004. Sensitivity, specificity, predictive values, and likelihood ratios for short-term (within 10 days) severe outcomes were computed for each decision rule and clinical judgment. Severe outcomes comprised death, major therapeutic procedures, and early readmission to hospital. Clinical judgment had a sensitivity of 77%, a specificity of 69%, and would have admitted less patients (34%, P < .05 vs decision rules). The OESIL risk score was characterized by a sensitivity of 88% and a specificity of 60% (admission 43%). San Francisco Syncope Rule sensitivity was 81% and specificity was 63% (admission 40%). According to both clinical rules, no discharged patient would have died. With combined OESIL risk score and clinical judgment, the probability of adverse events was 0.7% for patients with both low risk scores, whereas that for both high risk scores was roughly 16%. Because of a relatively low sensitivity, both risk scores were partially lacking in recognizing patients with short-term high-risk syncope. However, the application of the decision rules would have identified all patients who subsequently died, and OESIL risk score and clinical judgment combined seem to improve the decision-making process concerning the identification of high-risk patients who deserve admission. (c) 2010 Elsevier Inc. All rights reserved.

  2. Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

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    Samir Kanti Saha

    2013-01-01

    Full Text Available One hundred and forty four ambulatory, non-emergent human subjects from 20-88 years of age were investigated following routine 24 hour Holter monitoring referred by primary and tertiary care centers primarily for evaluation of palpitations and syncope. The patients were grouped into 3 different age categories: A 20-59 years of age (16%, B 60-69 years of age (26.4% and C > 70 years of age (57.6%. Heart rate profile, RR intervals, symptoms, frequency of premature supra ventricular and ventricular complexes were registered. The data show that though the occurrence and frequency of premature atrial and ventricular contractions over a period of 24 hours did not differ between the groups, the younger subjects documented more subjective discomforts during the Holter monitoring. Extra-systoles in excess of 1000 beats / 24 hour occured incessantly throughout the registration. Patients with syncope and those without did not differ as regards the Holter variables. However, subjects with atrial fibrillation had acceptable rate control and had significantly lower incidence of syncope than those with sinus rhythm. The findings suggest that in a county setting, Holter monitoring for evaluation of syncope may not be the first hand mode of investigation in a non emergent setting. On the contrary, the modality appears to be valuable for monitoring patients with atrial fibrillation. Even mild symptoms in the elderly population may warrant closer clinical follow up to prevent cardiac events and/or syncope leading to serious physical injury.

  3. Age-related prognosis of syncope associated with a preexcitation syndrome.

    Science.gov (United States)

    Brembilla-Perrot, Béatrice; Zinsch, Anne M; Sellal, Jean M; Zinzius, Pierre Y; Schwartz, Jérôme; Beurrier, Daniel; DE Chillou, Christian; Godenir, Jean P; Lethor, Jean P; Marchal, Cécile; Cloez, Jean L; Pauriah, Maheshwar; Nosu, Radu; Andronache, Marius; Marçon, François

    2013-07-01

    Syncope in Wolff-Parkinson-White syndrome (WPW) is without relationship with WPW or reveals a poorly tolerated arrhythmia. Electrophysiologic study (EPS) is recommended. The purpose of the study was to evaluate the influence of the patient's age on the causes and prognosis of syncope. A total of 98 patients, mean age 35 ± 18 years, with WPW were admitted for syncope. Note that 29 were aged between 9 and 19 years (mean 15 ± 3) (children and teenagers/group I), 45 between 20 and 49 years (mean 34 ± 8) (adults/group II), and 24 between 50 and 70 years (mean 60 ± 8) (elderly/group III). EPS consisted of atrial pacing and programmed atrial stimulation in control state and after isoproterenol. Potentially malignant form (rapid conduction in accessory pathway >240 beats/min in control state or >300 beats/min after isoproterenol and atrial fibrillation [AF] induction) was more frequent in group I (34%) than in groups II (7%) (P syncope and WPW syndrome depended on age: electrophysiological malignant form was frequent in children/teenagers, rare in adults, and absent in elderly. AVRT, the main cause of syncope, was as frequent in all ranges of age. AF's induction alone had no significance. Final prognosis was favorable. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  4. Diagnosis, management, and outcomes of patients with syncope and bundle branch block.

    Science.gov (United States)

    Moya, Angel; García-Civera, Roberto; Croci, Francesco; Menozzi, Carlo; Brugada, Josep; Ammirati, Fabrizio; Del Rosso, Attilio; Bellver-Navarro, Alejandro; Garcia-Sacristán, Jesús; Bortnik, Miriam; Mont, Lluis; Ruiz-Granell, Ricardo; Navarro, Xavier

    2011-06-01

    Although patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach. Patients with ≥1 syncope in the last 6 months, with QRS duration ≥120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR). Overall, 323 patients (left ventricular ejection fraction 56 ± 12%) were studied. The aetiological diagnosis was established in 267 (82.7%) patients (102 at initial evaluation, 113 upon EPS, and 52 upon ILR) with the following aetiologies: bradyarrhythmia (202), carotid sinus syndrome (20), ventricular tachycardia (18), neurally mediated (9), orthostatic hypotension (4), drug-induced (3), secondary to cardiopulmonary disease (2), supraventricular tachycardia (1), bradycardia-tachycardia (1), and non-arrhythmic (7). A pacemaker was implanted in 220 (68.1%), an implantable cardioverter defibrillator in 19 (5.8%), and radiofrequency catheter ablation was performed in 3 patients. Twenty patients (6%) had died at an average follow-up of 19.2 ± 8.2 months. In patients with syncope, BBB, and mean left ventricular ejection fraction of 56 ± 12%, a systematic diagnostic approach achieves a high rate of aetiological diagnosis and allows to select specific treatment.

  5. Simulation of Exercise-Induced Syncope in a Heart Model with Severe Aortic Valve Stenosis

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    Matjaž Sever

    2012-01-01

    Full Text Available Severe aortic valve stenosis (AVS can cause an exercise-induced reflex syncope (RS. The precise mechanism of this syncope is not known. The changes in hemodynamics are variable, including arrhythmias and myocardial ischemia, and one of the few consistent changes is a sudden fall in systemic and pulmonary arterial pressures (suggesting a reduced vascular resistance followed by a decline in heart rate. The contribution of the cardioinhibitory and vasodepressor components of the RS to hemodynamics was evaluated by a computer model. This lumped-parameter computer simulation was based on equivalent electronic circuits (EECs that reflect the hemodynamic conditions of a heart with severe AVS and a concomitantly decreased contractility as a long-term detrimental consequence of compensatory left ventricular hypertrophy. In addition, the EECs model simulated the resetting of the sympathetic nervous tone in the heart and systemic circuit during exercise and exercise-induced syncope, the fluctuating intra-thoracic pressure during respiration, and the passive relaxation of ventricle during diastole. The results of this simulation were consistent with the published case reports of exertional syncope in patients with AVS. The value of the EEC model is its ability to quantify the effect of a selective and gradable change in heart rate, ventricular contractility, or systemic vascular resistance on the hemodynamics during an exertional syncope in patients with severe AVS.

  6. Role of head-up tilt table testing in patients with syncope or transient loss of consciousness.

    Science.gov (United States)

    Furukawa, Toshiyuki

    2017-12-01

    The tilt table test (TTT) is a useful method for the management of reflex syncope. However, the TTT is incomplete and has several problems. The indications for this test are established using guidelines. The TTT is not suitable for all syncopal patients. It is currently unclear (1) When should the TTT be used, (2) for which types of patients TTT should be performed, and (3) does the TTT provide useful information to guide indication for pacing therapy for reflex syncope. The answers to these questions appear in recent reports from two guidelines published by the European Society of Cardiology and the Japan Circulation Society. The indications for TTT do not apply to all syncopal patients, but selected patients. For patients with low risks and rare syncopal events, the TTT is not necessary, even when diagnoses are unconfirmed. The TTT is used not only for diagnosis of reflex syncope, but also for many clinical management of several conditions (i.e., exclusion of cardiac syncope). Positive TTT results cannot predict the effects of pacing therapy for reflex syncope. The decision to use pacing therapy should be based on documented electrocardiograms and other findings, including TTT results.

  7. Practice variation and resource use in the evaluation of pediatric vasovagal syncope: are pediatric cardiologists over-testing?

    Science.gov (United States)

    Johnson, Erik R; Etheridge, Susan P; Minich, L Luann; Bardsley, Tyler; Heywood, Mason; Menon, Shaji C

    2014-06-01

    Syncope is a common problem in children and adolescents. Usually vasovagal in etiology, this benign problem often results in considerable testing and expense. We sought to define the current practice, practice variation, and resource utilization as well as evaluate a screening strategy for syncope at an academic tertiary care center. We reviewed the medical records of all patients age 8 to 19 years who presented with syncope between January 1994 and January 2012 and collected data regarding demographics, history, physical examination, and diagnostic tests. Practice variation was evaluated based on provider experience and subspecialty. The sensitivity and specificity of history, physical examination, and electrocardiogram (ECG) to identify a cardiac cause for syncope were calculated. Of the 617 patients studied, a cardiac cause for syncope was found in 15 (2 %). A screening strategy consisting of history, physical examination, and ECG was 100 % sensitive and 55 % specific for diagnosing a cardiac cause for syncope. Despite having a negative screen, 314 (54 %) patients had a total of 334 additional tests at an average charge of $983/patient. Although practice variation existed, it was not explained by provider experience or electrophysiology training. Factors associated with increased testing included greater number of clinic visits and increased frequency of events, whereas those associated with decreased testing included increased number of syncopal episodes and history of psychiatric medication use. A more standardized approach to syncope is needed to decrease resource use and cost while maintaining quality of care.

  8. Identifying cardiac syncope based on clinical history: a literature-based model tested in four independent datasets

    NARCIS (Netherlands)

    Berecki-Gisolf, Janneke; Sheldon, Aaron; Wieling, Wouter; van Dijk, Nynke; Costantino, Giorgio; Furlan, Raffaello; Shen, Win-Kuang; Sheldon, Robert

    2013-01-01

    We aimed to develop and test a literature-based model for symptoms that associate with cardiac causes of syncope. Seven studies (the derivation sample) reporting ≥2 predictors of cardiac syncope were identified (4 Italian, 1 Swiss, 1 Canadian, and 1 from the United States). From these, 10 criteria

  9. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  10. Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus.

    Science.gov (United States)

    Goto, Fumiyuki; Tsutsumi, Tomoko; Nakamura, Iwao; Ogawa, Kaoru

    2012-10-01

    A 72-year-old man with positional vertigo and tinnitus was referred to us. He did not want to perform provoking test except once due to his fear. No positional nystagmus was provoked. He found that his attacks usually occurred when he lay on his right ear. From his clinical history, benign paroxysmal positional vertigo was suspected. Conventional pharmacotherapy as well as non-specific physical therapy did not have significant effect. His feeling of positional vertigo with pyrosis was actually presyncope. We suspected cardiovascular disorders, and referred him to a cardiologist. Portable cardiogram monitoring revealed paroxysmal bradycardia. He was diagnosed with neurally mediated syncope, and a pacemaker was implanted. His paroxysmal dizziness soon disappeared. It is important to study the clinical history of the patients in detail, as they are not always able to accurately explain their symptoms. We should carefully rule out cardiovascular disorders, especially when we see the patients with suspected BPPV without the characteristic positional nystagmus. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Syncope in pediatric patients: a practical approach to differential diagnosis and management in the emergency department [digest].

    Science.gov (United States)

    Fant, Colleen; Cohen, Ari; Vazquez, Michelle N

    2017-04-22

    Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  12. Syncope associated with swallowing in two British Bulldogs with unilateral carotid body tumours.

    Science.gov (United States)

    Phan, A; Yates, G D; Nimmo, J; Holloway, S A

    2013-01-01

    Carotid body tumours were diagnosed in two British Bulldogs that each had a history of syncopal episodes induced by eating, drinking or pulling on the leash. In both dogs, a cervical mass was identified using computed tomography (CT) or magnetic resonance imaging, with carotid body tumour (CBT) being the histopathological diagnosis. A heart base mass was also identified in one dog by both CT and echocardiography. Swallowing syncope has been reported in the human literature in association with cervical mass lesions, but this is the first report in dogs. The present cases emphasise the value of advanced imaging of the head and neck in dogs presenting with clinical signs of syncope associated with swallowing and the importance of careful manipulation of the neck in patients with CBTs. © 2013 The Authors. Australian Veterinary Journal © 2013 Australian Veterinary Association.

  13. Usefulness of implantable loop recorder in a patient with syncope during bathing

    Directory of Open Access Journals (Sweden)

    Motohiro Nakao, MD

    2013-02-01

    Full Text Available A 27-year-old man presented to our hospital with a 1-year-hisory of repeated syncope, which particularly occurred while bathing or on a hot day. The head-up tilt test did not induce arrhythmia; however, blood pressure decreased by 39 mm Hg without any symptoms. Given that no bradycardia/tachycardia was induced on electrophysiological study and carotid sinus massage, an implantable loop recorder (ILR was implanted. After 2 months, syncope again occurred during bathing at midnight. Sinus arrest and a maximum ventricular pause of 10.2 s were documented using the ILR. After pacemaker implantation, the patient had not experienced syncope for 14 months.

  14. Recurrent syncope and cardiac arrest in a patient with systemic light chain amyloidosis treated with bortezomib

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    Navin Jaipaul

    2016-05-01

    Full Text Available About 10-15% of patients with multiple myeloma develop light chain (AL amyloidosis. AL amyloidosis is a systemic disease that may involve multiple organs, often including the heart. It may present clinically with bradyarrhythmia and syncope. The proteasome inhibitor bortezomib has been used with clinical efficacy in treating patients with AL amyloidosis but also implicated as a possible cause of cardiomyocyte injury. We report a case of a 48-year-old man with AL amyloidosis and increased frequency of syncope and cardiac arrest after starting bortezomib. The biologic and clinical plausibility of a heightened risk for cardiac arrest in patients with cardiac AL amyloidosis and history of syncope being treated with bortezomib is a possibility that is not well documented in the medical literature and warrants further investigation.

  15. Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry.

    Science.gov (United States)

    Edvardsson, Nils; Frykman, Viveka; van Mechelen, Rob; Mitro, Peter; Mohii-Oskarsson, Afsaneh; Pasquié, Jean-Luc; Ramanna, Hemanth; Schwertfeger, Frank; Ventura, Rodolfo; Voulgaraki, Despina; Garutti, Claudio; Stolt, Pelle; Linker, Nicholas J

    2011-02-01

    To collect information on the use of the Reveal implantable loop recorder (ILR) in the patient care pathway and to investigate its effectiveness in the diagnosis of unexplained recurrent syncope in everyday clinical practice. Prospective, multicentre, observational study conducted in 2006-2009 in 10 European countries and Israel. Eligible patients had recurrent unexplained syncope or pre-syncope. Subjects received a Reveal Plus, DX or XT. Follow up was until the first recurrence of a syncopal event leading to a diagnosis or for ≥1 year. In the course of the study, patients were evaluated by an average of three different specialists for management of their syncope and underwent a median of 13 tests (range 9-20). Significant physical trauma had been experienced in association with a syncopal episode by 36% of patients. Average follow-up time after ILR implant was 10±6 months. Follow-up visit data were available for 570 subjects. The percentages of patients with recurrence of syncope were 19, 26, and 36% after 3, 6, and 12 months, respectively. Of 218 events within the study, ILR-guided diagnosis was obtained in 170 cases (78%), of which 128 (75%) were cardiac. A large number of diagnostic tests were undertaken in patients with unexplained syncope without providing conclusive data. In contrast, the ILR revealed or contributed to establishing the mechanism of syncope in the vast majority of patients. The findings support the recommendation in current guidelines that an ILR should be implanted early rather than late in the evaluation of unexplained syncope.

  16. Identifying cardiac syncope based on clinical history: a literature-based model tested in four independent datasets.

    Science.gov (United States)

    Berecki-Gisolf, Janneke; Sheldon, Aaron; Wieling, Wouter; van Dijk, Nynke; Costantino, Giorgio; Furlan, Raffaello; Shen, Win-Kuang; Sheldon, Robert

    2013-01-01

    We aimed to develop and test a literature-based model for symptoms that associate with cardiac causes of syncope. Seven studies (the derivation sample) reporting ≥2 predictors of cardiac syncope were identified (4 Italian, 1 Swiss, 1 Canadian, and 1 from the United States). From these, 10 criteria were identified as diagnostic predictors. The conditional probability of each predictor was calculated by summation of the reported frequencies. A model of conditional probabilities and a priori probabilities of cardiac syncope was constructed. The model was tested in four datasets of patients with syncope (the test sample) from Calgary (n=670; 21% had cardiac syncope), Amsterdam (n=503; 9%), Milan (n=689; 5%) and Rochester (3877; 11%). In the derivation sample ten variables were significantly associated with cardiac syncope: age, gender, structural heart disease, low number of spells, brief or absent prodrome, supine syncope, effort syncope, and absence of nausea, diaphoresis and blurred vision. Fitting the test datasets to the full model gave C-statistics of 0.87 (Calgary), 0.84 (Amsterdam), 0.72 (Milan) and 0.71 (Rochester). Model sensitivity and specificity were 92% and 68% for Calgary, 86% and 67% for Amsterdam, 76% and 59% for Milan, and 73% and 52% for Rochester. A model with 5 variables (age, gender, structural heart disease, low number of spells, and lack of prodromal symptoms) was as accurate as the total set. A simple literature-based Bayesian model of historical criteria can distinguish patients with cardiac syncope from other patients with syncope with moderate accuracy.

  17. Identifying cardiac syncope based on clinical history: a literature-based model tested in four independent datasets.

    Directory of Open Access Journals (Sweden)

    Janneke Berecki-Gisolf

    Full Text Available BACKGROUND: We aimed to develop and test a literature-based model for symptoms that associate with cardiac causes of syncope. METHODS AND RESULTS: Seven studies (the derivation sample reporting ≥2 predictors of cardiac syncope were identified (4 Italian, 1 Swiss, 1 Canadian, and 1 from the United States. From these, 10 criteria were identified as diagnostic predictors. The conditional probability of each predictor was calculated by summation of the reported frequencies. A model of conditional probabilities and a priori probabilities of cardiac syncope was constructed. The model was tested in four datasets of patients with syncope (the test sample from Calgary (n=670; 21% had cardiac syncope, Amsterdam (n=503; 9%, Milan (n=689; 5% and Rochester (3877; 11%. In the derivation sample ten variables were significantly associated with cardiac syncope: age, gender, structural heart disease, low number of spells, brief or absent prodrome, supine syncope, effort syncope, and absence of nausea, diaphoresis and blurred vision. Fitting the test datasets to the full model gave C-statistics of 0.87 (Calgary, 0.84 (Amsterdam, 0.72 (Milan and 0.71 (Rochester. Model sensitivity and specificity were 92% and 68% for Calgary, 86% and 67% for Amsterdam, 76% and 59% for Milan, and 73% and 52% for Rochester. A model with 5 variables (age, gender, structural heart disease, low number of spells, and lack of prodromal symptoms was as accurate as the total set. CONCLUSION: A simple literature-based Bayesian model of historical criteria can distinguish patients with cardiac syncope from other patients with syncope with moderate accuracy.

  18. The use of an implantable loop recorder in the investigation of unexplained syncope in older people.

    Science.gov (United States)

    Armstrong, V Lynne; Lawson, Joanna; Kamper, Adriaan M; Newton, Julia; Kenny, Rose Anne

    2003-03-01

    Reveal is a patient activated implantable loop recorder device with an 18 month battery life now available to assist in the diagnosis of suspected syncope or arrhythmias. We present our experience using this device in older subjects referred to a dedicated falls and syncope clinic in whom usual clinical assessment had not satisfactorily identified an attributable diagnosis but where we still suspected a cardiovascular cause for syncope or falls. during the past 3 years 15 subjects (mean age 73 years, range 61-89 years) had Reveal implanted for symptoms of syncope alone (n=6; 40%) and unexplained falls (n=3; 20%) or symptoms of syncope and unexplained falls (n=6; 40%). Symptom duration was long (mean 48 months; range 4-200 months). Subjects had experienced significant morbidity, 6 subjects (40%) required A&E attendance or hospital admission and 4 (27%) experienced a fracture. Despite extensive and repeated investigations, which included 12-lead ECG, echocardiogram, 24-h ambulatory heart rate monitor, 24-h ambulatory blood pressure monitor, orthostatic blood pressure measurement, supine and erect carotid sinus massage, electroencephalogram, and passive and GTN head up tilt testing, the attributable diagnosis remained unexplained. Of the 15 subjects, 7 have activated the device at 4 (range 0-14) months after implantation. Bradycardia was identified in 3 and ventricular tachycardia in 1 subject. Two subjects did not activate the device during the 18 months it was in-situ. Four people had problems with device activation. This is comparable to rates noted using Reveal in younger subjects. Reveal offers additional diagnostic yield in complex elderly subjects with suspected cardiovascular causes of syncope or unexplained falls which have not been previously satisfactorily diagnosed despite extensive investigations.

  19. Adenosine 5'-Triphosphate Test in the Management of Patients With Syncope.

    Science.gov (United States)

    Flammang, Daniel; Benditt, David G; Church, Timothy R; Pelleg, Amir

    The response to adenosine 5'-triphosphate (ATP) identifies patients with syncope who might benefit from pacemaker therapy (ATP test). Two measures have been used to determine the outcome of the ATP test, which have lead to contrasting conclusions regarding its utility: (1) the duration of cardiac pause (CP) mainly due to AV block and (2) the longest RR interval (RRmax). We tested the hypothesis that the discrepancy regarding the utility of the ATP test is mainly because of the different way the 2 measures determine the outcome of the test. Post hoc analysis was applied to data obtained from patients with syncope (n = 33) with a positive and negative ATP test based on the CP duration and RRmax, respectively, subjected to pacemaker therapy. In 19 and 14 patients, the pacemaker was programmed to function as AAI pacing at 30 ppm (control) and as DDD pacing at 70 ppm, respectively. During the follow-up period of 17.0 ± 8.6 months, syncope recurred in only 1 of the 14 patients with DDD pacing; in contrast, 10 of 19 patients with AAI30 pacing experienced syncope within the first 5.3 ± 5.2 months of follow-up (P syncope who may benefit from pacemaker therapy; the identification of such patients would be missed when the RRmax measure is used to determine the outcome of the test. The efficacy of DDD pacing suggests that atrioventricular nodal conduction block is the primary cause of syncope in patients with a positive ATP test based on the CP measure.

  20. Evaluation rhythm problems in unexplained syncope etiology with implantable loop recorder.

    Science.gov (United States)

    Ergul, Yakup; Tanidir, Ibrahim Cansaran; Ozyilmaz, Isa; Akdeniz, Celal; Tuzcu, Volkan

    2015-06-01

    Syncope is a frequent complaint in children and adolescents and may be a significant sign of serious pathology. Although patient history, family history, and physical examination are sufficient to reach a diagnosis in most cases of syncope, the cause of syncope still cannot be determined after initial investigation in one-third to half of all patients. The aim of this study was to evaluate the diagnostic yield of implantable loop recorder (ILR) in children with unexplained syncope. A retrospective review was carried out of clinical data, indications, findings, and a final management strategy in patients who underwent ILR implantation. A total of 12 patients with a mean age of 9.4 ± 4.5 years underwent ILR (Reveal Plus; Medtronic) implantation. ILR implantation indication was syncope in all of the patients. Family history, routine cardiac assessment, including resting 12-lead electrocardiogram, transthoracic echocardiography, 24 h Holter recording, and event recorder findings, were normal with the exception of one patient with (previously corrected) tetralogy of Fallot. After an average of 20 months (range, 1-36 months), six patients developed symptoms. ILR memory showed torsades de pointes-ventricular fibrillation (n = 3), catecholaminergic polymorphic ventricular tachycardia (n = 1), asystole and ventricular tachycardia (n = 1), and normal sinus rhythm (n = 1). At the time of writing six patients were still in follow up with no symptoms after an average of 25.2 months. Implantable loop recorder plays an important role in the diagnosis of life-threatening arrhythmias in which syncope is otherwise unexplained. ILR implantation should be remembered in children whose symptoms are strongly correlated with rhythm disturbances. © 2014 Japan Pediatric Society.

  1. Muscle oxygen saturation increases during head-up tilt-induced (pre)syncope

    DEFF Research Database (Denmark)

    Lund, A.; Sorensen, H.; Jensen, T. W.

    2017-01-01

    be affected by superficial tissue oxygenation. Furthermore, we evaluated cerebral oxygenation (ScO2) and middle cerebral artery mean blood flow velocity (MCAvmean). Methods Twenty healthy male volunteers (median age 24 years; range 19–38) were subjected to passive 50° HUT for 1 h or until (pre)syncope. ScO2...... and SmO2 (near-infrared spectroscopy), MCAvmean (transcranial Doppler) along with mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) (Modelflow®) were determined. Results (Pre)syncopal symptoms appeared in 17 subjects after 11 min...

  2. Ebstein′s anomaly with severe aortic stenosis and syncope: Implications in management

    Directory of Open Access Journals (Sweden)

    Vijayakumar Subban

    2013-01-01

    Full Text Available Ebstein′s anomaly is a rare congenital heart disease involving the right side of the heart with typical malformations of the tricuspid valve and the right ventricle. Associated left heart anomalies, particularly aortic valve disease, are extremely rare. We report here an unusual case of Ebstein′s anomaly of the tricuspid valve and severe aortic stenosis who presented to us with recurrent syncopal episodes. The patient needed to undergo electrophysiological evaluation before aortic valve replacement to rule out arrhythmic causes of syncope.

  3. I passed out: now what?: general approach to the patient with syncope.

    Science.gov (United States)

    Hussein, Ayman A; Saliaris, Anastasios

    2012-11-01

    Syncope is the transient loss of consciousness and postural tone caused by transient cerebral hypoperfusion. It is a common problem that is often alarming to patients and their families. The differential diagnosis of the patient with transient loss of consciousness is broad and workup may be expensive. It is important to identify patients with life-threatening conditions and those with red flags indicating an increased risk of sudden death. An initial approach consisting of a careful history, physical examination, and electrocardiograms is essential. This review covers the general diagnostic approach to the patient with syncope. Copyright © 2012. Published by Elsevier Inc.

  4. From syncope to ICD: clinical paths of the Brugada syndrome

    Directory of Open Access Journals (Sweden)

    Ivan Comelli

    2010-09-01

    Full Text Available This review summarizes the evidences in the literature on the management of the Brugada syndrome (BS, an arrhythmogenic disease caused by genetic channelopathies, predisposing to syncope and sudden cardiac death in young, apparently healthy, typically male subjects, in the third and fourth decade of their life. Sudden cardiac death (SCD is defined as natural death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of symptoms. It ranks among the main causes of death in the western world, with an incidence ranging from 0.36 and 1.28‰ inhabitants per year, equal to 300,000 cases a year in the USA. In the majority of the cases it is due to the onset of arrhythmia in subjects with structural cardiac diseases, especially ischemic heart disease. However, in a non-negligible percentage of the cases, about 5-10%, the SCD arises in relatively young individuals in whom cardiac anomalies cannot be detected using traditional diagnostic techniques. About 20% of these cases can be attributed to SB. In spite of the many efforts produced to identify an effective pharmacological treatment, to date the only aid to reduce the mortality rate in subjects with SB is an implantable cardio-defibrillator (ICD. Since this approach often entails complications, the efforts of the scientific community is now focused on the assessment of the arrhythmic risk. The identification of high-risk subjects is one of the chief objectives in the therapeutic decision-making process. ABSTRACT clinica e terapia emergency

  5. 11. Prevalence of psychiatric symptoms among patients with recurrent vasovagal and unexplained syncope

    Directory of Open Access Journals (Sweden)

    A.W. Al-Johar

    2016-07-01

    Full Text Available Syncope is defined as a transient loss of consciousness and absence of postural tone followed by spontaneous recovery. Neurally mediated syncope (vasovagal and idiopathic unexplained syncope (US are the most common causes of syncope. Syncope is a very limiting disease that, if recurrent, affects the patients’ physical and psychological health. Our objective from this study is to measure the prevalence of psychiatric symptoms among patients with US. All patients (>12 years with vasovagal or US who were evaluated in King Khalid University Hospital were identified. Echocardiography and table tilt test reports were reviewed and patients who had cardiac syncope (due to arrhythmia or structural heart disease were excluded (N = 18. Ninety-four patients were included for further psychiatric assessment. The patients were contacted to fill the Symptoms Checklist-90-Revised (SCL-90-R, which is a self-reporting questionnaire used to evaluate traits of depression, anxiety, somatization disorder and phobia. SCL-90-R scale has been translated to Arabic and validated in previous studies. Of the included cohort, 43 responded to fill the assessment scale, and 51 were excluded due to failure of communication (N = 41 or refusal to participate (N = 10. A control group was recruited with a case: control ratio of 1:3 matching for age, gender, and chronic illnesses.There were 43 patients and 129 control subjects, with predominance of females (67.4% and an average age of 33.8 (SD = 16. There was no difference in average scores of depression (13 vs. 14.53, P = 0.31, anxiety (11.3 vs. 10.4, P = 0.51, or phobia (5.4 vs. 5.2, P = 0.88. However, the syncope group had a higher average score for somatization disorder (18.53 vs. 13.66, P = 0.002. Binary logistic regression model was measured after grouping the cohort into above and below median scores. After adjusting for age, gender, and chronic illnesses, the association between syncope and somatization

  6. Bedside Heart Type Fatty Acid Binding Protein (H-FABP): Is an Early Predictive Marker of Cardiac Syncope

    International Nuclear Information System (INIS)

    Sonmez, B. M.; Yilmaz, F.; Durdu, T.; Hakbilir, O.; Ongar, M.; Ozturk, D.; Altinbilek, E.; Kavalci, C.; Turhan, T.

    2015-01-01

    Objective: To determine the value of bedside heart-type fatty acid binding protein in diagnosis of cardiac syncope in patients presenting with syncope or presyncope. Methods: The prospective study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, between September 1, 2010, and January 1, 2011, and comprised patients aged over 18 years who presented with syncope or presyncope. Patients presenting to emergency department within 4 hours of syncope or presyncope underwent a bedside heart-type fatty acid binding protein test measurement. SPSS 16 was used for statistical analysis, Results: Of the 100 patients evaluated, 22(22 percent) were diagnosed with cardiac syncope. Of them, 13(59.1 percent) patients had a positive and 9(40.9 percent) had a negative heart-type fatty acid binding protein result. Consequently, the test result was 12.64 times more positive in patients with cardiac syncope compared to those without. Conclusions: Bedside heart-type fatty acid binding protein, particularly at early phase of myocardial injury, reduces diagnostic and therapeutic uncertainity of cardiac origin in syncope patients. (author)

  7. Association of corrected QT interval with long-term mortality in patients with syncope.

    Science.gov (United States)

    Balasubramaniyam, Nivas; Palaniswamy, Chandrasekar; Aronow, Wilbert S; Khera, Sahil; Balasubramanian, Gokulakrishnan; Harikrishnan, Prakash; Doshi, Jay V; Nabors, Christopher; Peterson, Stephen J; Sule, Sachin

    2013-12-30

    The electrocardiographic parameters QRS duration, QRS-T angle and QTc can predict mortality in patients with cardiovascular disease. The prgnostic value of these parameters in hospitalized patients with syncope needs investigation. We retrospectively studied 590 consecutive patients hospitalized with syncope. After excluding patients with baseline abnormal rhythm, QT- prolonging medications, and missing data, 459 patients were analyzed. Baseline demographic characteristics, co-morbidities, medication use, San Francisco Syncope Rule (SFSR) and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score and data on mortality were collected. The categorical variables and continuous variables of the 2 groups of patients with prolonged QTc and normal QTc interval were analyzed by Fischer's exact test and Mann-Whitney Test. A stepwise Cox regression model was used for time to death analysis. Of 459 patients, prolonged QTc interval was observed in 122 (27%). Mean follow-up was 41 months. Patients with prolonged QTc interval had higher prevalence of cardiovascular disease, OESIL score, high risk SFSR, hypertension, dyslipidemia, coronary artery disease, congestive heart failure, and increased mortality. Stepwise Cox regression analysis showed that significant independent prognostic factors for time to death were prolonged QTc interval (p = 0.005), age (p = 0.001), diabetes mellitus (p = 0.001) and history of malignancy (p = 0.006). QRS duration and QRS-T angle were not independent predictors of mortality. A prolonged QTc interval is an independent predictor of long-term mortality in hospitalized patients with syncope.

  8. Cryptococcal meningitis presenting with recurrent syncope in a patient with chronic lymphoid leukemia: a case report

    Science.gov (United States)

    2009-01-01

    The clinical presentations of cryptococcal meningitis in HIV-negative patients may be different from that infected with HIV. We report a case of 75-year old male with chronic lymphoid leukemia presenting with recurrent syncope, bi-frontal headache and diplopia. This case discusses the atypical presentations of cryptococcal meningitis in HIV-negative patients and its importance of early diagnosis. PMID:19178720

  9. Prediction of neurally mediated syncope based on heart rate and pulse arrival time

    NARCIS (Netherlands)

    Eickholt, C.; Drexel, T.; Muehlsteff, J.; Ritz, A.; Siekiera, M.; Kirmanoglou, K.; Shin, D.I.; Blazer, J.; Rassaf, T.; Kelm, M.; Meyer, C.

    2012-01-01

    Prediction of neurally mediated syncope based on heart rate and pulse arrival time Christian Eickholt1, Thomas Drexel1, Jens Mühlsteff2,Anita Ritz1, Markus Siekiera1, Kiriakos Kirmanoglou1, Dong-In Shin1, Jan Balzer1, Tienush Rassaf1, Malte Kelm1, Christian Meyer1 Background: We previously

  10. Do subjects with vasovagal syncope have subtle haemodynamic alterations during orthostatic stress?

    Science.gov (United States)

    Fucà, Giuseppe; Dinelli, Maurizio; Gianfranchi, Lorella; Bressan, Sabrina; Lamborghini, Catia; Alboni, Paolo

    2008-06-01

    There are conflicting reports on the presence of subtle haemodynamic alterations during orthostatic stress in subjects with vasovagal syncope (VVS). The aim of the present study was to investigate whether young/middle-aged subjects with VVS show abnormal responses to orthostatic stress. Four groups of subjects underwent tilt testing (TT) during the passive phase and, if negative, after nitroglycerin administration: Group I, 20 subjects with a history of syncope and positive passive TT; Group II, 23 subjects with a history of syncope and TT positive after nitroglycerin; Group III, 23 subjects with a history of syncope and negative TT; and Group IV, 20 normal control subjects. Heart rate, systolic, diastolic, and mean blood pressure, stroke volume, cardiac output, and total peripheral resistance were computed from pressure pulsations (Modelflow). The demographic data and the values of the haemodynamic variables in the supine position did not differ significantly among the four groups. The per cent changes in these variables did not differ significantly among the four groups after 2 and 5 min of TT and among Groups II, III, and IV, 2 min after nitroglycerin administration. Young/middle-aged subjects with VVS have a normal measured haemodynamic response to orthostatic stress; therefore, the vasovagal reflex is not secondary to an impairment of the primary vasoconstrictive mechanism.

  11. Mediastinal Teratoma with Neuroendocrine Features in 34-Year-Old Male with Syncope

    Directory of Open Access Journals (Sweden)

    Peter A. Andrawes

    2015-01-01

    Full Text Available Neuroendocrine tumors that arise in an extragonadal teratoma are extremely rare. Somatic-type malignancy, defined as any sarcoma, carcinoma, leukemia, or lymphoma developing in a germ cell tumor, occurs in approximately 2% of all germ cell tumors. Our case represents a mediastinal mass that was incidentally found in a patient with syncope. Surgical resection confirmed mature teratoma with neuroendocrine features.

  12. Genetic variation in the parasympathetic signaling pathway in patients with reflex syncope

    DEFF Research Database (Denmark)

    Holmegard, H N; Benn, M; Mehlsen, J

    2013-01-01

    Reflex syncope is defined by a self-terminating transient loss of consciousness associated with an exaggerated response of the vagal reflexes upon orthostatic challenges. A hereditary component has previously been suggested. We hypothesized that variations in genes encoding proteins mediating...

  13. Clinical findings as predictors of positivity of head-up tilt table test in neurocardiogenic syncope.

    Science.gov (United States)

    Asensio, Enrique; Oseguera, Jorge; Loría, Alvar; Gómez, María; Narváez, René; Dorantes, Joel; Hernández, Pablo; Orea, Arturo; Rebollar, Verónica; Ocaranza, Raymundo

    2003-01-01

    Neurocardiogenic (vasovagal) syncope occurs frequently and can be diagnosed with the head-up tilt table (HUTT) test. Our objective in this study was to identify clinical predictors of the positivity of HUTT test in neurocardiogenic syncope. We conducted a prospective study of 117 cases (81 women and 36 men, 13-85 years of age) referred to our Institution for HUTT testing. The ability of 10 symptoms and signs of clinical history to predict HUTT positivity were evaluated using logistic regression analysis. We observed a low rate of test-negative cases (24%) and 89 positives. Nearly all positives (87/89) were neurocardiogenic, principally of vasodepressor and mixed types (43 and 34 cases, respectively) and a few were cardioinhibitory (10, mostly young males). Regression analysis established that dizziness, nausea, and diaphoresis in past history were associated with HUTT positivity nearly 25 times more frequently than when absent. Our three conclusions are that syncope in absence of heart disease accompanied by dizziness, nausea, and diaphoresis may be treated as neurocardiogenic in settings where no HUTT is available. In addition, our low rate of negative tests may have been the result of our reexamining referrals prior to deciding test performance, and high frequency of young males in cardioinhibitory syncope needs further research.

  14. Symptoms and signs of syncope: a review of the link between physiology and clinical clues

    NARCIS (Netherlands)

    Wieling, Wouter; Thijs, Roland D.; van Dijk, N.; Wilde, Arthur A. M.; Benditt, David G.; van Dijk, J. Gert

    2009-01-01

    Detailed history taking is of paramount importance to establish a reliable diagnosis in patients with transient loss of consciousness. In this article the clinical symptoms and signs of the successive phases of a syncopal episode are reviewed. A failure of the systemic circulation to perfuse the

  15. Diagnostic Value of Neurological Studies in Diagnosing Syncope: A Systematic Review.

    Science.gov (United States)

    Pournazari, Payam; Oqab, Zardasht; Sheldon, Robert

    2017-12-01

    Syncope is common and approaches to establishing etiology remain a matter of clinical and financial importance. Patients often undergo comprehensive neurologic investigations despite a lack of compelling indications. The aim was to determine the prevalence of use and diagnostic yield of electroencephalography (EEG), head computed tomography (CT), head magnetic resonance imaging (MRI), and carotid Doppler ultrasound (CUS) examinations. We conducted a systematic search in EMBASE, PubMed, and Cochrane from 1970 to 2015 for studies reporting on the use of EEG, CT, MRI, and CUS in diagnosing the cause of syncope. The inclusion criteria were: (1) observational and randomized trials; (2) frequency of use of investigations; and (3) diagnostic yield. Diagnostic studies of the more general transient loss of consciousness were excluded. Of 149 screened studies, 15 studies having 6944 patients met the criteria. No studies met all 6 prespecified quality descriptors. The mean prevalence of test use were: EEG, 17.0%; CT, 57.3%; MRI, 10.5%; and CUS, 17.8%. The articles reported the likelihoods of a test providing diagnostic information for syncope etiology were: EEG, 1.35%; CT, 1.18%; MRI, 3.74%; and CUS, 2.4%. Only 2 new and informative results were noted in 6334 tests. Neurologic investigations for assessment of patients deemed to have syncope are used widely and are widely ineffective. Neurologic investigations should be obtained only with a very high degree of clinical suspicion. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. Prognosis Among Healthy Individuals Discharged With a Primary Diagnosis of Syncope

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth; Hansen, Morten Lock; Lamberts, Morten

    2012-01-01

    risk of all-cause mortality (hazard ratio [HR]: 1.06; 95% confidence interval [CI]: 1.02 to 1.10), cardiovascular hospitalization event rate of 26.5 per 1,000 PY (HR: 1.74; 95% CI: 1.68 to 1.80), recurrent syncope event rate of 45.1 per 1,000, stroke event rate of 6.8 per 1,000 PY (HR: 1.35; 95% CI: 1.......27 to 1.44), and pacemaker or implantable cardioverter-defibrillator event rate of 4.2 per 1,000 PY (HR: 5.52; 95% CI: 4.67 to 5.73; p syncope among healthy individuals significantly predicts the risk of all-cause mortality, stroke, cardiovascular......OBJECTIVE: This study sought to examine the risk of major cardiac adverse events and death in a nationwide cohort of patients without previous comorbidity admitted for syncope. BACKGROUND: Syncope is a common clinical event, but knowledge of prognosis is not fully elucidated in healthy individuals...

  17. Syncope prevalence in the ED compared to general practice and population: a strong selection process

    NARCIS (Netherlands)

    Olde Nordkamp, Louise R. A.; van Dijk, Nynke; Ganzeboom, Karin S.; Reitsma, Johannes B.; Luitse, Jan S. K.; Dekker, Lukas R. C.; Shen, Win-Kuang; Wieling, Wouter

    2009-01-01

    Objective: We assessed the prevalence and distribution of the different causes of transient loss of consciousness (TLOC) in the emergency department (ED) and chest pain unit (CPU) and estimated the proportion of persons with syncope in the general population who seek medical attention from either

  18. Overview of the contribution of recent clinical trials to advancement of syncope management.

    Science.gov (United States)

    Moya, Angel; Rivas, Nuria; Perez-Rodon, Jordi

    2013-01-01

    In this communication we review those trials that have contributed in recent years to improving our knowledge on the management (diagnosis and treatment) of syncope. In this regard, most recent trials focus on vasovagal syncope (VVS) and consequently these will be the focus of this manuscript. In essence, from a diagnostic perspective the ISSUE studies demonstrate the value of insertable loop recorders (ILR), while in terms of treatment, in the case of VVS current data strongly support use of non-pharmacologic treatment as a primary approach. There is no clear evidence supporting pharmacologic treatment with the possible exception of midodrine. Further, the most recent ISSUE trials suggest that in older very symptomatic patients with VVS in whom an asystole has been documented during spontaneous episode or possibly after ATP administration, implantation of a permanent pacemaker (PPM) can be effective. Which pacing or programming mode will be the more beneficial has not been completely clarified. Management of other forms of neurally-mediated syncope (e.g., carotid sinus syndrome) or other causes of syncope has not been addressed by clinical trials. In those cases, direction is provided by older evidence, the vast majority of which is based on observational reports or small non-randomized patient series. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. NT-pro-BNP for differential diagnosis in patients with syncope.

    Science.gov (United States)

    Costantino, Giorgio; Solbiati, Monica; Pisano, Giuseppina; Furlan, Raffaello

    2009-11-12

    NT-pro-BNP has been proposed as a good predictor of syncope adverse outcome in the Emergency Department (ED) [Pfister R, Diedrichs H, Larbig R, Erdmann E, Schneider CA. NT-pro-BNP for differential diagnosis in patients with syncope. Int J Cardiol 2008 Jan 29]. We hereby summarize four critical points that should be taken into account when seeking to identify a cardiac cause of syncope or dealing with a risk stratification approach of the patient in the ED. The first issue is that patients admitted to the hospital after syncope are usually sicker than those discharged because of a higher rate of co-morbidity. Secondly, the focus on discharged patients is of paramount importance to assess the goodness of a predictor. Aging, which affects NT-pro-BNP levels, is a limiting factor in interpreting results. Finally, in order to add valuable information to the clinical practice, we suggest to compare results obtained by NT-pro-BNP values and the most used prognostic risk scores, such as the OESIL and SFSR.

  20. [Diagnostic and prognostic efficiency of 24-hour Holter monitoring in patients with syncope].

    Science.gov (United States)

    Barbeito-Caamaño, Cayetana; Sánchez-Fernández, Gabriel; Bouzas-Mosquera, Alberto; Broullón, Francisco J; Álvarez-García, Nemesio; Vázquez-Rodríguez, José Manuel

    2016-08-19

    Syncope is a common condition and complex to diagnose. The yield of the 24h-Holter ECG in this context has not been clearly defined. The aim of this study was to evaluate its diagnostic and prognostic capacity in these patients. Retrospective study of 6,006 consecutive patients sent to our unit for 24h-Holter ECG monitoring for syncope. We registered the diagnostic findings and abnormal findings potentially related to an arrhythmic cause of syncope. The prognostic endpoint was a combination of death or the need for device implantation (pacemaker or defibrillator) within one year. 242 patients (4%) presented diagnostic findings and 472 (7.9%) had some abnormal findings. In 328 cases device implantation was necessary within one year, but up to 66% of these patients did not have any relevant findings on the Holter monitoring. A total of 564 patients presented the combined event, including 36.8% of patients with diagnostic findings and 8.2% without them. 24h-Holter ECG monitoring presents a limited diagnostic and prognostic yield in unselected patients with syncope. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  1. Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

    DEFF Research Database (Denmark)

    Brinth, Louise; Latif, Tabassam; Pors, Kirsten

    2014-01-01

    Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflex control - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorly understood. Methods: We studied the hemodynamic response to carotid sinus massage (CSM...

  2. The effects of exercise training on arterial baroreflex sensitivity in neurally mediated syncope patients.

    Science.gov (United States)

    Gardenghi, Giulliano; Rondon, Maria Urbana P B; Braga, Ana Maria F W; Scanavacca, Mauricio I; Negrão, Carlos Eduardo; Sosa, Eduardo; Hachul, Denise Tessariol

    2007-11-01

    The clinical effects of different modalities of treatment for neurally mediated syncope have been studied for years; however, their influences on its pathophysiological mechanisms still have not been determined. This research aimed to observe the effects of physical training, tilt training, and pharmacological therapy on the arterial baroreflex sensitivity and muscle sympathetic nerve activity in neurally mediated syncope patients. Seventy patients with recurrent neurally mediated syncope were included in this study. Patients were divided into the following four groups, depending on the treatment proposed: (i) physical training, (ii) tilt training, (iii) pharmacological therapy, and (iv) control group. All patients underwent an autonomic evaluation with microneurography, when the vagal and sympathetic arterial baroreflex gain were tested, using graded infusions of phenylephrine or sodium nitroprusside, before and 4 months after the interventions. The vagal and sympathetic arterial baroreflex gain significantly increased after a 4-month protocol of physical training. Tilt training, pharmacological therapy, and the control group had no significant change in the arterial baroreceptor responses. Physical training improves arterial baroreflex sensitivity in neurally mediated syncope patients and could be applied as a non-pharmacological therapeutic alternative for these patients.

  3. Role of head-up tilt table testing in patients with syncope or transient loss of consciousness

    OpenAIRE

    Furukawa, Toshiyuki

    2017-01-01

    The tilt table test (TTT) is a useful method for the management of reflex syncope. However, the TTT is incomplete and has several problems. The indications for this test are established using guidelines. The TTT is not suitable for all syncopal patients. It is currently unclear (1) When should the TTT be used, (2) for which types of patients TTT should be performed, and (3) does the TTT provide useful information to guide indication for pacing therapy for reflex syncope. The answers to these ...

  4. Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls.

    Science.gov (United States)

    Kerr, Simon R J; Pearce, Mark S; Brayne, Carol; Davis, Richard J; Kenny, Rose Anne

    2006-03-13

    Carotid sinus hypersensitivity is the most commonly reported cause of falls and syncope in older persons. Recent guidelines recommend 5 to 10 seconds of carotid sinus massage in supine and upright positions with beat-to-beat monitoring. The aim of this study was to determine the prevalence of carotid sinus hypersensitivity in (1) an unselected community sample of older people and (2) a subsample with no history of syncope, dizziness, or falls using recently standardized diagnostic criteria. One thousand individuals older than 65 years were randomly sampled from a single general practice register; 272 participants underwent supine and upright carotid sinus massage with continuous heart rate and phasic blood pressure monitoring. Carotid sinus hypersensitivity was defined as asystole of 3 seconds or greater and/or a drop in systolic blood pressure of 50 mm Hg or greater. Carotid sinus hypersensitivity was present in 107 individuals (39%); 24% had asystole of 3 seconds or greater during carotid sinus massage; and 16% had symptoms (including syncope) with carotid sinus hypersensitivity. Age (odds ratio, 1.05; 95% confidence interval, 1.00-1.09) and male sex (odds ratio, 1.71; 95% confidence intervals, 1.04-2.82) were the only predictors of carotid sinus hypersensitivity. In 80 previously asymptomatic individuals, carotid sinus hypersensitivity was present in 28 (35%) and accompanied by symptoms in 10. The 95th percentile for carotid sinus massage response was 7.3 seconds' asystole and a 77-mm Hg drop in systolic blood pressure. Carotid sinus hypersensitivity is common in older persons, even those with no history of syncope, dizziness, or falls. The finding of a hypersensitive response should not necessarily preclude further investigation for other causes of syncope.

  5. NEUROCARDIOGENIC SYNCOPE AND EXTRACURRICULAR ACTIVITIES OF ADOLESCENTS IN THE HIGH-INTENSITY EDUCATIONAL PROCESS

    Directory of Open Access Journals (Sweden)

    A. V. Pogodina

    2014-01-01

    Full Text Available Background: Neurocardiogenic syncope (NCS is widespread among adolescents, which makes it relevant to study the factors contributing to the implementation of syncopic readiness in susceptible persons. Objective: The aim was to assess the connection between extracurricular activities of adolescents and the emergence of NCS. Methods:The questionnaire survey among the Lyceum students aged 14–18 tried to find out the presence of syncope (presyncope and its nature in a child’s medical history; the nature and intensity of extracurricular loads; and intensity and success of curricular activities. Results: The study included the results of the questionnaire survey among 286 students (62.2% girls. Syncope and presinkope states were observed in a medical history of 136 (47.6% students, and 105 (77% of them had NCS. Independent risk factors for the development of NCS were private lessons with tutors, and only in cases where a child had no other extracurricular classes (creative, sports — OR 6.4 (95% CI 1.7–24.8. The NCS risk was also higher in adolescents, who had good grades at school — OR 2.2 (95% CI 1.1–4.6. Conclusion: The risk of NCS development in teenage schoolchildren is defined by the area of subject education: high risk of this kind of syncope is in children, who have private classes with tutors and no other extracurricular loads, as well as in children, who have good grades at school.

  6. Estimating the Cost of Care for Emergency Department Syncope Patients: Comparison of Three Models

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    Marc A. Probst

    2017-02-01

    Full Text Available Introduction: We sought to compare three hospital cost-estimation models for patients undergoing evaluation for unexplained syncope using hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management. Methods: We collected complete health services data, including disposition, testing, and length of stay (LOS, on 67 adult patients (age 60 years and older who presented to the emergency department (ED with syncope at a single hospital. Patients were excluded if a serious medical condition was identified. We created three hospital cost-estimation models to estimate facility costs: V1, unadjusted Medicare payments for observation and/or hospital admission; V2: modified Medicare payment, prorated by LOS in calendar days; and V3: modified Medicare payment, prorated by LOS in hours. Total hospital costs included unadjusted Medicare payments for diagnostic testing and estimated facility costs. We plotted these estimates against actual cost data from the hospital finance department, and performed correlation and regression analyses. Results: Of the three models, V3 consistently outperformed the others with regard to correlation and goodness of fit. The Pearson correlation coefficient for V3 was 0.88 (95% confidence interval [CI] 0.81, 0.92 with an R-square value of 0.77 and a linear regression coefficient of 0.87 (95% CI 0.76, 0.99. Conclusion: Using basic health services data, it is possible to accurately estimate hospital costs for older adults undergoing a hospital-based evaluation for unexplained syncope. This methodology could help assess the potential economic impact of implementing novel clinical algorithms for ED syncope. [West J Emerg Med. 2017;18(2253-257.

  7. Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments

    Science.gov (United States)

    Shin, Tae Gun; Jo, Ik Joon; Sim, Min Seob; Park, Seung-Jung

    2013-01-01

    Purpose The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. Materials and Methods This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. Results A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). Conclusion Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea. PMID:23918559

  8. Orthostatic hypotension as cause of syncope in patients older than 65 years admitted to emergency departments for transient loss of consciousness.

    Science.gov (United States)

    Mussi, Chiara; Ungar, Andrea; Salvioli, Gianfranco; Menozzi, Carlo; Bartoletti, Angelo; Giada, Franco; Lagi, Alfonso; Ponassi, Irene; Re, Giuseppe; Furlan, Raffaello; Maggi, Roberto; Brignole, Michele

    2009-07-01

    Syncope due to orthostatic hypotension (OH) refers to loss of consciousness caused by hypotension induced by the upright position; it is an important risk factor for fall-related physical injuries, especially in the elderly adults. We evaluated the prevalence of OH syncope and the clinical characteristics of patients older than 65 years with syncope due to OH in the Evaluation of Guidelines in Syncope Study 2 group population. Two hundred fifty nine patients older than 65 years consecutively admitted to the emergency department because of loss of consciousness in a period of a month were submitted to a standardized protocol approved by the European Task Force for the diagnosis of syncope; all the patients were studied by a trained physician who interacted with a central supervisor as the management of syncope was concerned, using a decision-making software. Prevalence of OH syncope was 12.4%. Patients with OH syncope were more likely to be affected by Parkinson's disease and by other neurological diseases. ST changes and longer values of QTc were found in OH syncope group, and they took a greater number of diuretics, nitrates, and digoxin. In multivariate analysis, Parkinson's disease (p = .001) and use of nitrates (p = .001) and diuretics (p = .020) were independently related to OH syncope. In patients older than 65 years, Parkinson's disease and neurological comorbidity are strictly related to OH syncope. Moreover, this study suggests the independent link between OH syncope and the use of vasoactive drugs, identifying the majority of cases as adverse drug reaction, a preventable risk factor for syncope and falls in the older population.

  9. Effectiveness of midodrine treatment in patients with recurrent vasovagal syncope not responding to non-pharmacological treatment (STAND-trial)

    NARCIS (Netherlands)

    Romme, Jacobus J. C. M.; van Dijk, Nynke; Go-Schön, Ingeborg K.; Reitsma, Johannes B.; Wieling, Wouter

    2011-01-01

    Initial treatment of vasovagal syncope (VVS) consists of advising adequate fluid and salt intake, regular exercise, and physical counterpressure manoeuvres. Despite this treatment, up to 30% of patients continue to experience regular episodes of VVS. We investigated whether additional Midodrine

  10. Abnormal cardiovascular responses to carotid sinus massage also occur in vasovagal syncope - implications for diagnosis and treatment.

    Science.gov (United States)

    Humm, A M; Mathias, C J

    2010-08-01

    Carotid sinus massage (CSM) is commonly used to identify carotid sinus hypersensitivity (CSH) as a possible cause for syncope, especially in older patients. However, CSM itself could provoke classical vasovagal syncope (VVS) in pre disposed subjects. Retrospective analysis of CSM, cardiovascular autonomic function tests (including tilt table testing) and medical history in 388 patients with recurrent syncope to identify and characterize patients in whom an abnormal response to CSM was more likely to reflect VVS than CSH. CSM was abnormal in 79 patients. In 53 patients (77.2 +/- 8.7 years), CSH was the likely cause of syncope. VVS was the more likely diagnosis in 26 younger patients (59.7 +/- 12.6 years) with longstanding syncope from youth, in whom fear or pain was as a trigger; 7/26 suffered from intense chronic or intermittent neck pain and one exacerbation of syncopal attacks followed a physical and emotional trauma to the neck. In VVS, 4/26 had spontaneous VVS during head-up tilt, another six after venepuncture (performed in 17/26). In 6/26, the abnormal response to CSM was delayed, occurring 62.8 +/- 28.4 s after completion of CSM. The response to CSM was predominantly of the mixed type (20/26) and abnormal on both sides in 14/26. An abnormal response to CSM may not indicate syncope caused by CSH and needs to be considered in the light of the patient's age, duration of syncopal episodes and detailed history of provocative stimuli. Differentiating CSH from VVS with an abnormal response to CSM has various implications from advice on driving to treatment strategies.

  11. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient.

    Science.gov (United States)

    Sanatani, Shubhayan; Chau, Vann; Fournier, Anne; Dixon, Andrew; Blondin, Renée; Sheldon, Robert S

    2017-02-01

    Pediatric syncope is a common problem that peaks in adolescence, for which there are few data or evidence-based consensus on investigation and management. This document offers guidance for practical evaluation/management of pediatric patients (age syncope encountered in the acute or primary care setting. The writing committee used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Most syncope is vasovagal, which is benign and does not require extensive investigation. This Position Statement presents recommendations to encourage an efficient and cost-effective disposition for the many patients with a benign cause of syncope, and highlights atypical or concerning clinical findings associated with other causes of transient loss of consciousness. The prodrome and the circumstances around which the event occurred are the most important aspects of the history. Syncope occurring midexertion suggests a cardiac etiology. A family history, which includes sudden death in the young or from unknown causes or causes that might be suspected to be other than natural can be a red flag. The electrocardiogram is the most frequently ordered test, but the yield is low and the test is not cost-effective when applied broadly to a population of patients with syncope. We recommend an electrocardiogram when the history is not suggestive of vasovagal syncope and there are features suggestive of a cardiac cause like absence of a prodrome, midexertional event, family history of early-life sudden death or heart disease, abnormal physical examination, or new medication with potential cardiotoxicity. For most patients with syncope, medical testing is not required and lifestyle modifications without medications suffice to prevent recurrences. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  12. Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

    OpenAIRE

    Paris, Yvonne; Toro?Salazar, Olga H.; Gauthier, Naomi S.; Rotondo, Kathleen M.; Arnold, Lucy; Hamershock, Rose; Saudek, David E.; Fulton, David R.; Renaud, Ashley; Alexander, Mark E.

    2016-01-01

    Background: Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs). Methods and Results: Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings wer...

  13. Syncope and sudden death from the emergency physician’s perspective: is there room for new biomarkers?

    Directory of Open Access Journals (Sweden)

    Rossella Marino

    2013-10-01

    Full Text Available Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope represents 1-2% of emergency department (ED visits and is coupled with a high risk for mortality, prolonged hospital admission, and immediate false diagnosis. Many patients who present to the ED with aspecific symptoms are mainly hospitalized because of diagnostic uncertainty. It is always very important to immediately distinguish syncope of cardiac and non-cardiac origins. Cardiac syncope has higher risk for mortality especially for sudden cardiac death, while non-cardiac one shows risk of repeated events of syncope with poor quality of life. Sudden cardiac death is defined as rapid and unexpected natural death due to cardiac etiology. Researchers from the GREAT Network hypothesized to evaluate some novel biomarkers in order to test acute cardiac condition that can suggest the presence of heart structural diseases, heart failure, and electrical disorders. The primary objective of this study is to test the diagnostic performance from patient history, clinical judgment, and novel biomarkers in the diagnosis of cardiac syncope in patients admitted to the ED. The trial is designed as a prospective international multicenter observational study accounting for 730 patients aged over 40 admitted to the ED with syncope within the last 12 h. A multimarker approach combining markers of different origin and mode of relapse, should add diagnostic information to correctly identify the cardiac conditions and to therefore be pertinent in the early diagnosis of cardiac syncope and in the prediction of cardiac events including sudden death. Future data should be needed to confirm the hypothesis presented here.

  14. The availability and the adherence to pediatric guidelines for the management of syncope in the Emergency Department.

    Science.gov (United States)

    Raucci, Umberto; Scateni, Simona; Tozzi, Alberto Eugenio; Drago, Fabrizio; Giordano, Ugo; Marcias, Michela; Faa, Francesca; Reale, Antonino

    2014-11-01

    To evaluate the impact of the 2009 Italian pediatric clinical guidelines on the management of syncope. A retrospective study of patients who presented to the Emergency Department (ED) of Bambino Gesù Children's Hospital with syncope during the 2 years before and then for 2 years after the establishment of the Italian pediatric clinical guidelines. Implementation of the clinical guidelines included educational seminars, additional training of health care workers, and the availability of clinical guidelines and its algorithms on ED examination rooms. We studied a population of 1073 patients (n = 470 vs n = 603). Most patients had neurocardiogenic syncope with a greater increase in postimplementation period (n = 241, 51.3% vs n = 454, 49.8%); we also noticed a parallel reduction of the number of patients with undefined syncope (30% vs 8.3%). We observed an increase in electrocardiogram (n = 328, 69.8% vs n = 512, 85.1%; P guidelines increased the efficiency of clinical management of pediatric syncope. Our study demonstrated that the implementation of pediatric clinical guidelines on syncope improve diagnosis, reduce hospital admissions, and decrease the use of unnecessary diagnostic tests. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. [Influence of age on the presumed cause of syncope in patients with the Wolff-Parkinson-White syndrome].

    Science.gov (United States)

    Chometon, F; Brembilla-Perrot, B

    2007-01-01

    The aim of this study was to assess the causes of syncope in patients with the Wolff-Parkinson-White syndrome (WPW) and to determine whether the age of the patients was a significant factor. Forty-seven patients with a WPW, aged 11 to 72 years, underwent electrophysiological study by the oesophageal approach because of an unexplained syncope. Nineteen patients were under 20 years of age (16 +/- 3 years: group I) and 28 were over 20 years of age (40 +/- 13 years: group II). Junctional tachycardia was induced in 8 patients of group I (42%) and in 13 of group II (46%) (NS); atrial fibrillation was induced in 8 patients of group I (42%) and in 9 of group II (35%) (NS). A potentially malignant form of WPW was identified in 8 patients of group I (42%) and in 11 of group II (39%) (NS); Syncope was directly attributed to the WPW in 14 patients of group I (74%) and in 19 of group II (78%), either after identification of a serious form or induction of junctional tachycardia (6 patients of group I and 8 of group II). The rest of the syncopal episodes had various causes. There were no deaths. The authors conclude that oesophageal electrophysiological investigations enable rapid identification of a high incidence of tachycardias probably responsible for syncope in WPW. The causes of syncope and incidence of potentially severe forms of WPW were not significantly influenced by the age of the patients.

  16. Syncope in the emergency department of a large northern Italian hospital: incidence, efficacy of a short-stay observation ward and validation of the OESIL risk score.

    Science.gov (United States)

    Numeroso, Filippo; Mossini, Gianluigi; Spaggiari, Eleonora; Cervellin, Gianfranco

    2010-09-01

    Syncope causes 1-3% of all emergency department (ED) visits, a high percentage of hospitalisations and prolonged hospital stay; nevertheless, many cases remain unexplained. This study analysed the incidence of syncope at the ED of the University Hospital of Parma in the first half of 2008; then a sample of 200 patients admitted later for syncope into the ED ward was studied, in order to evaluate the efficacy of a brief observation unit and to validate the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) risk score as a tool to identify cardiogenic syncopes. As reported in the literature, syncope accounts for 2.3% of ED consultations and for 4.2% of total hospital admissions. A brief observation ward in the ED seems to have the necessary characteristics for managing most cases of syncope quickly (3.5 days). The final diagnosis was certain in 60%, suspected in 33% and unexplained in 7% of patients. The commonest forms of syncope were non-cardiogenic. Factors associated with cardiogenic syncope were previous syncopal events, lack of prodromal symptoms and a high OESIL risk score.

  17. Neurocardiogenic Syncope and Supraventricular Tachycardia in Association with a Rare Congenital Aortic Valve Abnormality

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2016-01-01

    Full Text Available We report a case of a 26-year-old woman who presented with multiple episodes of syncope over a five-months period of time. Transthoracic echocardiogram had shown a normal functioning quadricuspid aortic valve (QAV which was also confirmed on a transesophageal echocardiogram. Computed tomographic angiography of heart and coronary arteries showed the QAV with equal size of all aortic cusps and normal coronary arteries. Intermittent chest pain and palpitations warranted an exercise stress test. The stress test revealed normal aerobic exertion, with achievement of 101% of maximal peak heart rate. However, during peak stress, we noted a drop in her blood pressure significantly resulting in dizziness. No arrhythmias were noted during the stress test. With recurrent syncope episodes and palpitations, Holter monitoring was done, revealing supraventricular tachycardia (SVT. We discuss current available literature and coassociations with QAV. New association of QAV with SVT needs further analysis.

  18. Muscle glycogen storage disease 0 presenting recurrent syncope with weakness and myalgia.

    Science.gov (United States)

    Sukigara, Sayuri; Liang, Wen-Chen; Komaki, Hirofumi; Fukuda, Tokiko; Miyamoto, Takeshi; Saito, Takashi; Saito, Yoshiaki; Nakagawa, Eiji; Sugai, Kenji; Hayashi, Yukiko K; Sugie, Hideo; Sasaki, Masayuki; Nishino, Ichizo

    2012-02-01

    Muscle glycogen storage disease 0 (GSD0) is caused by glycogen depletion in skeletal and cardiac muscles due to deficiency of glycogen synthase 1 (GYS1), which is encoded by the GYS1 gene. Only two families with this disease have been identified. We report a new muscle GSD0 patient, a Japanese girl, who had been suffering from recurrent attacks of exertional syncope accompanied by muscle weakness and pain since age 5 years until she died of cardiac arrest at age 12. Muscle biopsy at age 11 years showed glycogen depletion in all muscle fibers. Her loss of consciousness was gradual and lasted for hours, suggesting that the syncope may not be simply caused by cardiac event but probably also contributed by metabolic distress. Copyright © 2011 Elsevier B.V. All rights reserved.

  19. Is hospital admission valuable in managing syncope? Results from the STePS study.

    Science.gov (United States)

    Costantino, Giorgio; Dipaola, Franca; Solbiati, Monica; Bulgheroni, Mara; Barbic, Franca; Furlan, Raffaello

    2014-01-01

    The proper way to test the usefulness of hospitalization in syncope patients would be to conduct a randomized controlled trial. However, this approach is characterized by major theoretical and ethical limitations which make this procedure unfeasible. Data from observational studies indirectly show that hospitalization might help reduce the short-term risk of death and adverse events by promptly identifying and treating life-threatening events or conditions. Future research should focus on identifying which patients will benefit from hospitalization. In this regard, we should be able both to correctly risk-stratify patients and to analyze syncope observation units and protocols, which may provide a safe alternative for the evaluation of intermediate-risk patients.

  20. The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope.

    Science.gov (United States)

    Qingyou, Zhang; Junbao, Du; Chaoshu, Tang

    2006-12-01

    To determine whether midodrine hydrochloride therapy can prevent vasovagal syncope (VVS) in pediatric patients. Children with recurrent syncope (n = 26) were randomly assigned into 2 groups. Group I comprised children given midodrine hydrochloride as first-line therapy in addition to conventional therapy, and group II comprised patients receiving conventional therapy only. Repeat head-up tilt (HUT) testing and follow-up of least 6 months were conducted to evaluate the therapeutic effectiveness and side effects of midodrine in treating VVS in children. The HUT-based effective rate was significantly higher in group I than in group II (75% vs 20%; P Midodrine hydrochlorate is effective in treating VVS in children, especially in preventing recurrent episodes. Few side effects were observed in the present study.

  1. Comparison of different risk stratification systems in predicting short-term serious outcome of syncope patients

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2016-01-01

    Full Text Available Background: Determining etiologic causes and prognosis can significantly improve management of syncope patients. The present study aimed to compare the values of San Francisco, Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL, Boston, and Risk Stratification of Syncope in the Emergency Department (ROSE score clinical decision rules in predicting the short-term serious outcome of syncope patients. Materials and Methods: The present diagnostic accuracy study with 1-week follow-up was designed to evaluate the predictive values of the four mentioned clinical decision rules. Screening performance characteristics of each model in predicting mortality, myocardial infarction (MI, and cerebrovascular accidents (CVAs were calculated and compared. To evaluate the value of each aforementioned model in predicting the outcome, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated and receiver-operating curve (ROC curve analysis was done. Results: A total of 187 patients (mean age: 64.2 ΁ 17.2 years were enrolled in the study. Mortality, MI, and CVA were seen in 19 (10.2%, 12 (6.4%, and 36 (19.2% patients, respectively. Area under the ROC curve for OESIL, San Francisco, Boston, and ROSE models in prediction the risk of 1-week mortality, MI, and CVA was in the 30-70% range, with no significant difference among models (P > 0.05. The pooled model did not show higher accuracy in prediction of mortality, MI, and CVA compared to others (P > 0.05. Conclusion: This study revealed the weakness of all four evaluated models in predicting short-term serious outcome of syncope patients referred to the emergency department without any significant advantage for one among others.

  2. Comparison of different risk stratification systems in predicting short-term serious outcome of syncope patients.

    Science.gov (United States)

    Safari, Saeed; Baratloo, Alireza; Hashemi, Behrooz; Rahmati, Farhad; Forouzanfar, Mohammad Mehdi; Motamedi, Maryam; Mirmohseni, Ladan

    2016-01-01

    Determining etiologic causes and prognosis can significantly improve management of syncope patients. The present study aimed to compare the values of San Francisco, Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL), Boston, and Risk Stratification of Syncope in the Emergency Department (ROSE) score clinical decision rules in predicting the short-term serious outcome of syncope patients. The present diagnostic accuracy study with 1-week follow-up was designed to evaluate the predictive values of the four mentioned clinical decision rules. Screening performance characteristics of each model in predicting mortality, myocardial infarction (MI), and cerebrovascular accidents (CVAs) were calculated and compared. To evaluate the value of each aforementioned model in predicting the outcome, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated and receiver-operating curve (ROC) curve analysis was done. A total of 187 patients (mean age: 64.2 ± 17.2 years) were enrolled in the study. Mortality, MI, and CVA were seen in 19 (10.2%), 12 (6.4%), and 36 (19.2%) patients, respectively. Area under the ROC curve for OESIL, San Francisco, Boston, and ROSE models in prediction the risk of 1-week mortality, MI, and CVA was in the 30-70% range, with no significant difference among models ( P > 0.05). The pooled model did not show higher accuracy in prediction of mortality, MI, and CVA compared to others ( P > 0.05). This study revealed the weakness of all four evaluated models in predicting short-term serious outcome of syncope patients referred to the emergency department without any significant advantage for one among others.

  3. On the track of syncope induced by orthostatic stress - feedback mechanisms regulating the cardiovascular system

    DEFF Research Database (Denmark)

    Ottesen, Johnny T.

    2009-01-01

    A physiological realistic model of the controlled cardiovascular system is constructed and validated against clinical data. Special attention is paid to the heart rate control. Both sit-to-stand and head-up-tilt experiments are encapsulated by the model. The model may be used in studies of syncop....... Furthermore, the impact of the mechanical movement of diaphragm driving the respiration is considered. It turns out that this mechanical effect is significant....

  4. Progressive central hypovolaemia in man--resulting in a vasovagal syncope?

    DEFF Research Database (Denmark)

    Sander-Jensen, K; Mehlsen, J; Secher, N H

    1987-01-01

    rate and increments in the plasma concentrations of pancreatic polypeptide, indicating increased vagal activity and beta-endorphin, while plasma noradrenaline was unchanged. In emotionally induced syncope heart rate decreased to cardiac arrest for 13 s, associated with increments in the plasma...... concentrations of pancreatic polypeptide and beta-endorphin. It is concluded that normotensive functional haemorrhage in man is associated with increased sympathetic activity and that the qualitatively similar observations obtained during an emotionally and a hypovolaemic-induced hypotensive episode indicate...

  5. Left Ventricular Systolic Dyssynchrony in Patients with Hypertrophic Cardiomyopathy: The prevalence and its Relation to Syncope

    Directory of Open Access Journals (Sweden)

    N Behzadnia

    2010-12-01

    Full Text Available Background: The distribution and magnitude of left ventricularhypertrophy (LVH are not uniform in patients with hypertrophic cardiomyopathy (HCM , which results in regional heterogeneity of left ventricular ( LVsystolic function. The aim of this study was to evaluate LV regional systolicdyssynchrony in patients with HCM by Tissue Doppler Imaging (TDI and to findany correlation between TDI data and syncope.Methods: A total of 44 consecutive patients with HCM are recruited inthe present study. .All patients, underwent complete clinical andechocardiographic evaluation including TDI . The following were measured in 6different basal and 6 mid-myocardial segments: systolic peak velocity(Sm,early diastolic myocardial velocity (Em, pre-contraction time(Q-Sm frombeginning of Q- wave of ECG to the onset of Sm, total asynchrony index,interventricular mechanical delay(difference in Q-Aortic valve opening andQ-Pulmonic valve opening and maximum difference in time to peak systolicvelocity between 2 of 12 segments(ΔPVI.Results: TDI analysis in HCM subgroup with syncope showed bothsignificant interventricular (36.72±26.26 vs 14.74±11.30 msec, P<0.001 andintraventricular delays(39.40±22.38 vs27.70±17.32 msec, P=0.07. The prevalenceof LV systolic dyssynchrony was from 20.5% to 38.6% based on different methods.Patients with syncope had greater impairment of regional systolic and earlydiastolic function, remarkably lower Sm and Em velocities.Conclusion: The impairment of inter and intraventricular systolicsynchronicity is significantly related to syncope in patients with HCM.TDIanalysis may be able to select subgroups of HCM patients at increasing risk ofsyncope and major cardiac events

  6. Syncope in a patient being treated for hepatic and intestinal amoebiasis.

    Science.gov (United States)

    Yelve, Kavita; Phatak, Sanat; Patil, Meenakshi Amit; Pazare, Amar R

    2012-11-30

    A 63-year-old man presented to our hospital with amoebic liver abscess and was treated successfully for the same. During the course of his treatment, he developed syncopal attacks and was found to have Torsades de Pointes on electrocardiogram. The patient was treated with intravenous magnesium and direct current cardioversion. Hypokalaemia, chloroquine and sepsis were suspected to have precipitated the arrhythmia. The patient remained arrhythmia-free following the correction of these factors.

  7. Implantable "loop recorder": A new diagnostic tool for syncope of unknown cause

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    Milašinović Goran

    2005-01-01

    Full Text Available Introduction. The implantable loop recorder (ILR is a new diagnostic tool in cardiology for establishing The causes of unexplained syncope in patients where standard conventional tests, invasive tests included, have failed. The device is a diagnostic "pacemaker," surgically implanted underneath the skin of the chest, with leads attached to the case of the device, not requiring endovenous lead implantation. Heart rhythm is monitored continuously on the basis of an endless loop, up to a maximum period of 14 months. Recording is carried out either by applying an outside activator whenever symptoms occur, or automatically, according to a preset algorithm for bradycardia, tachycardia, and/or asystolic detection. Objective. The aim of this study was to present this new diagnostic method as well as our first experiences with its implementation. METHOD We followed 5 patients (3 male, 2 female, mean age: 46.4±19 who had ILRs ("Reveal Plus," Medtronic Inc., USA implanted at our centre, over a period of 14 months (7.6 ±5.5], concentrating on their clinical course, symptom occurrence, and electronically monitored heart rhythm at the time of ILR auto activation and/or recordings triggered by outside activation whenever a patient's symptoms were discernible. Results. In three patients, the ILR revealed syncope aetiology by documenting heart rhythm at the time of its occurrence. In one patient, involving a lethal outcome, the ILR was not explanted, so that the rhythm at the time of the fatal syncope, although assumed, remained undocumented, in one, most recently implanted patient, follow-up is still in progress. Conclusion. The implantable loop recorder represents an important innovation and a step forward in establishing the causes of recurrent syncope, which cannot be determined by standard invasive and non-invasive testing.

  8. Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals.

    Science.gov (United States)

    Brignole, Michele; Ungar, Andrea; Bartoletti, Angelo; Ponassi, Irene; Lagi, Alfonso; Mussi, Chiara; Ribani, Maria Angela; Tava, Gianni; Disertori, Marcello; Quartieri, Fabio; Alboni, Paolo; Raviele, Antonio; Ammirati, Fabrizio; Scivales, Alessandro; De Santo, Tiziana

    2006-08-01

    The study hypothesis was that a decision-making approach improves diagnostic yield and reduces resource consumption for patients with syncope who present as emergencies at general hospitals. This was a prospective, controlled, multi-centre study. Patients referred from 5 November to 7 December 2001 were managed according to usual practice, whereas those referred from 4 October to 5 November 2004 were managed according to a standardized-care pathway in strict adherence to the recommendations of the guidelines of the European Society of Cardiology. In order to maximize its application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correct application. The 'usual-care' group comprised 929 patients and the 'standardized-care' group 745 patients. The baseline characteristics of the two study populations were similar. At the end of the evaluation, the standardized-care group was seen to have a lower hospitalization rate (39 vs. 47%, P=0.001), shorter in-hospital stay (7.2+/-5.7 vs. 8.1+/-5.9 days, P=0.04), and fewer tests performed per patient (median 2.6 vs. 3.4, P=0.001) than the usual-care group. More standardized-care patients had a diagnosis of neurally mediated (65 vs. 46%, P=0.001) and orthostatic syncope (10 vs. 6%, P=0.002), whereas fewer had a diagnosis of pseudo-syncope (6 vs. 13%, P=0.001) or unexplained syncope (5 vs. 20%, P=0.001). The mean cost per patient and the mean cost per diagnosis were 19 and 29% lower in the standardized-care group (P=0.001). A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.

  9. Neural networks as a tool to predict syncope risk in the Emergency Department.

    Science.gov (United States)

    Costantino, Giorgio; Falavigna, Greta; Solbiati, Monica; Casagranda, Ivo; Sun, Benjamin C; Grossman, Shamai A; Quinn, James V; Reed, Matthew J; Ungar, Andrea; Montano, Nicola; Furlan, Raffaello; Ippoliti, Roberto

    2017-11-01

    There is no universally accepted tool for the risk stratification of syncope patients in the Emergency Department. The aim of this study was to investigate the short-term predictive accuracy of an artificial neural network (ANN) in stratifying the risk in this patient group. We analysed individual level data from three prospective studies, with a cumulative sample size of 1844 subjects. Each dataset was reanalysed to reduce the heterogeneity among studies defining abnormal electrocardiogram (ECG) and serious outcomes according to a previous consensus. Ten variables from patient history, ECG, and the circumstances of syncope were used to train and test the neural network. Given the exploratory nature of this work, we adopted two approaches to train and validate the tool. One approach used 4/5 of the data for the training set and 1/5 for the validation set, and the other approach used 9/10 for the training set and 1/10 for the validation set. The sensitivity, specificity, and area under the receiver operating characteristic curve of ANNs in identifying short-term adverse events after syncope were 95% [95% confidence interval (CI) 80-98%], 67% (95% CI 62-72%), 0.69 with the 1/5 approach and 100% (95% CI 84-100%), 79% (95% CI 72-85%), 0.78 with the 1/10 approach. The results of our study suggest that ANNs are effective in predicting the short-term risk of patients with syncope. Prospective studies are needed in order to compare ANNs' predictive capability with existing rules and clinical judgment. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

  10. Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy

    Directory of Open Access Journals (Sweden)

    Kenneth A. Mayuga

    2018-01-01

    Full Text Available A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

  11. [Efficacy of a protocol for the diagnosis and management of syncope in an unselected population].

    Science.gov (United States)

    Planas Comes, Francesc; San Vicente, Ludmila; Planas Ayma, Francesc; Viles, Joan; Planas, Albert; Serrado, Ana; Kaplinsky, Edgardo; Altimira, Montserrat

    2012-01-21

    To evaluate the efficacy of a protocol based on European guidelines for the management and diagnosis of syncope applied by a multidisciplinary team in unselected patients. 402 unselected patients were followed prospectively in a second-level country hospital, between November 2003 and November 2008 with a protocol based on European Guidelines. Syncope was diagnosed in 83.3% of patients and 26.6% required hospitalization. For every 100 cases, the number of tests carried out and their performance (percentage of positive diagnostic tests/number of tests carried out) was calculated. Tilt test: 31 and performance: 62.4%, Doppler-echocardiography. 17-8.3%, Holter 16-13.2%, cranial CT 5.2-0%, ergometry 1.9-0%, chest CT 1.4-16%, EPS 1.2-33%, ILR 0.7-33%. This study shows a high percentage of diagnoses with low number of tests carried out, emphasizing the performance of tilt test. The study of unselected patients with a protocol based on European Guidelines for the management and diagnosis of syncope applied by a multidisciplinary team was very effective. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  12. Impact of syncope on quality of life: validation of a measure in patients undergoing tilt testing.

    Science.gov (United States)

    Nave-Leal, Elisabete; Oliveira, Mário; Pais-Ribeiro, José; Santos, Sofia; Oliveira, Eunice; Alves, Teresa; Cruz Ferreira, Rui

    2015-03-01

    Recurrent syncope has a significant impact on quality of life. The development of measurement scales to assess this impact that are easy to use in clinical settings is crucial. The objective of the present study is a preliminary validation of the Impact of Syncope on Quality of Life questionnaire for the Portuguese population. The instrument underwent a process of translation, validation, analysis of cultural appropriateness and cognitive debriefing. A population of 39 patients with a history of recurrent syncope (>1 year) who underwent tilt testing, aged 52.1 ± 16.4 years (21-83), 43.5% male, most in active employment (n=18) or retired (n=13), constituted a convenience sample. The resulting Portuguese version is similar to the original, with 12 items in a single aggregate score, and underwent statistical validation, with assessment of reliability, validity and stability over time. With regard to reliability, the internal consistency of the scale is 0.9. Assessment of convergent and discriminant validity showed statistically significant results (pde Cardiologia. Published by Elsevier España. All rights reserved.

  13. Recurrent syncope in a hypertensive subject with vascular cognitive impairment and permanent pacemaker

    Directory of Open Access Journals (Sweden)

    Alberto Mazza

    2012-09-01

    Full Text Available Syncope following permanent pacemaker (PM implantation is a nightmare for electrophysiologists. We describe a case of daily recurrent syncope in an 84-year-old man having a dual-chamber pacemaker implanted for complete atrio-ventricular block occurred 4 years before the admission to our department. He had a history of arterial hypertension, parossistic atrial fibrillation, chronic obstructive pulmonary disease, stage-III chronic renal failure, mild vascular cognitive impairment and glaucoma. The initial work-up including electrocardiogram (ECG, repeated PM inter- rogations, Holter electrocardiogram, blood pressure measurement in orthostatic position, complete blood count, serum glycaemia, electrolytes and thyroid function tests showed normal findings. Syncope occurred in lying position and during 90° left clockwise neck rotation and was associated to pallor, sweating, tonic-clonic seizures and transient self-limited loss of consciousness lasting a few seconds. Electroencephalogram was normal. During continuous ECG monitoring, the right rotation of the head determined a ventricular asystolic pause lasting 9 seconds associated with loss of consciousness. Restoration of sinus rhythm was observed after bringing back the head in axis. The PM interrogation, performed during pacing failure, recorded low impedance of bipolar ventricular lead, suggesting a damage in lead insulation. It is likely that lead movements during clockwise neck rotation produced an intermittent short circuit that prevented sufficient energy delivery to the myocardium with a consequence of sudden loss of capture.

  14. Cardioneuroablation in the treatment of neurally mediated reflex syncope: a review of the current literature.

    Science.gov (United States)

    Aksu, Tolga; Güler, Tümer Erdem; Bozyel, Serdar; Özcan, Kazım Serhan; Yalın, Kıvanç; Mutluer, Ferit Onur

    2017-12-01

    An imbalance between parasympathetic and sympathetic tone is a main cause of neurally mediated reflex syncope (NMRS). These patients may be very symptomatic and the condition may require cardiac pacemaker implantation. Cardioneuroablation (CNA) is a relatively novel technique based on radiofrequency ablation of vagal ganglia that can be used in treatment of NMRS. The aim of this analysis was to compare potential role of CNA in patients with NMRS. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords "cardioneuroablation," "vagal denervation," "reflex syncope," "vagal ablation," and "ganglionic plexi ablation." Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria. Freedom from syncope and freedom from prodrome were 100% and between 50% and 100%, respectively, in the studies. Ablation was performed via both atria in 3 studies; only left atrial approach was used in the remaining studies. There was no major complication related to the procedure reported. Focused or extensive vagal ganglia ablation may be a potential alternative to pacemaker implantation in a carefully selected patient population. In contrast to pharmacological therapy and pacemaker implantation, ganglia ablation is designed to get to the root of the problem: disturbances in the intrinsic cardiac autonomic nervous system. This novel technique should be evaluated in large-scale, randomized, controlled trials.

  15. Pulse Arrival Time as surrogate for systolic blood pressure changes during impending neurally mediated syncope.

    Science.gov (United States)

    Muehlsteff, Jens; Ritz, Anita; Drexel, Thomas; Eickholt, Christian; Carvalho, Paulo; Couceiro, Ricardo; Kelm, Malte; Meyer, Christian

    2012-01-01

    Blood pressure regulation failures cause neurally mediated syncope often resulting in a fall. A warning device might help to make patients aware of an impending critical event or even trigger the patient to perform countermeasures such as lying down or isometric exercises. We previously demonstrated that the Pulse Arrival Time (PAT) methodology is a potential approach to enable early detection of impending faints. The aim of the present study was to evaluate whether PAT can be used as an easy to measure beat-to-beat surrogate for systolic blood pressure (SBP) changes during a passive standing exercise (head-up tilt table testing (HUTT)). A significant PAT increase of more than 10 % was accompanied with a critical SBP decrease in syncope patients. Although PAT is in general not considered as a good measure of absolute blood pressure we found strong correlations (R>0.89, P<0.01) of SBP and PAT after PAT began to increase. Therefore, our data suggest that the pulse arrival time is useful to monitor blood pressure changes in patients with neurally mediated syncope. This might open up new avenues to prevent falls in these patients.

  16. Selecting appropriate diagnostic tools for evaluating the patient with syncope/collapse.

    Science.gov (United States)

    Krahn, Andrew D; Andrade, Jason G; Deyell, Marc W

    2013-01-01

    The investigation of syncope is challenging and physicians have an ever-increasing array of diagnostic tools at their disposal. There are two essential goals that drive investigation: risk stratification and identification of etiology. In this review, we outline our approach while providing a synopsis of the available supportive evidence. The key to syncope is in the story as told by the patient and a bystander, since this drives both risk assessment and diagnostic testing. All patients should initially be evaluated with a systematic history and physical examination as well as an ECG. The initial evaluation provides an estimation of risk and directs whether inpatient or outpatient evaluation is appropriate. In a substantial proportion of patients, the etiology will be evident after initial evaluation and no further investigation is required. In the remaining, targeted use of additional investigations in the form of cardiac imaging, provocative testing and/or ambulatory ECG monitoring should be performed. A thoughtful and systematic approach to the investigation of syncope optimizes the diagnostic yield but also ensures efficient usage of limited health care resources. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology.

    Science.gov (United States)

    Paris, Yvonne; Toro-Salazar, Olga H; Gauthier, Naomi S; Rotondo, Kathleen M; Arnold, Lucy; Hamershock, Rose; Saudek, David E; Fulton, David R; Renaud, Ashley; Alexander, Mark E

    2016-02-19

    Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs). Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5-year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise-related or more problematic symptoms. Guideline-defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow-up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach. SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low-severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  18. Prospective multicentre systematic guideline-based management of patients referred to the Syncope Units of general hospitals.

    Science.gov (United States)

    Brignole, Michele; Ungar, Andrea; Casagranda, Ivo; Gulizia, Michele; Lunati, Maurizio; Ammirati, Fabrizio; Del Rosso, Attilio; Sasdelli, Massimo; Santini, Massimo; Maggi, Roberto; Vitale, Elena; Morrione, Alessandro; Francese, Giuseppina Maura; Vecchi, Maria Rita; Giada, Franco

    2010-01-01

    Although an organizational model for syncope management facilities was proposed in the 2004 guidelines of the European Society of Cardiology (ESC), its implementation in clinical practice and its effectiveness are largely unknown. This prospective study enrolled 941 consecutive patients referred to the Syncope Units of nine general hospitals from 15 March 2008 to 15 September 2008. A median of 15 patients per month were examined in each unit, but the five older units had a two-fold higher volume of activity than the four newer ones (instituted diagnosis was established on initial evaluation in 191 (21%) patients and early by means of 2.9 +/- 1.6 tests in 541 (61%) patients. A likely reflex cause was established in 67%, orthostatic hypotension in 4%, cardiac in 6% and non-syncopal in 5% of the cases. The cause of syncope remained unexplained in 159 (18%) patients, despite a mean of 3.5 +/- 1.8 tests per patient. These latter patients were older, more frequently had structural heart disease or electrocardiographic abnormalities, unpredictable onset of syncope due to the lack of prodromes, and higher OESIL and EGSIS risk scores than the other groups of patients. The mean costs of diagnostic evaluation was 209 euro per outpatient and 1073 euro per inpatient. The median cost of hospital stay was 2990 euro per patient. We documented the current practice of syncope management in specialized facilities that have adopted the management model proposed by the ESC. The results are useful for those who wish to replicate this model in other hospitals. Syncope remains unexplained during in-hospital evaluation in more complex cases at higher risk.

  19. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals.

    Science.gov (United States)

    Brignole, Michele; Menozzi, Carlo; Bartoletti, Angelo; Giada, Franco; Lagi, Alfonso; Ungar, Andrea; Ponassi, Irene; Mussi, Chiara; Maggi, Roberto; Re, Giuseppe; Furlan, Raffaello; Rovelli, Gianni; Ponzi, Patrizia; Scivales, Alessandro

    2006-01-01

    The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting. Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9+/-1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%). The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope.

  20. Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope.

    Science.gov (United States)

    Miyake, Christina Y; Motonaga, Kara S; Fischer-Colbrie, Megan E; Chen, Liyuan; Hanisch, Debra G; Balise, Raymond R; Kim, Jeffrey J; Dubin, Anne M

    2016-06-01

    This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes. Study design We carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded. A total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis. Children with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.

  1. The benefit of a remotely monitored implantable loop recorder as a first line investigation in unexplained syncope: the EaSyAS II trial.

    Science.gov (United States)

    Sulke, Neil; Sugihara, Conn; Hong, Paul; Patel, Nik; Freemantle, Nick

    2016-06-01

    This prospective randomized controlled study evaluated the first-line use of a novel remotely monitored implantable loop recorder (ILR) in the initial investigation of unexplained syncope, and compared this to conventional therapy and a dedicated Syncope Clinic (SC). A total of 246 patients (mean age 70.3 years) were randomly allocated to conventional management, SC alone, ILR alone, or SC + ILR. Median follow-up was 20 months (IQR 15-25 months). Time to electrocardiogram (ECG) diagnosis was significantly shorter with ILR alone vs. conventional [hazard ratio (HR) 35.5, P = 0.0004] and with SC vs. conventional (HR 25.6, P = 0.002). Seventy-four per cent of first syncopal events documented in the SC groups occurred during provocative tilt testing. Twenty-two per cent of patients who received an ILR were found to have a bradycardia indication for permanent pacing, compared with 3% of patients who did not. Overall, more investigative tests were undertaken in the conventional group than in any other. Only patients who received an ILR had a significant increase in time to second syncope (P = 0.02), suggesting successful diagnosis and management of treatable causes of syncope. Implantable loop recorder monitoring achieved a more rapid diagnosis in unexplained syncope than usual care. Conventional management of syncope failed to achieve an ECG diagnosis despite a large number of investigative tests. Syncope Clinic and provocative tilt testing delivered a rapid ECG diagnosis, but did not prevent recurrent syncope. Implantable loop recorders offered rapid diagnosis, increased the likelihood of syncope being reported, demonstrated a high rate of intermittent bradycardia requiring pacing, and reduced recurrent syncope. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  2. [The management of syncope in the hospital: the OESIL Study (Osservatorio Epidemiologico della Sincope nel Lazio)].

    Science.gov (United States)

    Ammirati, F; Colivicchi, F; Minardi, G; De Lio, L; Terranova, A; Scaffidi, G; Rapino, S; Proietti, F; Bianchi, C; Uguccioni, M; Carunchio, A; Azzolini, P; Neri, R; Accogli, S; Sunseri, L; Orazi, S; Mariani, M; Fraioli, R; Calcagno, S; De Luca, F; Santini, M

    1999-05-01

    While syncope is generally considered a frequent finding in clinical practice, no clear epidemiological evidence is available about the relevance of such an event in the general population of Italy. The OESIL Study was designed and undertaken in 15 hospitals of the Italian region of Latium in order to assess the percentage of emergency-room visits and admissions due to syncope, as well as to analyze the in-hospital diagnostic work-up performed for this condition. During a two-month observation period, 781 (372 males and 409 females, mean age 55.2 (22.8 years) consecutive patients came to the emergency rooms of the 15 hospitals included in the investigation due to a syncope spell (0.9% of emergency room visits); 450/781 patients (57.6%) were subsequently hospitalized (1.3% of all admissions): 48.0% of the admissions were admitted to a general medical ward, 29.3% to an observation ward, 13.3% to a cardiology section, 1.6% to a neurology section and 7.8% to other clinical sections (neurosurgery, general surgery). The mean duration of in-hospital stay was 6.9 (5.8 days; range 1-40 days). During the hospitalization period, 93.1% of patients underwent an ECG, 51.0% an EEG, 44.3% a CT scan of the central nervous system, 40.2% an echocardiogram and 19.5% a tilt-test. The syncope spell was considered to have a cardiovascular origin in 33.8% of the cases and a non-cardiovascular in 11.6% of the cases, while the origin was unknown in 54.4% of the cases. Collected data support the idea that syncope represents a frequent event in the general population and is responsible for a significant percentage of emergency-room visits and hospital admissions. However, the performance of conventional diagnostic work-ups is far from being satisfactory.

  3. Hospital admissions for orthostatic hypotension and syncope in later life: insights from the Malmö Preventive Project.

    Science.gov (United States)

    Ricci, Fabrizio; Manzoli, Lamberto; Sutton, Richard; Melander, Olle; Flacco, Maria E; Gallina, Sabina; De Caterina, Raffaele; Fedorowski, Artur

    2017-04-01

    We explored incidence, predictors, and long-term prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension. We analyzed a cohort of 32 628 individuals (68.2% men; age, 45.6 ± 7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6 ± 7.5 years. One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n = 462, 1.42%) or syncope (n = 632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12-1.16], smoking (hazard ratio 1.35, 95% CI: 1.12-1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00-2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05-1.98), in particular, by SBP fall at least 30 mmHg (hazard ratio 3.93, 95% CI: 2.14-7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07-1.11), smoking (hazard ratio 1.27, 95% CI: 1.08-1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20-1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10 727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02-1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.07-1.19). Hospital admissions due to syncope and orthostatic hypotension occur in ≈3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified

  4. Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic☆

    Science.gov (United States)

    Akdemir, Baris; Krishnan, Balaji; Senturk, Tunay; Benditt, David G.

    2015-01-01

    Syncope is among the most frequent forms of transient loss of consciousness (TLOC), and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED) or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i) the patient's immediate (usually considered 1 week to 1 month) mortality risk and risk for physical injury (e.g., falls risk), ii) the patient's ability to care for him/herself, and iii) whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation). However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step. PMID:26937094

  5. Gastroesophageal reflux in chronic cough and cough syncope and the effect of antireflux treatment: case report and literature review.

    Science.gov (United States)

    Hu, Zhi-Wei; Wang, Zhong-Gao; Zhang, Yu; Tian, Shu-Rui; Wu, Ji-Min; Zhu, Guang-Chang; Liang, Wei-Tao

    2014-10-01

    This study aimed to evaluate the efficacy of antireflux treatment on gastroesophageal reflux (GER)-related cough syncope. The method used was a retrospective review of the outcomes of antireflux treatment with proton pump inhibitor (PPI), Stretta radiofrequency (SRF), or laparoscopic fundoplication (LF) of 8 patients with chronic cough and cough syncope that was clinically evaluated to be GER related over a period of 2 to 5 years. In the 8 selected cases, the typical GER symptoms disappeared in 7 cases and were significantly eased in 1 case. The chronic cough diminished to mild and occasional occurrence in 6 cases and was completely relieved in 2 cases. Meanwhile, the cough syncope disappeared in all cases. Seven of the patients resumed physical and social functions after the antireflux treatments, except for 1 person, who had a stroke due to other causes. For chronic cough and cough syncope of unknown cause, the GER assessment could be valuable. In treating well-selected GER-related chronic cough and cough syncope, PPI, SRF, and LF can be considered. Moreover, satisfactory restoration of physical and social functions could be achieved after effective antireflux therapy. © The Author(s) 2014.

  6. "Cardio-Neuromodulation" With a Multielectrode Irrigated Catheter: A Potential New Approach for Patients With Cardio-Inhibitory Syncope.

    Science.gov (United States)

    Debruyne, Philippe

    2016-09-01

    Syncope is frequently neurally mediated and can seriously affect quality of life. Different ablation strategies have been successfully performed. These approaches have not gained wide acceptance and are quite extensive and complex, exposing patients to significant risks. This article reports the case of a 16-year-old girl who was severely affected by frequent and prolonged episodes of syncope and was treated by tailored ablation of the anterior right ganglionated plexus with a multielectrode irrigated catheter. She had fainted >30 times in the 5 years preceding treatment, experiencing approximately 10 severe episodes of syncope in the previous 12 months. After 3 minutes of ablation, the P-P interval was reduced by >400 milliseconds. Syncope disappeared and the patient has remained completely asymptomatic over a follow-up of 22 months. The "reset" basal P-P interval has remained unchanged (follow-up electrocardiogram at 16 months). At 6 months, there was no residual heart rate activity 16,000 beats. We believe that this case report is original for several reasons: the unusual clinical presentation; the unique structure targeted; the very limited ablation, implying much lower risks for the patient; the anatomical approach; and the different endpoint. This new "cardio-neuromodulation" approach could be useful for the treatment of patients with neurally mediated syncope. © 2016 Wiley Periodicals, Inc.

  7. Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic.

    Science.gov (United States)

    Akdemir, Baris; Krishnan, Balaji; Senturk, Tunay; Benditt, David G

    2015-01-01

    Syncope is among the most frequent forms of transient loss of consciousness (TLOC), and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED) or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i) the patient's immediate (usually considered 1 week to 1 month) mortality risk and risk for physical injury (e.g., falls risk), ii) the patient's ability to care for him/herself, and iii) whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation). However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.

  8. Arrhythmias are not to blame for all cardiac syncope patients: left atrial myxoma causing syncope in a middle-aged man.

    Science.gov (United States)

    Rajani, Ali Raza; Muaz, Reem Naif; Govindaswamy, Pushpa Rani; Mian, Muhammad Hamid

    2015-04-15

    A 47-year-old man presented with a history of syncope that lasted for 3 min and was not accompanied by jerky movement of limbs or incontinence. After regaining consciousness, he felt generalised weakness. There was no history of chest pain or palpitation. ECG showed normal sinus rhythm. All blood investigations were normal. Transthoracic echocardiography showed a large multilobulated echo dense mass in the left atrium. The mass was prolapsing through the mitral valve during diastole. Transoesophageal echocardiography verified these findings and also showed the stalk of the mass attached to the interatrial septum near the fossa ovalis. The mass was highly suggestive of myxoma. The patient underwent surgical resection of the mass and histopathology confirmed the diagnosis of left atrial myxoma. 2015 BMJ Publishing Group Ltd.

  9. Accuracy and quality of clinical decision rules for syncope in the emergency department: a systematic review and meta-analysis.

    Science.gov (United States)

    Serrano, Luis A; Hess, Erik P; Bellolio, M Fernanda; Murad, Mohammed H; Montori, Victor M; Erwin, Patricia J; Decker, Wyatt W

    2010-10-01

    We assess the methodological quality and prognostic accuracy of clinical decision rules in emergency department (ED) syncope patients. We searched 6 electronic databases, reviewed reference lists of included studies, and contacted content experts to identify articles for review. Studies that derived or validated clinical decision rules in ED syncope patients were included. Two reviewers independently screened records for relevance, selected studies for inclusion, assessed study quality, and abstracted data. Random-effects meta-analysis was used to pool diagnostic performance estimates across studies that derived or validated the same clinical decision rule. Between-study heterogeneity was assessed with the I(2) statistic, and subgroup hypotheses were tested with a test of interaction. We identified 18 eligible studies. Deficiencies in outcome (blinding) and interrater reliability assessment were the most common methodological weaknesses. Meta-analysis of the San Francisco Syncope Rule (sensitivity 86% [95% confidence interval {CI} 83% to 89%]; specificity 49% [95% CI 48% to 51%]) and the Osservatorio Epidemiologico sulla Sincope nel Lazio risk score (sensitivity 95% [95% CI 88% to 98%]; specificity 31% [95% CI 29% to 34%]). Subgroup analysis identified study design (prospective, diagnostic odds ratio 8.82 [95% CI 3.5 to 22] versus retrospective, diagnostic odds ratio 2.45 [95% CI 0.96 to 6.21]) and ECG determination (by evaluating physician, diagnostic odds ratio 25.5 [95% CI 4.41 to 148] versus researcher or cardiologist, diagnostic odds ratio 4 [95% CI 2.15 to 7.55]) as potential explanations for the variability in San Francisco Syncope Rule performance. The methodological quality and prognostic accuracy of clinical decision rules for syncope are limited. Differences in study design and ECG interpretation may account for the variable prognostic performance of the San Francisco Syncope Rule when validated in different practice settings. Copyright © 2010 American

  10. The implantable loop recorder-an important addition to the armentarium in the management of unexplained syncope.

    Science.gov (United States)

    Shanmugam, Nesan; Liew, Reginald

    2012-03-01

    Unexplained syncope is a common condition with a significant impact both on the patient and on healthcare expenditure. Often, the diagnosis is hampered due to the temporary sporadic nature of the symptoms. Conventional monitoring methods have a low yield for identifying an abnormality during a spontaneous event. The implantable loop recorder (ILR), often underutilised, is an important diagnostic device that may fi ll this void in the early assessment of patients presenting with syncope. This article begins with 2 case vignettes which highlight the clinical utility of ILRs in making a definitive diagnosis and guiding subsequent management. This is followed by a review of the existing evidence for ILRs, including the recent international guidelines, underpinning the role of ILRs in the present management algorithm of patients presenting with unexplained syncope. The technical aspects and cost implications will also be reviewed. Present evidence-based international guidelines have recommended the early use of ILRs in the management of patients with unexplained syncope. Furthermore, there may also be an important role for ILR use in patients with presumed epilepsy refractory to treatment and in the neurally mediated syncope cohort with recurrent symptoms. Cost benefit analysis also demonstrates advantages with early ILR use. The early use of ILR in selected patients remains an accurate, cost-effective, high yield tool for diagnosis and management of patients with unexplained syncope. However, its use should not detract from the importance of taking a detailed medical history and physical examination in the initial assessment to facilitate identification of the aetiology and risk stratification of patients.

  11. Diagnostic utility of carotid artery duplex ultrasonography in the evaluation of syncope: a good test ordered for the wrong reason.

    Science.gov (United States)

    Kadian-Dodov, Daniella; Papolos, Alexander; Olin, Jeffrey W

    2015-06-01

    Syncope refers to a transient loss of consciousness and postural tone secondary to cerebral hypoperfusion. Guidelines recommend against neurovascular testing in cases of syncope without neurologic symptoms; however, many pursue carotid artery duplex ultrasonography (CUS) due to the prognostic implications of identified cerebrovascular disease. Our objective was to determine the diagnostic utility of CUS in the evaluation of syncope and the identification of new or severe atherosclerosis with the potential to change patient management. We reviewed records of 569 patients with CUS ordered for the primary indication of syncope through an accredited vascular laboratory at an academic, urban medical centre. Findings on CUS, patient demographic, clinical and laboratory information, and medications within 6 months of the CUS exam were reviewed. Bivariate relationships between key medical history characteristics and atherosclerosis status (known vs. new disease) were examined. Among 495 patients with complete information, cerebrovascular findings could potentially explain syncope in 2% (10 patients). Optimization of cardiovascular risk factors would benefit patients with known (56.6%) and new atherosclerosis (33.5%) with suboptimal lipid control, (LDL > 70 in 42.2 and 34.9% respectively; LDL > 100 in 15.7 and 20.4%), and those not on high-intensity statin therapy (80 and 87.5%) or antiplatelet medications (13.2 and 50.6%). CUS is a low-yield diagnostic test in the evaluation of syncope, but it is useful in the diagnosis of atherosclerosis and identification of subjects who would benefit from optimal medical therapy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  12. Yield of diagnostic tests and its impact on cost in adult patients with syncope presenting to a community hospital.

    Science.gov (United States)

    Johnson, Philip C; Ammar, Hussam; Zohdy, Wael; Fouda, Ragai; Govindu, Rukma

    2014-11-01

    Total annual costs for syncope-related hospitalizations were $2.4 billion in 2000. The aim of this study was to examine the type and number of tests ordered for patients admitted with syncope and whether these tests helped establish the cause. We studied the records of 1038 patients coded as "syncope" in billing records, and 167 fulfilled the eligibility criteria. The main outcome measures were the diagnostic yield of the ordered tests, the incremental cost/incremental benefit, and the number of admissions that can be averted if risk stratification were used in the evaluation. The etiology of the syncope was identified in 48.3% of the patients. Postural blood pressure measurement has the highest diagnostic yield at 58.7%, whereas history taking diagnosed 19.7% of cases. The diagnostic yields of telemetry, electrocardiogram, radionuclide stress test, echocardiography, and troponin measurement were 4.76%, 4.24%, 3.44%, 0.94%, and 0.62%, respectively. Chest x-ray, carotid ultrasonography, 24-hour Holter monitoring, brain computed tomography, and brain magnetic resonance imaging did not yield the diagnosis in any of the patients. Only 1.9% of the money spent in the evaluation of syncope was effective in leading to a definitive diagnosis. The orthostatic blood pressure measurement was ranked first in the incremental cost/incremental benefit ratio and the radionuclide stress test was ranked last (17.03 vs 42,369.0, respectively). Approximately 6% of the patients did not meet the admission criteria. Physicians ordered unnecessary tests that have a low yield and are not cost-effective. A standardized algorithmic approach should be the cornerstone in the evaluation of syncope.

  13. Comparison of 1-Day Emergency Department Observation and Inpatient Ward for 1-Day Admissions in Syncope Patients.

    Science.gov (United States)

    Grossman, Atira M; Volz, Katherine A; Shapiro, Nathan I; Salem, Roee; Sanchez, Leon D; Smulowitz, Peter; Grossman, Shamai A

    2016-02-01

    In an era of increasing health care costs, the need for hospitalization is being scrutinized. In particular, 1-day hospitalizations are thought to be especially costly and unnecessary, and, increasingly, emergency department observation units (EDOUs) are being used as alternatives. Our aim was to determine the differences in outcomes and diagnoses between 1-day inpatient and EDOU stays for syncope. We retrospectively reviewed a cohort of patients with syncope who were seen in an urban ED with 1-day admission to an inpatient ward, EDOU, or full hospitalization. Etiology of syncope was classified as benign (vasovagal, dehydration), serious (dysrhythmia, sepsis, stroke/intracranial bleed, hemorrhage, valvular, ischemia, pulmonary embolism), or unknown. Data were analyzed using Fisher's exact test and t-test. One hundred and seventy-two of 351 patients were >1-day admissions, 152 (85%) were admitted for 1 day, and 27 (15%) were admitted to EDOU. The mean (standard deviation [SD]) age when admitted to the hospital was significantly higher at 72 (18.4) years for > 1-day admissions and 68.8 (19.6) years for 1-day admissions vs. 53.0 (18.9) years for EDOU patients (p syncope and 38% had serious causes of syncope; in 1-day admitted patients, 48% had benign etiologies and 14% had serious causes. Among EDOU patients, 44% had benign etiologies and none were serious. One-day patients were more likely to have unknown causes of syncope at discharge (36%; 95% confidence interval 0.28 to 0.43) when compared with admitted patients (26%; 95% CI 0.2 to 0.33); similarly, observation patients were more likely to be discharged without a diagnosis (56%; 95% CI 0.37 to 0.74; p ≤ 0.05). EDOU patients were less likely than patients admitted to the hospital to be discharged with an etiology of their syncope. Future EDOU protocols can benefit from set admission criteria and standardized evaluation protocols to facilitate maximal use of EDOU for syncope. Copyright © 2016 Elsevier Inc. All

  14. Update on the role of pacemaker therapy in vasovagal syncope and carotid sinus syndrome.

    Science.gov (United States)

    Parry, Steve W; Matthews, Iain G

    2013-01-01

    Vasovagal syncope (VVS) and carotid sinus syndrome (CSS) are related, neurally mediated disorders with different clinical features and treatment implications. Pacemaker intervention studies in both syndromes are hampered by a dearth of randomized, controlled (particularly with placebo) studies, unfortunate premature termination of studies, and variation in both the clinical presentation and cardiovascular profile of patients enrolled. Given this relatively limited evidence base, pacing therapy in VVS should be reserved for older sufferers with relatively frequent symptoms and spontaneous asystole documented during real-life monitoring. The long term course of patients paced for vasovagal syncope needs clarification, both in terms of symptom and device-related burden, while a comprehensive health economic evaluation of the costs and benefits of such an invasive approach for this usually benign condition is essential. It will also be important to determine the efficacy of closed loop stimulation pacing in an adequately powered study, including a comparison with standard pacing. Pacing should be considered in those with unexplained syncope with reproduction of symptoms during a cardio-inhibitory or mixed response to carotid sinus massage (asystole >3 s), though the evidence base for this recommendation is firmly in the consensus rather than pragmatic randomized controlled trial camp. Patients presenting with unexplained falls and drop attacks, particularly where injuries are prominent and where patients cannot give a clear account of their fall ("I just ended up on the floor, didn't slip or trip"), should also be considered for pacing. Pacing is not recommended for the vasodepressor sub-type of CSS. Copyright © 2013. Published by Elsevier Inc.

  15. [Efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope].

    Science.gov (United States)

    Liu, Xiao-Yan; Wang, Cheng; Wu, Li-Jia; Hu, Chun-Yan; Lin, Ping; Li, Ming-Xiang; Cui, Xiao-Li; Xie, Zhen-Wu

    2009-07-28

    To explore the efficacy of midodrine hydrochloride in the treatment of vasovagal syncope (VVS) in children. Forty-eight children with unexplained syncope and prodromata (21 males, 27 females, aged 6 -17 years, mean 11 years +/- 3 years) were randomly assigned into 3 groups. They were health education group, cresol group and midodrine hydrochloride group respectively. Cresol group was comprised of children given cresol as first-line therapy in addition to health education and midodrine hydrochloride group patients given midodrine hydrochloride on the basis of cresol group. Repeated head-up tilt testing (HUTT) and follow-ups of at least 6 months were conducted to evaluate the therapeutic efficacy, side effects of midodrine hydrochloride and hemodynamic changes in treating pediatric VVS. (1) The HUTT-based effective rate of 3 group was 20.0% (2/10), 60.9% (14/23) and 80.0% (12/15) respectively. It was significantly higher in cases of midodrine hydrochloride group and cresol group than that of health education group (P midodrine hydrochloride group (P > 0.05). (2) During the follow-up period, the recurrence rate of syncope was significantly lower in midodrine hydrochloride group than in other two groups (P 0.05). (3) There was no statistic difference in supine hemodynamic indices (HR, SBP, DBP) between before and after treatment in 3 groups. After midodrine therapy, the effects of midodrine upon changes in systolic and diastolic pressures and heart rate, between upright beginning and supine positions, were statistically significant (P midodrine hydrochloride. Such a regimen is effective and safe in treating pediatric VVS.

  16. Sincope en la infancia y adolescencia Syncope in infants and adolescents

    Directory of Open Access Journals (Sweden)

    Sergio A. Antoniuk

    2007-01-01

    precoz.Aim: To review the syncope in infants and adolescents as well as its etiology, clinical manifestations, physiopathology, diagnostic methods and treatment. Development: The syncope is a clinical entity characterized by sudden and transient loss of consciousness and postural tone, with a quick and complete recovery. The syncope is frequent in children and adolescents. The most common cause is neurocardiogenic (vasovagal, which has a benign evolution. Other causes may be neurological, cardiac and metabolic diseases, with a variable prognosis, which may come to be severe and potentially lethal. Evaluation of the syncope is mainly based on present clinical history, and on a detailed clinical examination. Basic complementary exams may help on the diagnosis, as a glycemia test, determination of electrolytes (sodium, potassium, magnesium, a hemogram and an electrocardiogram. The Tilt Test is "the" test to confirm the neurocardiogenic syncope. Treatment is indicated in syncopes with recurrent episodes or with risk of physical lesions. Prevention and education are indicated for all patients. Specific treatment should be individually given to each patient. In the case of neurocardiogenic syncope, beta-blockers, alpha-adrenergic stimulants, serotonin reuptake inhibitors, and fludrocortisone are used. In the frequently recurrent neurocardiogenic syncope, when preventive actions are not enough or there is risk of lesions in consequence of falls, beta-blockers, alpha-adrenergic stimulants, serotonin reuptake inhibitors, and fludrocortisone are used, as well as a pacemaker for severe cases non-responsive to pharmacological treatment. Conclusion: The syncope is a frequent clinical entity in infancy and adolescence, with benign evolution but potentially lethal. Diagnosis and correct etiology are important for the implementation of specific and early treatment.

  17. [Large mitral annulus myxoma presenting with syncope: Report of one case].

    Science.gov (United States)

    Vega, Julián; Gabrielli, Luigi; Olivares, Gabriel; Córdova, Samuel; Méndez, Manuel; González, Rodrigo

    2016-12-01

    We report a 23-year-old woman, with three recent exertional syncopes. Transthoracic (TTE) and transesophageal (TEE) echocardiography found a large heterogeneous mass (38 x 35 mm) arising from the posterior mitral annulus, protruding in systole through the left ventricular outflow tract (LVOT). Heart MRI confirmed the echocardiography findings, suggesting a cardiac myxoma. Cardiac surgery accomplished the complete resection of the lesion, confirming a mass arising from the posterior mitral annulus and preserving mitral anatomy and function. Pathology was positive for a myxoma. Uneventful evolution allowed the discharge of the patient at the fifth postoperative day. Control TTE discarded any complication.

  18. Ventricular oversensing of atrial electrical activity that inhibits VVI pacemaker and causes syncope

    Directory of Open Access Journals (Sweden)

    Elibet Chávez González

    2015-10-01

    Full Text Available Far-field oversensing of atrial electrical activity caused by a VVI pacemaker is a rare phenomenon; however, it may have serious clinical consequences. It has several causes and its timely identification may avoid a possible ventricular asystole. This article reports the case of a 72-year-old male who had a Biotronik Axios SR pacemaker implanted, in VVIR mode, six years ago, due to blocked atrial fibrillation. He suffered syncope due to pacemaker inhibition caused by ventricular oversensing of atrial electrical activity.

  19. Management of Wolff-Parkinson-White Tachyarrhythmia Presenting as Syncope with Seizure-like Activity

    Directory of Open Access Journals (Sweden)

    Samuel Kaplan

    2017-09-01

    Full Text Available Audience: Emergency Medicine residents and medical students. Introduction: An estimated 3% of the United States population suffers from recurrent convulsive episodes that are most often attributed to primary epileptic seizures.1 However, recent studies have estimated about 20%-30% of such episodes are associated with occult cardiac etiology,2 which carry one-year mortality rates of up to 30%.3 Cardiogenic cerebral hypoxia has been associated with a wide variety of neurologic disturbances, including dizzy spells, headache, syncope, focal motor deficit, generalized tonic-clonic seizure, confusion, dementia, and psychosis.4 Convulsive activity has tentatively been ascribed to the ensuing activation of the medullary reticular formation.5,6 This scenario is based on a patient that presented to University of California Irvine Medical Center Emergency Department in April 2017 who, following witnessed seizure-like episodes, was diagnosed with underlying Wolff-Parkinson-White (WPW disorder. WPW is a congenital condition involving aberrantly conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit and ventricular pre-excitation.7 Diagnosis is primarily based on the presence of a short PR interval and delta waves on electrocardiography.8 While definitive treatment is catheter-based radiofrequency ablation of the accessory pathway, the hallmark of acute management is vagal maneuvers and antiarrhythmic drugs in the symptomatic but hemodynamically stable patient, and synchronized cardioversion in the unstable patient.9 WPW is thought to affect between 0.1% and 0.3% of the population, and while the usual clinical course is benign, sudden cardiac death occurs in about 3%-4% of such patients.7,10 One survey found 19% of patients with WPW had a history of syncopal episodes;11 however, precise prevalence surveys of WPW-associated seizure-like episodes are lacking in the current literature. This case

  20. A syncopated leap-frog algorithm for orbit consistent plasma simulation of materials processing reactors

    International Nuclear Information System (INIS)

    Cobb, J.W.; Leboeuf, J.N.

    1994-01-01

    The authors present a particle algorithm to extend simulation capabilities for plasma based materials processing reactors. The orbit integrator uses a syncopated leap-frog algorithm in cylindrical coordinates, which maintains second order accuracy, and minimizes computational complexity. Plasma source terms are accumulated orbit consistently directly in the frequency and azimuthal mode domains. Finally they discuss the numerical analysis of this algorithm. Orbit consistency greatly reduces the computational cost for a given level of precision. The computational cost is independent of the degree of time scale separation

  1. Managing Syncope in the Elderly: The Not So Simple Faint in Aging Patients.

    Science.gov (United States)

    Solbiati, Monica; Sheldon, Robert; Seifer, Colette

    2016-09-01

    Providing care to the elderly patient with syncope poses problems that are unusual in their complexity. The differential diagnosis is broad, and sorting through it is made more difficult by the relative lack of symptoms surrounding the faint. Indeed, distinguishing faints from falls is often problematic. Many elderly patients are frail and are at risk of trauma if they should have an unprotected faint or fall to the ground. However, not all elderly patients are frail, and definitions of frailty vary. Providing accurate, effective, and appropriate care for the frail elderly patient who faints may require a multidisciplinary approach. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  2. Multiple syncope mechanisms coexisting in a Brugada syndrome patient requiring a single therapeutic approach.

    Science.gov (United States)

    Vouliotis, A I; Gatzoulis, K A; Dilaveris, P; Stefanadis, C

    2013-05-01

    We report the case of a Brugada syndrome patient with a history of syncopal and presyncopal episodes and evidence of sinus node and atrioventricular (AV) conduction abnormalities. The patient developed sinus bradycardia, sinoatrial conduction abnormalities, prolonged HV interval, early appearance of AV block, AV nodal reentrant tachycardia and polymorphic ventricular tachycardia in the electrophysiological study. He was treated with a dual-chamber pacemaker defibrillator. At the 9-year follow-up, the patient remained asymptomatic with several episodes of 1:1 AV-relationship tachycardia, interrupted with antitachycardia pacing, while the predominant pacing states of the device were AP-VS and AS-VP for most of the time.

  3. Simplified Cardioneuroablation in the Treatment of Reflex Syncope, Functional AV Block, and Sinus Node Dysfunction.

    Science.gov (United States)

    Aksu, Tolga; Golcuk, Ebru; Yalin, Kivanç; Guler, Tümer Erdem; Erden, Ismail

    2016-01-01

    Cardio neuroablation (CNA) is a lesser-known technique for management of patients with excessive vagal activation on the basis of radiofrequency catheter ablation (RFCA) of the areas related to the three main autonomic ganglia around the heart. We investigated the effectiveness of selective and/or stepwise RFCA of these areas via right atrium (RA) and/or left atrium (LA) in the patients with recurrent syncope due to excessive vagal activity. Twenty-two patients presenting symptomatic functional bradyarrhythmias, neurally mediated reflex syncope (NMS), symptomatic atrioventricular (AV) block, and symptomatic sinus node dysfunction (SND; number = 8, 7, 7, respectively) were enrolled. The three main paracardiac ganglia were targeted via RA and LA in the patients with NMS and SND. The procedure was performed via RA in the patients with AV block, followed by RFCA of all ganglia via LA, if AV conduction disorder persists. The sites showing fragmented potentials were identified by electrical mapping and verified by high-frequency stimulation and ablated until atrial electrical potential was completely eliminated (AV block. Despite the increased heart rate, the resolution of AV block after the RFCA could not be achieved in one patient who had partial resolution with atropine infusion on admission. CNA may be an alternative and safe strategy to reduce NMS episodes, and to treat functional AV block and symptomatic SND, especially in young patients. © 2015 Wiley Periodicals, Inc.

  4. Entropy Measures in the Assessment of Heart Rate Variability in Patients with Cardiodepressive Vasovagal Syncope

    Directory of Open Access Journals (Sweden)

    Beata Graff

    2015-03-01

    Full Text Available Sample entropy (SampEn was reported to be useful in the assessment of the complexity of heart rate dynamics. Permutation entropy (PermEn is a new measure based on the concept of order and was previously shown to be accurate for short, non-stationary datasets. The aim of the present study is to assess if SampEn and PermEn obtained from baseline recordings might differentiate patients with various outcomes of the head-up tilt test (HUTT. Time-domain heart rate variability (HRV indices and several nonlinear parameters were calculated using 500 RR interval-long ECG recordings done before tilting in patients with a history suggesting vasovagal syncope. Groups of patients with so-called cardiodepressive vasovagal syncope (VVS_2 during HUTT and patients who did not faint during the test were compared. Two types of HUT tests were analyzed: with spontaneous (SB or controlled breathing (CB. In our study, SampEn was higher in VVS_2 patients during SB, and PermEn was higher in VVS_2 patients during CB. Irrespective of the type of breathing during the test, SampEn and PermEn were similar in patients with the same type of reaction during HUTT. The use of several entropy-based parameters seems to be useful in HRV assessment in patients with vasovagal fainting.

  5. Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

    Science.gov (United States)

    Tomson, Todd T; Passman, Rod

    Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promising and emerging use for ICMs is in the management of anticoagulation in patients with known paroxysmal AF. The introduction in recent years of ICMs with automatic AF detection algorithms and continuous remote monitoring in combination with novel oral anticoagulants have opened the door for targeted anticoagulation guided by remote monitoring, a strategy that has recently shown promise in pilot studies of this technique. While further research is needed before official recommendations can be given, this use of ICMs opens exciting new possibilities for personalized medicine that could potentially reduce bleeding risk and improve quality of life in patients with atrial fibrillation.

  6. Vasovagal syncope in the Canon of Avicenna: the first mention of carotid artery hypersensitivity.

    Science.gov (United States)

    Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marios; Khalili, Majid; Alakbarli, Farid; Cohen-Gadol, Aaron A

    2009-05-29

    Ibn Sina, known as Avicenna in the West, was a celebrated Persian thinker, philosopher, and physician who is remembered for his masterpiece, The Canon of Medicine. The Canon that served as an essential medical encyclopedia for scholars in the Islamic territories and Europe for almost a millennium consisted of 5 books. In the third book, Avicenna described patients with symptoms of carotid hypersensitivity syndrome. These patients, who had excessive yawning, fatigue, and flushing, dropped following pressure on their carotids. Based on such history, it seems that Avicenna was the first to note the carotid sinus hypersensitivity, which presents with vasovagal syncope following compression of the carotid artery. In this paper, we presented a brief account of Avicenna's life and works and discuss his description of the so-called carotid hypersensitivity syncope. Notwithstanding his loyalty to the Greek theory of humoralism, Avicenna set forth his own version of "theory of spirits" to explain the mechanism of this disease. An account of the theory of spirits is also given.

  7. Vasovagal syncope related to emotional stress predicts coronary events in later life.

    Science.gov (United States)

    Zysko, Dorota; Melander, Olle; Fedorowski, Artur

    2013-08-01

    The aim of the study was to assess whether history of vasovagal syncope (VVS) mediated by emotional (emotional VVS) or orthostatic stress (orthostatic VVS) is associated with an increased risk of cardiovascular (CV) events in later life. Retrospective analysis based on medical records of the consecutive 3,288 cardiologic outpatients (mean age, 61 ± 12 years; 43% men). A total of 254 patients (7.7%) reported emotional VVS, whereas 294 (9.0%) had history of orthostatic VVS. First-ever syncopal episode was reported at a median age of 16 years (interquartile range [IQR], 12 years to 28 years), and the median total number of episodes was two (IQR, 1 to 5). There were 779 patients (23.7%) with at least one CV event, and the median age for the first CV event was 59 years (IQR, 52 years to 67 years). In the fully adjusted model, history of emotional VVS was predictive of CV event (hazard ratio [95% confidence interval]: 1.63, [1.27-2.09]; P emotional VVS and gender. Emotional VVS was predictive of CV event in men (1.89 [1.41-2.53]; P emotional but not orthostatic VVS is independently associated with increased risk of coronary events in later life. The relationship between predisposition to emotional VVS in adolescence and development of cardiovascular disease requires further studies. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  8. Convulsive syncope related to a small dose of quetiapine in an adolescent with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Lai J

    2017-07-01

    Full Text Available Jianbo Lai,1,2 Qiaoqiao Lu,3 Tingting Huang,3 Shaohua Hu,1,2 Yi Xu1,2 1Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, 2Key Laboratory of Mental Disorder Management in Zhejiang Province, 3Department of Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China Abstract: Quetiapine, an atypical antipsychotic, has been extensively used in patients with bipolar disorder. Overdose of quetiapine can result in severe complications, such as coma, seizure, respiratory depression, arrhythmia, and even death. However, the paucity of toxicological evaluation in adolescence causes more potential risks in this population. Herein, we present a case of hypotension and convulsive syncope after exposure to a small dose of quetiapine in a 16-year-old who was diagnosed with bipolar disorder. After cessation of quetiapine, no additional convulsive movements were reported. This case indicates that even in young patients without predisposing factors, close monitoring of adverse effects should be warranted for safety concerns, especially at the initiation of quetiapine treatment. Keywords: quetiapine, bipolar disorder, hypotension, convulsive syncope

  9. Role of Baroreflex Sensitivity in Predicting Tilt Training Response in Patients with Neurally Mediated Syncope.

    Science.gov (United States)

    Chun, Kwang Jin; Yim, Hye Ran; Park, Jungwae; Park, Seung Jung; Park, Kyoung Min; On, Young Keun; Kim, June Soo

    2016-03-01

    An association between baroreflex sensitivity (BRS) and the response to tilt training has not been reported in patients with neurally mediated syncope (NMS). This study sought to investigate the role of BRS in predicting the response to tilt training in patients with NMS. We analyzed 57 patients who underwent tilt training at our hospital. A responder to tilt training was defined as a patient with three consecutive negative responses to the head-up tilt test (HUT) during tilt training. After tilt training, 52 patients (91.2%) achieved three consecutive negative responses to the HUT. In the supine position before upright posture during the first session of tilt training for responders and non-responders, the mean BRS was 18.17 ± 10.09 ms/mm Hg and 7.99 ± 5.84 ms/mm Hg (p=0.008), respectively, and the frequency of BRS ≥ 8.945 ms/mm Hg was 45 (86.5%) and 1 (20.0%; p=0.004), respectively. Age, male gender, frequency of syncopal events before HUT, type of NMS, phase of positive HUT, total number of tilt training sessions, and mean time of tilt training did not differ between the study groups. In the multivariate analysis, BRS training. The BRS value in the supine position could be a predictor for determining the response to tilt training in patients with NMS who are being considered for inpatient tilt training.

  10. [Comparative efficacy and tolerance of atenolol and midodrine in patients with vasovagal syncopes].

    Science.gov (United States)

    Kuchinskaia, E A; Pevzner, A V; Vershuta, E V; Al'bitskaia, K V; Kheĭmets, G I; Rogoza, A N; Golitsyn, S P

    2006-01-01

    To compare efficacy and tolerance of atenolol and midodrine in patients with vasovagal syncopes (VVS). The trial included 35 patients with recurrent VVS confirmed at long passive head-up tilt table test (HTTT) or maximal load bicycle exercise test (MET). These tests were also used for assessing efficacy of atenolol and midodrine in cases when syncopes occur in repeated tests. If recurrent induction of VVS was absent, efficacy of the drugs was assessed by long-term (up to 12 months) clinical observation. Long-term administration of atenolol and midodrine was continued in patients with effect by HTTT and/or MET. Eighteen patients were randomized to take atenolol in a daily dose up to 50 mg, seventeen--to take midodrine in a daily dose up to 15 mg. Efficacy of atenolol by HTTT and MET was 8%, midodrine--57% (p = 0.01). All the patients benefited from the drugs in their long-term regimen. Long-term administration of atenolol induced remission of VVS in 82% cases, midodrine--in 89% (insignificant). Overall efficacy of atenolol was 44%, of midodrine--70% (insignificant). In 5 of 6 patients resistant to atenolol and midodrine monotherapy, combined use of the drugs was effective. Treatment with atenolol, midodrine and their combination prevented VVS in 89% patients. Both short- and long-term courses of atenolol and midodrine were safe in terms of side effects. Atenolol and midodrine as well as their combination were highly effective and well tolerated in the treatment of VVS patients.

  11. Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Ivo Casagranda

    2016-06-01

    Full Text Available The recommendations enclosed in the present document have been developed by a group of experts appointed by the Gruppo Multidisciplinare per lo Studio della Sincope (Multidisciplinary Group for the Study of Syncope; GIMSI and Academy of Emergency Medicine and Care (AcEMC. The aim is to define the diagnostic pathway and the management of patients referred to the Emergency Department (ED for transient loss of consciousness of suspected syncopal cause, which is still unexplained after the initial evaluation. The risk stratification enables the physician to admit, discharge or monitor shortly the patient in the intensive short-stay Syncope Observation Unit (SOU. There are three risk levels of life-threatening events or serious complications (low, moderate, high. Low risk patients can be discharged, while high risk ones should be monitored and treated properly in case of worsening. Moderate risk patients should undergo clinical and instrumental monitoring in SOU, inside the ED. In all these three cases, patients can be subsequently referred to the Syncope Unit for further diagnostic investigations.

  12. [Congenital long QT-syndrome: the cause of recurrent syncope and sudden death at a young age

    NARCIS (Netherlands)

    Akkerhuis, J.M.; Baars, H.F.; Marcelis, C.L.M.; Akkerhuis, K.M.; Wilde, A.A.M.

    2007-01-01

    Congenital long QT-syndrome (LQTS) was diagnosed in three patients. The first patient, a 10-year-old girl, presented with recurrent episodes of syncope during swimming and was diagnosed with type 1 LQTS. The second patient, a 36-year-old asymptomatic man, was accidentally diagnosed with type 2 LQTS.

  13. Panic symptoms in transient loss of consciousness: Frequency and diagnostic value in psychogenic nonepileptic seizures, epilepsy and syncope.

    Science.gov (United States)

    Rawlings, G H; Jamnadas-Khoda, J; Broadhurst, M; Grünewald, R A; Howell, S J; Koepp, M; Parry, S W; Sisodiya, S M; Walker, M C; Reuber, M

    2017-05-01

    Previous studies suggest that ictal panic symptoms are common in patients with psychogenic nonepileptic seizures (PNES). This study investigates the frequency of panic symptoms in PNES and if panic symptoms, just before or during episodes, can help distinguish PNES from the other common causes of transient loss of consciousness (TLOC), syncope and epilepsy. Patients with secure diagnoses of PNES (n=98), epilepsy (n=95) and syncope (n=100) were identified using clinical databases from three United Kingdom hospitals. Patients self-reported the frequency with which they experienced seven symptoms of panic disorder in association with their episodes. A composite panic symptom score was calculated on the basis of the frequency of symptoms. 8.2% of patients with PNES reported "never" experiencing any of the seven panic symptoms in their episodes of TLOC. Patients with PNES reported more frequent panic symptoms in their attacks than those with epilepsy (pepilepsy from syncope. Patients with PNES report TLOC associated panic symptoms more commonly than those with epilepsy or syncope. Although panic symptoms are reported infrequently by most patients with PNES, a composite symptom score may contribute to the differentiation between PNES and the other two common causes of TLOC. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  14. Kernel based support vector machine for the early detection of syncope during head-up tilt test

    International Nuclear Information System (INIS)

    Khodor, N; Amoud, H; Khalil, M; Matelot, D; Carrault, G; Ville, N; Carre, F; Hernandez, A

    2014-01-01

    This study aims to analyze the autonomic nervous system response during head-up tilt test (HUTT), by exploring the changes in dynamic properties of heart rate variability in subjects with and without syncopes, to predict the outcome of HUTT. Baroreflex response, as well as linear and non-linear parameters of RR-interval time series, have been extracted from the ECG of 66 subjects: 35 with and 31 without syncope during HUTT. The results show that, when considering the first 15 min of tilting position, the total power spectrum, the standard deviation, the long-term fractal scale of RR-interval and ΔRR-interval of time series increase, while the sample entropy decreases in the positive group compared to the negative one. These indices may be good predictors of positive response in patients with reflex syncope. Additionally, an analysis of the first 15 min of tilting position using kernel support vector machines leads to a correct classification of 85% of patients, within negative and positive response groups (specificity = 80.6% and sensitivity = 88.5%). In medical applications, it is important to avoid false negative diagnosis of syncopes during HUTT. Taking this into account, an overall accuracy of 72.1% can be obtained in the same window allowing the reduction of the examination time in the clinical domain. (paper)

  15. Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3).

    Science.gov (United States)

    Ungar, Andrea; Sgobino, Paolo; Russo, Vitantonio; Vitale, Elena; Sutton, Richard; Melissano, Donato; Beiras, Xulio; Bottoni, Nicola; Ebert, Hans H; Gulizia, Michele; Jorfida, Marcella; Moya, Angel; Andresen, Dietrich; Grovale, Nicoletta; Brignole, Michele

    2013-12-01

    According to the guidelines of the European Society of Cardiology, a presumed diagnosis of neurally mediated syncope (NMS) can be made when patients have a consistent history and competing diagnoses are excluded. In the present study, we compared the initial diagnosis of NMS by means of implantable loop recorder (ILR) documentation. In this prospective multicentre observational study which involved 51 hospitals in nine countries in Europe and Canada, 504 NMS patients ≥40 years, who had suffered ≥3 syncopal episodes in the previous 2 years received an ILR and were followed up for a mean of 15±11 months. ILR recorded a spontaneous syncope in 187 cases, with an estimated diagnostic yield of 47% at 3 years. ILR findings were consistent with the initial diagnosis of presumed NMS in 162 (87%) patients whereas did not confirm NMS in another 25 (13%), who had an intrinsic cardiac arrhythmic cause (atrial tachyarrhythmias (#6), long pause on termination of tachyarrhythmia (#8), persistent bradycardia (#3), ventricular tachycardia (#4)) or a non-arrhythmic loss of consciousness (non-syncopal (#3), orthostatic hypotension (#1)). No clinical baseline feature was able to predict an intrinsic cardiac cause with the exception of more frequent non-syncopal atrial tachyarrhythmias on clinical history, which were present in 38% of cardiac versus 5% of NMS patients (p=0.001). Tilt table testing (TT) was positive in 76/136 (56%) presumed NMS and in 9/21 (43%) non-NMS patients (p=0.35); an asystolic response was present in 28/136 (21%) NMS and in 0/21 (0%) non-NMS patients (p=0.03). ILR findings showed results other than NMS in a small, although non-negligible, number of patients older than 40 years. TT was unable to discriminate between presumed NMS and non-NMS with the exception of an asystolic response which was highly specific.

  16. Incidence and influence of hospitalization for recurrent syncope and its effect on short- and long-term all-cause and cardiovascular mortality.

    Science.gov (United States)

    Ruwald, Martin H; Numé, Anna-Karin; Lamberts, Morten; Hansen, Carolina M; Hansen, Morten L; Vinther, Michael; Kober, Lars; Torp-Pedersen, Christian; Hansen, Jim; Gislason, Gunnar H

    2014-05-15

    Recurrence of syncope is a common event, but the influence of recurrent syncope on the risk of death has not previously been investigated on a large scale. We examined the prognostic impact of recurrent syncope in a nationwide cohort of patients with syncope. All patients (n = 70,819) hospitalized from 2001 to 2009 in Denmark with a first-time diagnosis of syncope aged from 15 to 90 years were identified from national registries. Recurrence of syncope was incorporated as a time-dependent variable in multivariable-adjusted Cox models on the outcomes of 30-day, 1-year, and long-term all-cause mortality and cardiovascular death. During a mean follow-up of 3.9 ± 2.6 years, a total of 11,621 patients (16.4%) had at least 1 hospitalization for recurrent syncope, with a median time to recurrence of 251 days (33 to 364). A total of 14,270 patients died, and 3,204 deaths were preceded by a hospitalization for recurrent syncope. The long-term risk of all-cause death was significantly associated with recurrent syncope (hazard ratio 2.64, 95% confidence interval 2.54 to 2.75) compared with those with no recurrence. On 1-year mortality, recurrent syncope was associated with a 3.2-fold increase in risk and on 30-day mortality associated with a threefold increase. The increased mortality risk was consistent over age groups 15 to 39, 40 to 59, and 60 to 89 years, and a similar pattern of increase in both long-term and short-term risk of cardiovascular death was evident. In conclusion, recurrent syncope is independently associated with all-cause and cardiovascular mortality across all age groups exhibiting a high prognostic influence. Increased awareness on high short- and long-term risk of adverse events in subjects with recurrent syncope is warranted for future risk stratification. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

    Directory of Open Access Journals (Sweden)

    Pasqualetti G

    2017-04-01

    Full Text Available Giuseppe Pasqualetti,1 Valeria Calsolaro,1 Giacomo Bini,1 Umberto Dell’Agnello,1 Marco Tuccori,2 Alessandra Marino,2 Alice Capogrosso-Sansone,2 Martina Rafanelli,3 Massimo Santini,4 Eugenio Orsitto,4 Andrea Ungar,3 Corrado Blandizzi,2 Fabio Monzani1 On behalf of the ANCESTRAL-ED study group 1Geriatrics Unit, 2Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 3Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence, 4Emergency Department, University Hospital of Pisa, Pisa, Italy Abstract: It is difficult to distinguish unexplained falls (UFs from accidental falls (AFs or syncope in older people. This study was designed to compare patients referred to the emergency department (ED for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65–105] years, 66.3% female were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF. The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17–1.77. When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27–0.58], 0.40 [0.24–0.68], 0.35 [0.14–0.82], and 0.31 [0.20–0.49], respectively, while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07–5.90] and 1.24 [1.07–1.44], respectively. Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50–0.84], 0.52 [0.30–0.89], 0.40 [0.20–0.77], and 0.26 [0.13–0.55], respectively

  18. Mapping clinical journeys of Asian patients presenting to the Emergency Department with syncope: Strict adoption of international guidelines does not reduce hospitalisations.

    Science.gov (United States)

    Kojodjojo, Pipin; Boey, Elaine; Elangovan, Anita; Chen, Xianyi; Tan, Yuquan; Singh, Devinder; Yeo, Wee Tiong; Lim, Toon Wei; Seow, Swee Chong; Sim, Tiong Beng

    2016-09-01

    Limited data exists about management of syncope in Asia. The American College of Emergency Physicians (ACEP) and European Society of Cardiology (ESC) guidelines have defined the high-risk syncope patient. This study aims to determine the effectiveness of managing syncope in an Asian healthcare system and whether strict adherence of international guidelines would reduce hospitalizations. Patients attending the Emergency Department of a Singaporean tertiary hospital with syncope were identified. Clinical journeys of all patients were meticulously mapped by interrogation of a comprehensive electronic medical record system and linkages with national datasets. Primary endpoint was hospitalization. Secondary endpoints were recurrent syncope within 1year and all-cause mortality. Expected admission rates based on application of ACEP/ESC guidelines were calculated. 638 patients (43.8±22.4years, 49.0% male) presented with syncope. 48.9% were hospitalized for 2.9±3.2days. Yields of common investigations ranged from 0 to 11.5% and no diagnosis was reached in 51.5% of patients. Diuretics use (HR 5.1, p=0.01) and prior hospitalization for syncope (HR 6.9, psyncope. Over 2.8 SD 0.3years of follow-up, 40 deaths occurred. 24 patients who died within 12months of presentation were admitted or had a firm diagnosis upon discharge. Application of guidelines did not significantly reduce hospitalisations, with limited agreement which patients warrant admission. (Actual 376, ACEP 354, ESC 391 admissions, p=NS). Unstructured management of syncope results in nearly half of patients being admitted and substantial healthcare expenditures, yet with limited diagnostic yield. Strict adoption of ACEP or ESC guidelines does not reduce admissions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Long-range correlation in synchronization and syncopation tapping: a linear phase correction model.

    Directory of Open Access Journals (Sweden)

    Didier Delignières

    Full Text Available We propose in this paper a model for accounting for the increase in long-range correlations observed in asynchrony series in syncopation tapping, as compared with synchronization tapping. Our model is an extension of the linear phase correction model for synchronization tapping. We suppose that the timekeeper represents a fractal source in the system, and that a process of estimation of the half-period of the metronome, obeying a random-walk dynamics, combines with the linear phase correction process. Comparing experimental and simulated series, we show that our model allows accounting for the experimentally observed pattern of serial dependence. This model complete previous modeling solutions proposed for self-paced and synchronization tapping, for a unifying framework of event-based timing.

  20. Electrical Storm or Naxos Syndrome in an Adult Causing Recurrent Syncope.

    Science.gov (United States)

    Maqbool, Muhammad Furrakh; Sajid, Muhammad; Noeman, Ahmed

    2017-04-01

    Among the rare and well-known causes of sudden cardiac death by malignant arrthymias is a condition called arrhythmogenic right ventricular cardiomyopathy. It commonly presents with right ventricular dilatation, dysfunction and ventricular tachycardia of left bundle branch morphology due to fibro-fatty infiltration of right ventricle in second to fifth decade of life, making it an unrecognized and important cause of sudden cardiac death. Two rare variants of arrhythmogenic right ventricular cardiomyopathy are Carvajal syndrome and Naxos syndrome. Both variants have systemic manifestations. Being a rare variant of arrhythmogenic right ventricular dysplasia, Naxos syndrome was initially described in the families of the Greek island of Naxos. It is a recessive disorder with cardio-cutaneous manifestations characterized by arrhythmogenic right ventricular cardiomyopathy, palmoplantar keratoderma and wooly hair. We report a rare case of Naxos syndrome in an adult patient presented with recurrent episodes of palpitation and syncope.

  1. Cor triatriatum sinister in a 43-year-old man with syncope.

    Science.gov (United States)

    Eichholz, Janet L; Hodroge, Samer S; Crook, Jerry J; Mack, John W; Wortham, Dale C

    2013-01-01

    Cor triatriatum sinister, a congenital cardiac anomaly involving a fibromuscular membrane that partitions the left atrium into 2 chambers, has been reported in only 0.1% to 0.4% of patients with congenital heart disease. The posterosuperior chamber receives blood from the pulmonary veins, and the anteroinferior chamber contains the left atrial appendage and mitral valve orifice. Most patients are diagnosed with the condition in infancy or childhood; adult cases are rare. We describe a case of cor triatriatum sinister in a 43-year-old man whose only presenting symptom was recurrent syncope. He underwent corrective resection of the membrane and was asymptomatic thereafter. In addition to discussing the patient's case, we review the relevant medical literature.

  2. Postural Syncope and Constipation: An Unusual Presentation of a Duodenal Dieulafoy’s Lesion

    Directory of Open Access Journals (Sweden)

    Ahmed Dirweesh

    2017-01-01

    Full Text Available Dieulafoy lesions are a rare etiology of gastrointestinal bleeding from a large caliber-persistent tortuous submucosal artery. They account for 1-2% of all causes of acute gastrointestinal hemorrhage with 80%–95% of these lesions located in the stomach along the lesser curvature. One-third of these lesions present at an extragastric location, with the proximal duodenum accounting for 15% of them. We present a 21-year-old male with no significant past medical history or risk factors, who presented with repeated syncopal episodes followed by hematemesis, found to have a Dieulafoy lesion located at the duodenal bulb. This lesion was diagnosed and successfully treated via upper endoscopy with epinephrine injection and the application of 2 endoscopic clips.

  3. Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial - the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio)

    Science.gov (United States)

    Ammirati, F; Colivicchi, F; Santini, M

    2000-06-01

    In some patients with syncope health care is inappropriate and ineffective. In a recent observational investigation in community hospitals of the Lazio region of Italy (the OESIL study) 54.4% of patients admitted with syncope from the emergency room were discharged without a conclusive diagnosis. A simplified two-step diagnostic algorithm was developed and prospectively implemented in nine community hospitals of the Lazio region of Italy in order to improve the diagnostic performance of clinicians, thereby reducing the number of undiagnosed patients. The study population included 195 consecutive patients (85 males and 110 females, mean age 62.5 years, range 13-95 years) presenting with a syncopal spell at the emergency room of one of the nine participating hospitals in a 2-month period. The systematic implementation of the proposed diagnostic algorithm resulted in a striking reduction of undiagnosed cases. The percentage of patients discharged without a conclusive diagnosis decreased from 54.4% to 17.5%. Neurally mediated syncope was diagnosed in 35.2% of cases, cardiac syncope in 20.9% and neurological syncope in 13.8%. The use of specific, simplified diagnostic guidelines and algorithms results in an improvement of overall clinical performance. However, the development of such decision-making aids should carefully consider the local circumstances of daily clinical practice. Copyright 2000 The European Society of Cardiology.

  4. Are echocardiography, telemetry, ambulatory electrocardiography monitoring, and cardiac enzymes in emergency department patients presenting with syncope useful tests? A preliminary investigation.

    Science.gov (United States)

    Chiu, David T; Shapiro, Nathan I; Sun, Benjamin C; Mottley, J Lawrence; Grossman, Shamai A

    2014-07-01

    Prior studies of admitted geriatric syncope patients suggest that diagnostic tests affect management telemetry, ambulatory electrocardiography monitoring, and troponin) were studied. Interobserver agreement as to whether test results determined the etiology of the syncope was measured using kappa (κ) values. Of 570 patients with syncope, 73 patients (8%; 95% confidence interval 7-10%) had studies that were diagnostic. One hundred fifty (26%) had echocardiography, with 33 (22%) demonstrating a likely etiology of the syncopal event, such as critical valvular disease or significantly depressed left ventricular function (κ = 0.75). On hospitalization, 330 (58%) patients were placed on telemetry, and 19 (3%) had worrisome dysrhythmias (κ = 0.66). There were 317 (55%) patients who had troponin levels drawn, of whom 19 (3%) had positive results (κ = 1); 56 (10%) patients were discharged with monitoring, with significant findings in only 2 (0.4%) patients (κ = 0.65). Although routine testing is prevalent in ED patients with syncope, the diagnostic yield is relatively low. Nevertheless, some testing, particularly echocardiography, may yield critical findings. Current efforts to reduce the cost of medical care by eliminating nondiagnostic medical testing and increasing emphasis on practicing evidence-based medicine argue for more discriminate testing when evaluating syncope. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Incidence and Influence of Hospitalization for Recurrent Syncope and Its Effect on Short- and Long-Term All-Cause and Cardiovascular Mortality

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Numé, Anna-Karin; Lamberts, Morten

    2014-01-01

    by a hospitalization for recurrent syncope. The long-term risk of all-cause death was significantly associated with recurrent syncope (hazard ratio 2.64, 95% confidence interval 2.54 to 2.75) compared with those with no recurrence. On 1-year mortality, recurrent syncope was associated with a 3.2-fold increase in risk...... from 2001 to 2009 in Denmark with a first-time diagnosis of syncope aged from 15 to 90 years were identified from national registries. Recurrence of syncope was incorporated as a time-dependent variable in multivariable-adjusted Cox models on the outcomes of 30-day, 1-year, and long-term all...... and on 30-day mortality associated with a threefold increase. The increased mortality risk was consistent over age groups 15 to 39, 40 to 59, and 60 to 89 years, and a similar pattern of increase in both long-term and short-term risk of cardiovascular death was evident. In conclusion, recurrent syncope...

  6. Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study.

    Science.gov (United States)

    Baron-Esquivias, Gonzalo; Martínez-Alday, Jesús; Martín, Alfonso; Moya, Angel; García-Civera, Roberto; Paz López-Chicharro, M; Martín-Mendez, María; del Arco, Carmen; Laguna, Pedro

    2010-06-01

    To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%). ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient loss of consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.

  7. Midodrine for orthostatic hypotension and recurrent reflex syncope: A systematic review.

    Science.gov (United States)

    Izcovich, Ariel; González Malla, Carlos; Manzotti, Matias; Catalano, Hugo Norberto; Guyatt, Gordon

    2014-09-23

    Symptomatic orthostatic hypotension (SOH) and recurrent reflex syncope (RRS) can be disabling. Midodrine has been proposed in the management of patients with these conditions but its impact on patient important outcomes remains uncertain. We performed a systematic review to evaluate the efficacy and safety of midodrine in patients with SOH and RRS. We searched multiple electronic databases without language restriction from their inception to June 2013. We included randomized controlled trials of patients with SOH or RRS that compared treatment with midodrine against a control and reported data on patient important outcomes. We graded the quality of evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Eleven trials involving 593 patients were included in this review. Three studies addressed health-related quality of life in patients with RRS, showing improvement with midodrine: risk difference 14% (95% confidence interval [CI] -3.5 to 31.6), very low confidence. Seven studies addressed symptom improvement and provided poolable data showing improvement with midodrine in patients with SOH: risk difference 32.8% (95% CI 13.5-48), low confidence; and RRS: risk difference 63.3% (95% CI 47.6-68.2), very low confidence. Five studies reported syncope recurrence in patients with RRS showing improvement with midodrine: risk difference 37% (95% CI 20.8%-47.4%), moderate confidence. The most frequent side effects in the midodrine arm were pilomotor reactions (33.6%, risk ratio 4.58 [95% CI 2.03-10.37]). Evidence warranting low/moderate confidence suggests that midodrine improves clinical important outcomes in patients with SOH and RRS. © 2014 American Academy of Neurology.

  8. Fainiting (Syncope)

    Science.gov (United States)

    ... MOC) Scientific Sessions Certified Education Courses & Online Learning Co-Sponsored & Endorsed Events Educational Resources Career Resources Job Board Fellowships & Program Directors IBHRE Exam Jobs at HRS Policy & Payment QPP Resource Center Clinical Guidelines & Documents Safety Alert ...

  9. Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

    Science.gov (United States)

    Varosy, Paul D; Chen, Lin Y; Miller, Amy L; Noseworthy, Peter A; Slotwiner, David J; Thiruganasambandamoorthy, Venkatesh

    2017-08-01

    To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Of 3,188 citations reviewed, 10 studies met the inclusion criteria for systematic review, including a total of 676 patients. These included 9 randomized trials and 1 observational study. Of the 10 studies, 4 addressed patients with carotid sinus hypersensitivity, and the remaining 6 addressed vasovagal syncope. Among the 6 open-label (unblinded) studies, we found that pacing was associated with a 70% reduction in recurrent syncope (relative risk [RR]: 0.30; 95% confidence interval [CI]: 0.15-0.60). When the 2 analyzable studies with double-blinded methodology were considered separately, there was no clear benefit (RR: 0.73; 95% CI: 0.25-2.1), but confidence intervals were wide. The strongest evidence was from the randomized, double-blinded ISSUE-3 (Third International Study on Syncope of Uncertain Etiology) trial, which demonstrated a benefit of pacing among patients with recurrent syncope and asystole documented by implantable loop recorder. There are limited data with substantive evidence of outcome ascertainment bias, and only 2 studies with a double-blinded study design have been conducted. The evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by implantable loop recorder. Copyright © 2017 American College of Cardiology Foundation, American Heart Association

  10. Increased heart rate caused by atrial pacing with the closed-loop stimulation function prevented micturition syncope

    Directory of Open Access Journals (Sweden)

    Tatsuo Haraki, MD,PhD

    2013-10-01

    Full Text Available A 70-year-old man had been experiencing syncope several times a year. We implanted a DDD pacemaker with closed-loop stimulation (CLS function. When he urinated early in the morning, his increased atrial pacing rates elevated his heart rate (HR during and after micturition. After implantation of the DDD-CLS mode, he did not experience symptoms. In contrast, in the DDD-R mode, his intrinsic HR changed to atrial pacing after micturition but decreased to the basal rate within 2 min, and he experienced a sense of cold perspiration and presyncope. Increased HRs caused by atrial pacing with the CLS function were useful in the prevention of micturition syncope.

  11. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen

    DEFF Research Database (Denmark)

    Fanoe, Søren; Hvidt, C; Ege, P

    2007-01-01

    Background: Methadone is prescribed to heroin addicts to decrease illicit opioid use. Prolongation of the QT interval in the ECG of patients with torsade de pointes (TdP) has been reported in methadone users. As heroin addicts sometimes faint while using illicit drugs, doctors might attribute too...... were collected in a population of adult heroin addicts treated with methadone or buprenorphine on a daily basis. Of the patients at the Drug Addiction Service in the municipal of Copenhagen, 450 ( 52%) were included. The QT interval was estimated from 12 lead ECGs. All participants were interviewed...... odds for syncope. Conclusions: Methadone is associated with QT prolongation and higher reporting of syncope in a population of heroin addicts. Abbreviations: HERG, human ether-a-go-go related gene; LQT2, type 2 of the long QT syndrome; TdP, torsade de pointes....

  12. Síncope inducido por el ejercicio: Reporte de un caso Exercise-induced syncope: case report

    Directory of Open Access Journals (Sweden)

    Andrés Alvarado

    2011-04-01

    Full Text Available El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adaptativa común que a veces puede causar síncope cardioinhibitorio asociado con el ejercicio, cuya presentación puede variar desde bradiarritmias hasta asistolia, por lo cual constituye un reto diagnóstico.Exercise-induced syncope is a condition that should alert the treating physician; structural cardiac abnormalities that predispose to sudden death should be discarded, and the presence of arrhythmias that may potentially cause this condition are evaluated. In patients over 35 years, coronary and valvular disease are ruled-out as a possible cause of syncope associated with exercise. In subjects who train frequently, increased vagal tone is a common adaptive condition that may sometimes cause cardio-inhibitory syncope associated with exercise, whose presentation may vary from bradyarrhythmia to asystolia, thereby providing a diagnostic challenge.

  13. Assessment of a structured management pathway for patients referred to the Emergency Department for syncope: results in a tertiary hospital.

    Science.gov (United States)

    Ungar, Andrea; Tesi, Francesca; Chisciotti, Valentina Maddalena; Pepe, Giuseppe; Vanni, Simone; Grifoni, Stefano; Balzi, Daniela; Rafanelli, Martina; Marchionni, Niccolò; Brignole, Michele

    2016-03-01

    High hospitalization rates (39-58% in the literature) of patients admitted to Emergency Department (ED) for transient loss of consciousness (T-LOC) suspected for syncope are still an unresolved issue. The presence of an Observation Unit has reduced hospital admissions and the duration of hospitalization in controlled studies, and a Syncope Unit (SU) in the hospital may reduce hospitalization and increase the number of diagnoses in patients with T-LOC. We assessed the effect of a structured organization on hospitalization rate and outcome. Consecutive patients referred to the ED for a T-LOC of a suspected syncopal nature as the main diagnosis were included. The ED physician was trained to choose between: hospital admission (directly or after short observation); discharge after short (cause occurred in 72 (24%) patients; re-admission rates were 45.9, 19.3, 11.5, and 18.0% among admitted, observation, SU, and ED-discharged patients, respectively. The availability of short observation and a SU seems to reduce the hospitalization rate compared with previous reported historical reports from our and other centres. Most deaths during follow-up occurred in patients who had been hospitalized. High rates of re-admission to the ED within 1 year are still an issue. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  14. Carotid sinus syndrome is common in very elderly patients undergoing tilt table testing and carotid sinus massage because of syncope or unexplained falls.

    Science.gov (United States)

    Paling, David; Vilches-Moraga, Arturo; Akram, Qasim; Atkinson, Oliver; Staniland, John; Paredes-Galán, Emilio

    2011-08-01

    Although the incidence of falls and syncope increase with age, the underlying mechanisms are not fully understood, particularly in very old patients. We report diagnostic outcomes of tilt table and carotid sinus massage (TT/CSM) testing in a population of older old subjects (82% over 80 years of age) referred for TT/CSM from a falls clinic for assessment of syncope or unexplained falls. Prospective observational study between January 1, 2001 and January 1, 2005 involving 290 consecutive subjects undergoing TT/CSM testing according to European Society of Cardiology guidelines for the diagnosis and management of syncope. Combination of TT/CSM provided a positive result in 62% of subjects, and was significantly more likely to be positive in subjects over the age of 80 (68% vs 50%, p=0.001). Carotid sinus syndrome (CSS) was the most common diagnosis, and was significantly more common in subjects over 80 (48% vs 34%, p=0.022) particularly due to a higher incidence of mixed CSS (16% vs 7%, p=0.023). There was no significant difference in the diagnosis of subjects referred due to falls and those reporting syncope (p=0.93). No cardiovascular or neurological adverse events occurred. In our cohort of very elderly patients, the diagnostic accuracy of tilt testing and carotid sinus massage was high and adverse incidents absent when testing was indicated by a geriatrician experienced in the assessment of falls and syncope. We advocate the use of TT/CSM testing as part of a comprehensive falls/syncope assessment for the diagnostic evaluation of older patients presenting with unexplained falls and/or syncope in whom structured assessment has not identified a cause for their symptoms.

  15. The "syncope and dementia" study: a prospective, observational, multicenter study of elderly patients with dementia and episodes of "suspected" transient loss of consciousness.

    Science.gov (United States)

    Ungar, Andrea; Mussi, Chiara; Nicosia, Franco; Ceccofiglio, Alice; Bellelli, Giuseppe; Bo, Mario; Riccio, Daniela; Landi, Francesco; Martone, Anna Maria; Langellotto, Assunta; Ghidoni, Giulia; Noro, Gabriele; Abete, Pasquale

    2015-12-01

    Syncope and related falls are one of the main causes and the predominant cause of hospitalization in elderly patients with dementia. However, the diagnostic protocol for syncope is difficult to apply to patients with dementia. Thus, we developed a "simplified" protocol to be used in a prospective, observational, and multicenter study in elderly patients with dementia and transient loss of consciousness suspected for syncope or unexplained falls. Here, we describe the protocol, its feasibility and the characteristics of the patients enrolled in the study. Patients aged ≥65 years with a diagnosis of dementia and one or more episodes of transient loss of consciousness during the previous 3 months, subsequently referred to a Geriatric Department in different regions of Italy, from February 2012 to May 2014, were enrolled. A simplified protocol was applied in all patients. Selected patients underwent a second-level evaluation. Three hundred and three patients were enrolled; 52.6% presented with episodes suspected to be syncope, 44.5% for unexplained fall and 2.9% both. Vascular dementia had been previously diagnosed in 53.6% of participants, Alzheimer's disease in 23.5% and mixed forms in 12.6%. Patients presented with high comorbidity (CIRS score = 3.6 ± 2), severe functional impairment, (BADL lost = 3 ± 2), and polypharmacy (6 ± 3 drugs). Elderly patients with dementia enrolled for suspected syncope and unexplained falls have high comorbidity and disability. The clinical presentation is often atypical and the presence of unexplained falls is particularly frequent.

  16. Transcranial magnetic stimulation as an antidepressant alternative in a patient with Brugada syndrome and recurrent syncope.

    Science.gov (United States)

    Alampay, Miguel M; Haigney, Mark C; Flanagan, Michael C; Perito, Robert M; Love, Kathleen M; Grammer, Geoffrey G

    2014-11-01

    Brugada syndrome (BrS) is a common occult cause of sudden cardiac arrest in otherwise healthy-appearing adults. The pathognomonic electrocardiographic pattern may be unmasked only by certain medications, many of which are unknown. We report a case of a depressed but otherwise healthy man with an asymptomatic right bundle branch block on electrocardiography who experienced antidepressant-induced BrS and ultimately recovered with transcranial magnetic stimulation (TMS). After an initial trial of nortriptyline, the patient's depressive symptoms improved; however, he experienced a syncopal event and was subsequently diagnosed as having BrS. Cross titration to bupropion, which had not previously been known to exacerbate BrS, was followed by another cardiac event. As a result, the patient was referred for TMS as a substitute for pharmacotherapy. After 31 TMS sessions over 8 weeks, the patient demonstrated significant improvement by subjective report and objective reduction in his Patient Health Questionnaire-9 scores from 10 (moderate) to 1 (minimal). Transcranial magnetic stimulation is a Food and Drug Administration-approved nonpharmacologic treatment for depression. Given the potential lethality of BrS with known and unknown psychopharmacologic agents, providers should consider TMS as first-line therapy in this patient population. Bupropion should be added to the list of agents known to exacerbate this disease. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  17. Short QT syndrome presenting as syncope: how short is too short?

    Science.gov (United States)

    Portugal, Guilherme; Martins Oliveira, Mário; Silva Cunha, Pedro; Ferreira, Filipa; Lousinha, Ana; Fiarresga, António; Nogueira da Silva, Manuel; Cruz Ferreira, Rui

    2014-10-01

    We report the case of a 52-year-old man who presented to our emergency department (ED) after three episodes of syncope in the seven hours before admission. During his stay in the ED he had recurrent ventricular tachycardia (VT) requiring external electrical cardioversion. A 12-lead electrocardiogram (ECG) showed a short QT (SQT) interval (270 ms, QTc 327 ms), with frequent R-on-T extrasystoles triggering sustained polymorphic VT. After exclusion of other precipitating causes, the patient was diagnosed as having SQT syndrome (SQTS) according to the Gollob criteria. To our knowledge, this is the first known documentation of an SQT-caused arrhythmic episode on a 12-lead ECG, as well as the first reported case of SQTS in Portugal. The patient received an implantable cardioverter-defibrillator and was discharged. At a follow-up assessment 14 months later he was symptom-free, interrogation of the device showed no arrhythmic events, and the ECG showed a QT interval of 320 ms (QTc 347 ms). Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  18. Recurrent syncope, orthostatic hypotension and volatile hypertension: think outside the box

    Directory of Open Access Journals (Sweden)

    Thein Aung

    2013-07-01

    Full Text Available The baroreceptors in the neck and aortic arch are important regulators of sudden blood pressure changes. They are innervated by CN IX and X and synapse in the brainstem. Baroreceptor failure is an under-recognized cause of recurrent syncope, orthostatic hypotension, and volatile hypertension, which is refractory to and may in fact worsen with conventional treatments. Baroreflex failure can be the result of neck and chest radiation, head and neck surgery, and cerebrovascular accidents involving the brainstem nuclei. The management of baroreflex failure is a challenge since patient education, lifestyle changes, and family support are extremely important in managing blood pressure. Leg exercises and Thrombo-Embolic Deterrent Stockings (TED stockings are important in treating orthostatic hypotension. Clonidine is the antihypertensive of choice for supine hypertension. Low-dose benzodiazepines are helpful in suppressing sympathetic surges. We have encountered two patients with baroreflex failure after chemotherapy and radiation to the neck or upper chest. Temporal relationship between symptoms onset and the history of head, neck, and upper chest radiation or trauma is important in reaching a diagnosis.

  19. Syncope in high-risk cardiomyopathy patients with implantable defibrillators: frequency, risk factors, mechanisms, and association with mortality: results from the multicenter automatic defibrillator implantation trial-reduce inappropriate therapy (MADIT-RIT) study.

    Science.gov (United States)

    Ruwald, Martin H; Okumura, Ken; Kimura, Takeshi; Aonuma, Kazutaka; Shoda, Morio; Kutyifa, Valentina; Ruwald, Anne-Christine H; McNitt, Scott; Zareba, Wojciech; Moss, Arthur J

    2014-02-04

    There is a relative paucity of studies investigating the mechanisms of syncope among heart failure patients with implantable cardioverter-defibrillators, and it is controversial whether nonarrhythmogenic syncope is associated with increased mortality. The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) randomized 1500 patients to 3 different implantable cardioverter-defibrillator programming arms: (1) Conventional programming with therapy for ventricular tachycardia ≥170 bpm; (2) high-rate cutoff with therapy for ventricular tachycardia ≥200 bpm and a monitoring zone at 170 to 199 bpm, and (3) prolonged 60-second delay with a monitoring zone before therapy. Syncope was a prespecified safety end point that was adjudicated independently. Multivariable Cox models were used to identify risk factors associated with syncope and to analyze subsequent risk of mortality. During follow-up, 64 of 1500 patients (4.3%) had syncope. The incidence of syncope was similar across the 3 treatment arms. Prognostic factors for all-cause syncope included the presence of ischemic cardiomyopathy (hazard ratio [HR], 2.48; 95% confidence interval [CI], 1.42-4.34; P=0.002), previous ventricular arrhythmias (HR, 2.99; 95% CI, 1.18-7.59; P=0.021), left ventricular ejection fraction ≤25% (HR, 1.65; 95% CI, 0.98-2.77; P=0.059), and younger age (by 10 years; HR, 1.25; 95% CI, 1.00-1.52; P=0.046). Syncope was associated with increased risk of death regardless of its cause (arrhythmogenic syncope: HR, 4.51; 95% CI, 1.39-14.64, P=0.012; nonarrhythmogenic syncope: HR, 2.97; 95% CI, 1.07-8.28, P=0.038). Innovative programming of implantable cardioverter-defibrillators with therapy for ventricular tachycardia ≥200 bpm or a long delay is not associated with increased risk of arrhythmogenic or all-cause syncope, and syncope caused by slow ventricular tachycardias (<200 bpm) is a rare event. The clinical risk factors associated with syncope are

  20. Numerous Brugada syndrome-associated genetic variants have no effect on J-point elevation, syncope susceptibility, malignant cardiac arrhythmia, and all-cause mortality

    DEFF Research Database (Denmark)

    Ghouse, Jonas; Have, Christian T; Skov, Morten W

    2017-01-01

    PURPOSE: We investigated whether Brugada syndrome (BrS)-associated variants identified in the general population have an effect on J-point elevation as well as whether carriers of BrS variants were more prone to experience syncope and malignant ventricular arrhythmia and had increased mortality......S-associated variants. Electrocardiograms (ECG) were analyzed electronically, and data on syncope, ventricular arrhythmias, and mortality were obtained from administrative health-care registries. RESULTS: In HGMD, 382 BrS-associated genetic variants were identified. Of these, 28 variants were identified in the study...... cohort. None of the carriers presented with type 1 BrS ECG pattern. Mean J-point elevation in V1 and V2 were within normal guideline limits for carriers and noncarriers. There was no difference in syncope susceptibility (carriers 8/624; noncarriers 98/5,562; P = 0.51), ventricular arrhythmia (carriers 4...

  1. A single-center randomized controlled trial observing the safety and efficacy of modified step-up graded Valsalva manoeuver in patients with vasovagal syncope.

    Directory of Open Access Journals (Sweden)

    Li He

    Full Text Available Non-pharmacological therapies, especially the physical maneuvers, are viewed as important and promising strategies for reducing syncope recurrences in vasovagal syncope (VVS patients. We observed the efficacy of a modified Valsalva maneuver (MVM in VVS patients. 72 VVS patients with syncope history and positive head-up tilt table testing (HUTT results were randomly divided into conventional treatment group (NVM group, n = 36 and conventional treatment plus standard MVM for 30 days group (MVM group, n = 36. Incidence of recurrent syncope after 12 months (6.5% vs. 41.2%, P<0.01 and rate of positive HUTT after 30 days (9.7% vs.79.4%, P<0.01 were significantly lower in MVM group than in NVM group. HRV results showed that low frequency (LF, LF/ high frequency (HF, standard deviation of NN intervals (SDNN and standard deviation of all 5-min average NN intervals (SDANN values were significantly lower in the NVM and MVM groups than in the control group at baseline. After 30 days treatment, LF, LF/HF, SDNN, SDANN values were significantly higher compared to baseline in MVM group. Results of Cox proportional hazard model showed that higher SDNN and SDANN values at 30 days after intervention were protective factors, while positive HUTT at 30 days after intervention was risk factor for recurrent syncope. Our results indicate that 30 days MVM intervention could effectively reduce the incidence of recurrent syncope up to 12 months in VVS patients, possibly through improving sympathetic function of VVS patients.

  2. Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study

    Science.gov (United States)

    2014-01-01

    Background While Canadian ED physicians discharge most syncope patients with no specific further follow-up, approximately 5% will suffer serious outcomes after ED discharge. The goal of this study is to prospectively identify risk factors and to derive a clinical decision tool to accurately predict those at risk for serious outcomes after ED discharge within 30 days. Methods/Design We will conduct a prospective cohort study at 6 Canadian EDs to include adults with syncope and exclude patients with loss of consciousness > 5 minutes, mental status changes from baseline, obvious witnessed seizure, or head trauma prior to syncope. Emergency physicians will collect standardized clinical variables including historical features, physical findings, and results of immediately available tests (blood, ECG, and ED cardiac monitoring) prior to ED discharge/hospital admission. A second emergency physician will evaluate approximately 10% of study patients for interobserver agreement calculation of predictor variables. The primary outcome will be a composite serious outcome occurring within 30 days of ED discharge and includes three distinct categories: serious adverse events (death, arrhythmia); identification of serious underlying disease (structural heart disease, aortic dissection, pulmonary embolism, severe pulmonary hypertension, subarachnoid hemorrhage, significant hemorrhage, myocardial infarction); or procedures to treat the cause of syncope. The secondary outcome will be any of the above serious outcomes either suspected or those occurring in the ED. A blinded Adjudication Committee will confirm all serious outcomes. Univariate analysis will be performed to compare the predictor variables in patients with and without primary outcome. Variables with p-values syncope patients; however, validation and implementation will still be required. This program of research should lead to standardized care of syncope patients, and improve patient safety. PMID:24629180

  3. Comparison of Incidence, Predictors, and the Impact of Co-Morbidity and Polypharmacy on the Risk of Recurrent Syncope in Patients <85 Versus ≥85 Years of Age

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth; Hansen, Morten Lock; Lamberts, Morten

    2013-01-01

    Recurrent syncope is a major cause of hospitalizations and may be associated with cardiovascular co-morbidities. Despite this, prognostic factors and the clinical characteristics among patients are not well described. Therefore, we identified and analyzed data on all patients >50 years of age...... discharged after a first-time episode of syncope in the period 2001 to 2009 through nationwide administrative registries. We identified the clinical characteristics of 5,141 patients ≥85 years of age and 23,454 patients...

  4. Self-controllable prodromal symptoms of syncope attributed to carotid sinus syndrome during the end stage of cancer: a case report

    OpenAIRE

    Hasuo, Hideaki; Kanbara, Kenji; Sakuma, Hiroko; Matsumori, Rie; Fukunaga, Mikihiko

    2016-01-01

    Background Carotid sinus syndrome (CSS) can cause prodromal symptoms of syncope such as dizziness and nausea. Patients with end-stage cancer lose self-efficacy associated with reduced activities of daily life (ADL). Herein, we report a case of end-stage cancer in which self-efficacy was enhanced as the patient gained self-control of prodromal symptoms of syncope. Case presentation A 70-year-old patient with end-stage esophageal cancer and enlarged supraclavicular lymph nodes developed CSS. Th...

  5. The Elusive Path of Brain Tissue Oxygenation and Cerebral Perfusion in Harness Hang Syncope in Mountain Climbers.

    Science.gov (United States)

    Lanfranconi, Francesca; Pollastri, Luca; Corna, Giovanni; Bartesaghi, Manuela; Novarina, Massimiliano; Ferri, Alessandra; Miserocchi, Giuseppe Andrea

    2017-12-01

    Lanfranconi, Francesca, Luca Pollastri, Giovanni Corna, Manuela Bartesaghi, Massimiliano Novarina, Alessandra Ferri, and Giuseppe Andrea Miserocchi. The elusive path of brain tissue oxygenation and cerebral perfusion in harness hang syncope in mountain climbers. High Alt Med Biol. 18:363-371, 2017. Harness hang syncope (HHS) is a risk that specifically affects wide ranges of situations requiring safety harnesses in mountains. An irreversible orthostatic stasis could lead to death if a prompt rescue is not performed. We aimed at evaluating the risk of developing HHS and at identifying the characteristics related to the pathogenesis of HHS. Forty adults (aged 39.1 [8.2] years) were enrolled in a suspension test lasting about 28.7 (11.4) minutes. We measured cardiovascular parameters, and near infrared spectroscopy (NIRS) was used to assess cerebral hypoxia by changes in the concentration of oxyhemoglobin (Δ[HbO 2 ]) and de-oxyhemoglobin (Δ[HHb]). In the four participants who developed HHS: (1) systolic and diastolic blood pressure showed ample oscillations with a final abrupt drop (∼30 mmHg); (2) Δ[HbO 2 ] increased after 8-12 minutes of suspension and reached a plateau before HHS; and (3) Δ[HHb] decreased with a final abrupt increase before syncope. Participants who developed HHS failed to activate cardiovascular reflexes that usually safeguard O 2 availability to match the metabolic needs of the brain tissue. Since cerebral hypoxia was detected as an early phenomenon by Δ[HbO 2 ] and Δ[HHb] changes, NIRS measurement appears to be the most important parameter to monitor the onset of HHS.

  6. Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system

    Science.gov (United States)

    Jacob, G.; Robertson, D.; Mosqueda-Garcia, R.; Ertl, A. C.; Robertson, R. M.; Biaggioni, I.

    1997-01-01

    PURPOSE: Orthostatic intolerance is the cause of significant disability in otherwise normal patients. Orthostatic tachycardia is usually the dominant hemodynamic abnormality, but symptoms may include dizziness, visual changes, discomfort in the head or neck, poor concentration, fatigue, palpitations, tremulousness, anxiety and, in some cases, syncope. It is the most common disorder of blood pressure regulation after essential hypertension. There is a predilection for younger rather than older adults and for women more than men. Its cause is unknown; partial sympathetic denervation or hypovolemia has been proposed. METHODS AND MATERIALS: We tested the hypothesis that reduced plasma renin activity, perhaps from defects in sympathetic innervation of the kidney, could underlie a hypovolemia, giving rise to these clinical symptoms. Sixteen patients (14 female, 2 male) ranging in age from 16 to 44 years were studied. Patients were enrolled in the study if they had orthostatic intolerance, together with a raised upright plasma norepinephrine (> or = 600 pg/mL). Patients underwent a battery of autonomic tests and biochemical determinations. RESULTS: There was a strong positive correlation between the blood volume and plasma renin activity (r = 0.84, P = 0.001). The tachycardic response to upright posture correlated with the severity of the hypovolemia. There was also a correlation between the plasma renin activity measured in these patients and their concomitant plasma aldosterone level. CONCLUSIONS: Hypovolemia occurs commonly in orthostatic intolerance. It is accompanied by an inappropriately low level of plasma renin activity. The degree of abnormality of blood volume correlates closely with the degree of abnormality in plasma renin activity. Taken together, these observations suggest that reduced plasma renin activity may be an important pathophysiologic component of the syndrome of orthostatic intolerance.

  7. Transvenous stimulation of the renal sympathetic nerves increases systemic blood pressure: a potential new treatment option for neurocardiogenic syncope.

    Science.gov (United States)

    Madhavan, Malini; Desimone, Christopher V; Ebrille, Elisa; Mulpuru, Siva K; Mikell, Susan B; Johnson, Susan B; Suddendorf, Scott H; Ladewig, Dorothy J; Gilles, Emily J; Danielsen, Andrew J; Asirvatham, Samuel J

    2014-10-01

    Neurocardiogenic syncope (NCS) is a common and sometimes debilitating disorder, with no consistently effective treatment. NCS is due to a combination of bradycardia and vasodilation leading to syncope. Although pacemaker devices have been tried in treating the bradycardic aspect of NCS, no device-based therapy exists to treat the coexistent vasodilation that occurs. The renal sympathetic innervation has been the target of denervation to treat hypertension. We hypothesized that stimulation of the renal sympathetic nerves can increase blood pressure and counteract vasodilation in NCS. High-frequency stimulation (800-900 pps, 10 V, 30-200 seconds) was performed using a quadripolar catheter in the renal vein of 7 dogs and 1 baboon. A significant increase in blood pressure (BP; mean [SD] systolic BP 117 [±28] vs. 128 [±33], diastolic BP 75 [±19] vs. 87 [±29] mmHg) was noted during the stimulation, which returned to baseline after cessation of stimulation. The mean increase in systolic and diastolic BP was 13.0 (±3.3) (P = 0.006) and 10.2 (±4.6) (P = 0.08), respectively. We report the first ever study of feasibility and safety of high-frequency electrical stimulation of the renal sympathetic innervation to increase BP in animal models. This has potential applications in the treatment of hypotensive states such as NCS. © 2014 Wiley Periodicals, Inc.

  8. Syncope in children and adolescents as asudden, transient, short-term and spontaneously reversible loss of consciousness caused by adecrease in cerebral perfusion

    Directory of Open Access Journals (Sweden)

    Ewa Nowakowska

    2014-09-01

    Full Text Available Syncope is a common symptom in adolescents who come to the hospital emergency wards. The most common form of syncope is neurogenic type caused by impaired autoregulation of the circulatory system. This syncope is not generally life-threatening condition in a contrast to the less common but most dangerous cardiogenic type (e.g. cardiac arrhythmias due to Wolff–Parkinson–White syndrome, long QT time interval, atrioventricular blocks, haemodynamic obstructions in the outflow tract of the left or right ventricle, cardiomyopathy or coronary abnormalities. This paper refers to a new term, i.e. transient loss of consciousness. According to the new definition of syncope from 2009, temporary loss of consciousness has four components: a sudden occurrence, transient nature, short duration, and spontaneous regression. Currently, there are three main types of syncope associated with the cardiovascular system: neurogenic, orthostatic hypotension and a cardiac. The most common form in adolescents are neurogenic fainting which are often preceded by prodromal symptoms, i.e. decrease in blood pressure and heart rate. They can also occur in response to the stress or unusual situations. In the orthostatic syncope the loss of consciousness occurs in a very short time after the upright position and unlike neurogenic form, usually there are no prodromal symptoms, but tachycardia is present. The rarest, but also the most dangerous form of syncope is a cardiogenic type caused by arrhythmias or structural heart disease. This form may be the first sign of serious heart disease or even precede sudden cardiac death.

  9. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score.

    Science.gov (United States)

    Colivicchi, Furio; Ammirati, Fabrizio; Melina, Domenico; Guido, Vincenzo; Imperoli, Giuseppe; Santini, Massimo

    2003-05-01

    Aim of the present study was the development and the subsequent validation of a simple risk classification system for patients presenting with syncope to the emergency departments. A group of 270 consecutive patients (145 females, mean age 59.5 years) presenting with syncope to the emergency departments of six community hospitals of the Lazio region of Italy was used as a derivation cohort for the development of the risk classification system. Data from the baseline clinical history, physical examination and electrocardiogram were used to identify independent predictors of total mortality within the first 12 months after the initial evaluation. Multivariate analysis allowed the recognition of the following predictors of mortality: (1) age >65 years; (2) cardiovascular disease in clinical history; (3) syncope without prodromes; and (4) abnormal electrocardiogram. The OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) score was calculated by the simple arithmetic sum of the number of predictors present in every single patient. Mortality increased significantly as the score increased in the derivation cohort (0% for a score of 0, 0.8% for 1 point; 19.6% for 2 points; 34.7% for 3 points; 57.1% for 4 points; p<0,0001 for trend). A similar pattern of increasing mortality with increasing score was prospectively confirmed in a second validation cohort of 328 consecutive patients (178 females; mean age, 57.5 years). Clinical and electrocardiographic data available at presentation to the emergency department can be used for the risk stratification of patients with syncope. The OESIL risk score may represent a simple prognostication tool that could be usefully employed for the triage and management of patients with syncope in emergency departments.

  10. Application Of The American College Of Emergency Physicians (ACEP) Recommendations And a Risk Stratification Score (OESIL) For Patients With Syncope Admitted From The Emergency Department.

    Science.gov (United States)

    Baranchuk, Adrian; McIntyre, William; Harper, William; Morillo, Carlos A

    2011-09-01

    The goals of this study were to apply the 2001 ACEP recommendations for admission to hospital after a syncopal event and to validate the OESIL risk stratification score, in patients with syncope admitted to a general internal medicine ward. A retrospective study applied the 2001 ACEP recommendations and OESIL score to all the patients admitted from the emergency department to a general internal medicine ward with a diagnosis of syncope during a 12-month period. The patients were classified as meeting criteria for 2001 ACEP class B or C recommendations and OESIL score 0-1 (low-risk for a major cardiac event) or 2-4 (high-risk for a major cardiac event). The sensitivity and specificity of each group for predicting high-risk patients was calculated. After applying the 2001 ACEP recommendations to our population, 25% (19 patients) were classified as level B, whereas 68% of the patients were classified as Level C. Sensitivity for ACEP level B recommendations was 100% and specificity was 81%. The ACEP level C recommendations also had 100% sensitivity but markedly reduced specificity at 26%. An OESIL score of 0-1 points was calculated for 30.6% of the population, identifying them as low-risk. An OESIL score of 2-4 points was documented in the remaining 69.4% with a mortality risk of 20 % /year. A significant proportion (30%) of patients presenting with syncope to a tertiary care University Hospital emergency department and admitted to an Internal Medicine ward were retrospectively classified as low-risk and could have potentially been managed as outpatients. Implementing current guidelines and clinical pathways for the management of syncope may improve this approach.

  11. Costs of unstructured investigation of unexplained syncope: insights from a micro-costing analysis of the observational PICTURE registry.

    Science.gov (United States)

    Edvardsson, Nils; Wolff, Claudia; Tsintzos, Stelios; Rieger, Guido; Linker, Nicholas J

    2015-07-01

    The observational PICTURE (Place of Reveal In the Care pathway and Treatment of patients with Unexplained Recurrent Syncope) registry enrolled 570 patients with unexplained syncope, documented their care pathway and the various tests they underwent before the insertion of an implantable loop recorder (ILR). The aims were to describe the extent and cost of diagnostic tests performed before the implant. Actual costs of 17 predefined diagnostic tests were characterized based on a combination of data from PICTURE and a micro-costing study performed at a medium-sized UK university hospital in the UK. The median cost of diagnostic tests per patient was £1114 (95% CI £995-£1233). As many patients received more than the median number of tests, the mean expenditure per patient was higher with £1613 (95% CI £1494-£1732), and for 10% of the patients the cost exceeded £3539. Tests were frequently repeated, and early use of specific and expensive tests was common. In the 12% of patients with types of tests entirely within the recommendations for an initial evaluation before ILR implant, the mean cost was £710. Important opportunities to reduce test-related costs before an ILR implant were identified, e.g. by more appropriate use of tests recommended in the initial evaluation, by decreasing repetition of tests, and by avoiding early use of specialized and expensive tests. A structured multidisciplinary approach would be the best model to achieve an optimal outcome. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  12. Home orthostatic training in vasovagal syncope modifies autonomic tone: results of a randomized, placebo-controlled pilot study.

    Science.gov (United States)

    Tan, Maw Pin; Newton, Julia L; Chadwick, Tom J; Gray, Janine C; Nath, Samiran; Parry, Steve W

    2010-02-01

    To detect possible autonomic changes due to home orthostatic training (HOT) and to assess the feasibility of a larger, placebo-controlled study of HOT in vasovagal syncope (VVS). Twenty-two consecutive patients, aged 18-85, diagnosed with VVS following a positive head-up tilt-table test were randomized to 40 min of HOT (n = 12) or 10 min of sham training (n = 10) daily for 6 months. Baroreflex sensitivity (BRS) and heart rate variability (HRV) were measured at weeks 0, 1, 4, and 24. Symptom response was assessed by event diaries. Home orthostatic training resulted in increases in up and down slope BRS at week 4 (e(log difference) = 1.59, 95% CI = 0.84-3.03 and 1.79, 95% CI = 1.00-3.22) and week 24 (e(log difference) = 1.75, 95% CI = 1.01-3.06 and 1.53, 95% CI = 0.66-2.68) compared with placebo. Relative improvements in low- and high-frequency HRV were also observed in the HOT group compared with placebo at week 4 (e(log difference) = 3.22, 95% CI = 1.06-9.86 and 3.19, 95% CI = 1.03-10.59) and week 24 (e(log difference) = 2.11, 95% CI = 0.72-6.17 and 2.13, 95% CI = 0.52-8.79). Fifty percentage of HOT subjects and 20% of control subjects were syncope-free at 6 months. This was the first placebo-controlled study in orthostatic training which has demonstrated that such a study is indeed feasible. An enhancement in overall autonomic tone is observed with HOT in tandem with a non-significant trend in symptom improvement. A larger, adequately powered, randomized controlled trial of tilt-training is now needed.

  13. An early literary description of emotional syncope in the Fifth Canto of Dante Alighieri's Commedia: 'E caddi come corpo morto cade'.

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    Bruno, Estañol; Guillermo, Delgado; Eduardo, Jiménez-Mayo; Horacio, Sentíes-Madrid; Madrid, Horacio Sentíes

    2014-07-01

    Dante's Divine Comedy is universally acclaimed as one of the great masterpieces in world literature. It is written in first person singular and this gives an intimate acquaintance with the vision of the poet. In the Fifth Canto, he exquisitely describes the story of Paolo Malatesta and Francesca da Rimini, illicit lovers killed by Francesca's husband, Gianciotto Malatesta. The story, dramatically told by Francesca, deeply moves the poet, who suddenly faints. In the words of Dante himself: 'E caddi come corpo morto cade' (And fell, even as a dead body falls). This probably is the first literary description of an emotional syncope in world literature. We found that three great plastic artists (John Flaxman, William Blake and Gustave Doré) captured the crucial moment of the syncope in three extraordinary images left for posterity.

  14. A Study of the Relationship between Syncope Attacks and Diminished Carotid and Vertebral Artery Flow Using Doppler Ultrasonography of Cervical Vessels

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    V Shaygan Nejad

    2005-03-01

    Full Text Available Background:Syncope or drop attack is a common and potentially serious condition and prompt evaluation of the affected patients should be evaluated prompting for cardiac disease, seizure, structural lesions of the brain or peripheral nerves, as well as drug induced and metabolic disturbances. This study was conducted to evaluate carotid and vertebral arteries blood flow in patients with syncope in which other etiologies had been ruled out. Methods: This one-year retrospective case-control study involved 33 patients (case group and 33 normal individuals (control group. Carotid and vertebral arteries blood flow was measured in all subjects (ml/min and SPSS was used for data analysis. Results: Mean blood flow in vertebral arteries in the case group was significantly lower than in the control group (P<0.001, however mean carotid artery flow was not significantly different between them (P=0.58. Conclusion: Based on our results and findings of some other studies, we recommend duplex ultrasonography of vertebral and cervical arteries in patients suffering from drop attacks, after ruling out the prominent etiologies, such as seizure, heart disease, etc. Keywords: syncope, ultrasound, carotid artery, vertebral artery

  15. Role of emergency department observation units in the management of patients with unexplained syncope: a critical review and meta-analysis.

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    Numeroso, Filippo; Mossini, Gianluigi; Lippi, Giuseppe; Cervellin, Gianfranco

    2017-12-01

    This meta-analysis aimed to establish the role of standardized emergency department (ED) observation protocols in the management of syncopal patients as an alternative to ordinary admission. A systematic electronic literature search was performed to identify randomized controlled trials or observational studies evaluating syncopal patients managed in ED observation units. Data regarding mean length of stay, rate of etiological diagnosis, admission rate, and incidence of short-term serious outcomes were extracted. Six mostly single-center, small sized studies characterized by high heterogeneity, were included. A total of 458 patients were included with a balanced sex distribution (male 50.2%), a mean age of 60.1 years, and a considerable prevalence of heart disease (32.4%). Pooled analysis of the outcomes showed a mean stay of 28.2 hours, an etiological diagnosis rate of 67.3%, an admission rate of 18.5%, and a very low incidence of short-term serious outcomes (2.8%). Due to elevated diagnostic yield and low incidence of short-term adverse events, ED observation units-based management strategy seems ideal for patients with syncope. Nevertheless, further research is needed to identify criteria for selecting patients to be managed with this approach, define evaluation protocols, and confirm the safety of this strategy.

  16. Self-controllable prodromal symptoms of syncope attributed to carotid sinus syndrome during the end stage of cancer: a case report.

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    Hasuo, Hideaki; Kanbara, Kenji; Sakuma, Hiroko; Matsumori, Rie; Fukunaga, Mikihiko

    2016-01-01

    Carotid sinus syndrome (CSS) can cause prodromal symptoms of syncope such as dizziness and nausea. Patients with end-stage cancer lose self-efficacy associated with reduced activities of daily life (ADL). Herein, we report a case of end-stage cancer in which self-efficacy was enhanced as the patient gained self-control of prodromal symptoms of syncope. A 70-year-old patient with end-stage esophageal cancer and enlarged supraclavicular lymph nodes developed CSS. The CSS was a mixed type with both bradycardia and decreased blood pressure, accompanied by prodromal symptoms prior to syncope episodes. The patient incidentally discovered that he could decrease the duration of symptoms by contracting the muscles in his hands and legs. By applying this coping method at the onset of prodromal symptoms, he was also able to reduce the severity and duration of symptoms, which resulted in enhanced self-efficacy. As a result, the frequency of prodromal symptoms also decreased even though ADL improved. This patient was diagnosed with vasoinhibitory-predominant mixed-type CSS. The coping method the patient developed seemed to avoid the onset of abrupt blood pressure decrease via peripheral vascular constriction action. Achievement of adequate coping such as self-control of prodromal symptoms enabled our patient to improve his self-efficacy even at the end stages of cancer. This case of enhanced self-efficacy could possibly illustrate a placebo effect for prevention of recurrence.

  17. Central and cardiovascular responses to emotional stimuli are normal in non-phobic subjects with Reflex Syncope.

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    Calandra-Buonaura, G; Cortelli, P; Pierangeli, G; Ribani, M A; Barletta, G; Mazzetti, M; Codispoti, M

    2008-09-01

    Reflex Syncope (RS) is a self-limited loss of consciousness due to systemic arterial hypotension resulting from widespread vasodilatation and/or bradycardia. Higher neural centres have been implicated in the pathophysiology of RS, particularly in blood/injury phobic patients. We investigated interictal central autonomic functions in non-phobic RS subjects compared to non-phobic controls evaluating their central and cardiovascular responses to emotional stimuli. Cardiovascular responses to Valsalva Manoeuvre (VM), Deep Breathing (DB) and during presentation of 108 slides selected from the International Affective Picture System were assessed in 20 non-phobic RS subjects and 20 controls. Slide onset visual event-related potentials (ERPs) were also computed. No significant difference in cardiovascular responses and ERP amplitude were found in non-phobic RS subjects and controls at rest, in response to VM and DB or during picture presentation. Non-phobic patients with RS not only have a normal interictal autonomic control of the cardiovascular system but also a normal modulation and adaptation of central and cardiovascular response to emotional processing, in our experimental setting. Non-phobic patients with RS present normal interictal central and cardiovascular responses. Autonomic dysfunction observed in phobic RS patients could be related to mechanisms underlying the phobia itself rather than the mechanisms causing RS.

  18. A Right-sided Aortic Arch with Kommerell's Diverticulum of the Aberrant Left Subclavian Artery Presenting with Syncope

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    Ming-Hsun Yang

    2009-05-01

    Full Text Available A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch. Fewer than 50 cases have been reported in the literature. A number of operative strategies are described. Right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. In our patient with symptoms of dysphagia, syncope, and left subclavian steal syndrome, a left thoracotomy was used. The repair was accomplished by division of a left ligamentum arteriosum, obliteration of the Kommerell's aneurysm, and an aorto-subclavian bypass. Postoperative complications included left vocal cord palsy and Horner's syndrome. Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up. We believe a left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method without the increased morbidity found in other procedures.

  19. [Determination of prognostic value of the OESIL risk score at 6 months in a Colombian cohort with syncope evaluated in the emergency department; first Latin American experience].

    Science.gov (United States)

    Díaz-Tribaldos, Diana Carolina; Mora, Guillermo; Olaya, Alejandro; Marín, Jorge; Sierra Matamoros, Fabio

    2017-07-14

    To establish the prognostic value, with sensitivity, specificity, positive predictive value, and negative predictive value for the OESIL syncope risk score to predict the presentation of severe outcomes (death, invasive interventions, and readmission) after 6 months of observation in adults who consulted the emergency department due to syncope. Observational, prospective, and multicentre study with enrolment of subjects older than 18 years, who consulted in the emergency department due to syncope. A record was mad of the demographic and clinical information of all patients. The OESIL risk score was calculated, and severe patient outcomes were followed up during a 6 month period using telephone contact. A total of 161 patients met the inclusion criteria and were followed up for 6 months. A score above or equal to 2 in the risk score, classified as high risk, was present in 72% of the patients. The characteristics of the risk score to predict the combined outcome of mortality, invasive interventions, and readmission for a score above or equal to 2 were 75.7, 30.5, 43.1, and 64.4% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. A score above or equal to 2 in the OESIL risk score applied in Colombian population was of limited use to predict the studied severe outcomes. This score will be unable to discriminate between patients that benefit of early admission and further clinical studies. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient.

    Science.gov (United States)

    Clemmensen, Tor Skibsted; Mølgaard, Henning; Andersen, Niels Frost; Baerentzen, Steen; Poulsen, Steen Hvitfeldt

    2016-01-01

    Patients with cardiac amyloidosis are at increased AV-block and syncope risk. Therefore, a prophylactic pacemaker is often implanted. However, this case illustrates that other mechanisms should be ruled out prior to pacemaker implantation. The patient studied had mitral valve thickening without increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients' symptoms were likely explained by these findings. Therefore, a comprehensive clinical evaluation is warranted prior to pacemaker implantation in cardiac amyloidosis patients.

  1. Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient

    Directory of Open Access Journals (Sweden)

    Tor Skibsted Clemmensen

    2016-01-01

    Full Text Available Patients with cardiac amyloidosis are at increased AV-block and syncope risk. Therefore, a prophylactic pacemaker is often implanted. However, this case illustrates that other mechanisms should be ruled out prior to pacemaker implantation. The patient studied had mitral valve thickening without increased left ventricular outflow track (LVOT velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients’ symptoms were likely explained by these findings. Therefore, a comprehensive clinical evaluation is warranted prior to pacemaker implantation in cardiac amyloidosis patients.

  2. Síncope y escalas de riesgo: ¿Qué evidencia se tiene? Syncope and risk scales: What evidence do we have?

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    Guillermo Mora

    2011-12-01

    Full Text Available Objetivo: hacer una revisión de las escalas de riesgo existentes para predecir eventos adversos relacionados con síncope. Metodología: se realizó una búsqueda de artículos en MEDLINE, EMBASE y Cochrane Database of Systematic Reviews con el uso de las palabras clave relacionadas con reglas de predicción clínica (algoritmos, análisis multivariado, guías de predicción clínica, escalas, modelos logísticos, valoración de riesgo y síncope. Adicionalmente, se buscó literatura con el uso de la estrategia de bola de nieve. Resultados: se encontraron nueve escalas que relacionaron el síncope con predicción de eventos adversos. Se hallaron diferencias en los criterios para definir riesgo, las variables de desenlace, la población estudiada, el uso de una estrategia prospectiva o retrospectiva y el tiempo de seguimiento. Conclusiones: aunque existen varias escalas para la definición de riesgo con el paciente que ingresa por síncope a urgencias, no hay evidencia de que alguna sea superior a otra, tienen poca validez externa y no se han aplicado en nuestro medio.Objective: perform a review of the existing risk scales to predict adverse events associated with syncope. Method: we conducted a search of MEDLINE, EMBASE and Cochrane Database of Systematic Reviews using the keywords related to clinical prediction rules (algorithms, multivariate analysis, clinical prediction guides, scales, logistic models, risk assessment and syncope. Additionally, literature was searched using the snowball strategy. Results: we found nine scales that associated syncope with prediction of adverse events. We found differences in the criteria for defining risk, the outcome variables, the study population, the use of a prospective or retrospective strategy and the follow-up time. Conclusions: although there are several scales for the definition of risk facing the patient admitted with syncope to the ER, there is no evidence that any one is superior to another, have

  3. Differential effect of ganglionic plexi ablation in a patient with neurally mediated syncope and intermittent atrioventricular block.

    Science.gov (United States)

    Fukunaga, Masato; Wichterle, Dan; Peichl, Petr; Aldhoon, Bashar; Čihák, Robert; Kautzner, Josef

    2017-01-01

    In patients with severe neurally mediated syncope (NMS), radiofrequency catheter ablation (RFA) of ganglionic plexi (GP) has been proposed as a new therapeutic approach. Cardio-inhibitory response during NMS is usually related to the sinoatrial (SA) and less frequently to atrioventricular (AV) node. Differential effect of GP ablation on SA and AV node is poorly understood. We report a case of a 35-year-old female with frequent symptomatic episodes of advanced AV block treated by anatomically guided RFA at empirical sites of GPs. After RFA at the septal portion of the right atrium-superior vena cava junction, heart rate accelerated from 62 to 91 beats/min and PR interval prolonged from 213 to 344 ms. Sustained first-degree AV block allowed to observe directly the effects of subsequent RFA on the AV nodal properties. Subsequent RFA at right- and left-sided aspects of the inter-atrial septum had no further effect on heart rate and PR interval. Ablation at the inferior left GP was critical for restoration of normal AV conduction (final PR interval of 187 ms). No bradycardia episodes were observed by implantable loop recorder during the follow-up of 10 months and the patient was symptomatically improved. This is the first clinical case showing the differential effect of GP ablation on SA and AV nodal function, and critical importance of targeting the GP at the postero-inferior left atrium. The successful procedure corroborates clinical utility of ablation treatment instead of pacemaker implantation in selected patients with cardio-inhibitory NMS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  4. Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

    Science.gov (United States)

    Martens, Leon; Goode, Grahame; Wold, Johan F H; Beck, Lionel; Martin, Georgina; Perings, Christian; Stolt, Pelle; Baggerman, Lucas

    2014-01-01

    To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines. Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four. With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests. Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

  5. Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

    Directory of Open Access Journals (Sweden)

    Leon Martens

    Full Text Available To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1 Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2 Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3 Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048 and a 75% increase in diagnostic yield (p = 0.007. There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

  6. Treatment for Syncope

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  7. Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence Neuralgia glossofaríngea com síncope como um sinal de recidiva de câncer do pescoço

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    Reinaldo Teixeira Ribeiro

    2007-12-01

    Full Text Available Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.Neuralgia glossofaríngea com síncope como um sinal de câncer do pescoço é uma condição muito rara. Uma revisão da literatura revelou apenas 29 casos relatados anteriormente. Apresentamos o primeiro caso brasileiro de tal associação. Um homem de 68 anos se apresentou com dores paroxísticas insuportáveis no lado direito do pescoço, algumas vezes seguidas de síncope. Dada a suspeita de recidiva tumoral derivada de uma malignidade cervical tratada previamente, realizou-se um exame de tomografia computadorizada que evidenciou um tumor parafaríngeo direito. As dores e as síncopes foram controladas satisfatoriamente com carbamazepina e o paciente foi submetido à radioterapia paliativa.

  8. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

    Energy Technology Data Exchange (ETDEWEB)

    Avanesov, Maxim; Weinrich, Julius; Well, Lennart; Tahir, Enver; Adam, Gerhard; Lund, Gunnar [University Hospital Hamburg Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Muench, Julia; Patten, Monica [University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg (Germany); DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg (Germany); Saering, Dennis [University of Applied Sciences, Information Technology and Image Processing, Wedel (Germany); Stehning, Christian [Philips Research, Hamburg (Germany); Bohnen, Sebastian; Radunski, Ulf K.; Muellerleile, Kai [University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg (Germany)

    2017-12-15

    To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. (orig.)

  9. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

    International Nuclear Information System (INIS)

    Avanesov, Maxim; Weinrich, Julius; Well, Lennart; Tahir, Enver; Adam, Gerhard; Lund, Gunnar; Muench, Julia; Patten, Monica; Saering, Dennis; Stehning, Christian; Bohnen, Sebastian; Radunski, Ulf K.; Muellerleile, Kai

    2017-01-01

    To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. (orig.)

  10. [Experience with the use of an implantable loop recorder in a series of older people with falls and suspected arrhythmic syncopes].

    Science.gov (United States)

    Martínez, Paula; Pilar Sáez, María; Rubio, José Amador; Cánovas, Ester; Esteban, Elena; Botas, Javier

    2014-01-01

    To review our experience on using an implantable loop recorder (ILR) in patients with recurrent falls, when an arrhythmogenic cause is suspected. This is a retrospective, observational study of patients with repetitive unexplained falls, suspected syncope, or electrocardiographic abnormalities. All of them had been evaluated by a cardiologist, who decided to implant a loop recorder (ILR) for an accurate diagnosis. A total of 13 patients received an ILR. The average falls rate for the sample was 3.3. The mean age was 78 years, and 46% were female, with a mean follow-up period of 24 months. During this time, three patients did not suffer from a new fall. An arrhythmogenic diagnosis was obtained in 5 patients: bradycardia was identified in 4 cases, and tachycardia in one of them. The symptoms did not coincide with a documented arrhythmia in the rest of the patients. ILR is a helpful tool to establish an arrhythmogenic cause of unexplained and recurrent falls, in this selected sample of older adults. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

  11. Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise

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    Ran Baik

    2010-02-01

    Full Text Available Anomalous origins of coronary arteries are a rare type of disease among children. These anomalies can be categorized into 3 types according to the anatomical relationship of the aorta and pulmonary trunks. Among these types, the interarterial type, as observed in our case, needs early diagnosis and treatment, because it can increase the risk for the patient, causing sudden cardiac death in young individuals. Although there are controversies concerning the management of anomalous origins of the left coronary artery (LCA in children, the result can be very beneficial, if treated accurately. Three well-known methods for correction of anomalous origins of LCA are re-implantation, coronary arterial bypass grafting (CABG, and unroofing. We report on the case of a 12-year-old girl who had chest discomfort and syncope with physical exercise and was later diagnosed with an anomalous origin of LCA by transthoracic echocardiography (TTE and heart computed tomography (CT. She underwent a corrective operation by re-implantation, CABG, and unroofing.

  12. Esclerosis sistémica complicada con síncope y bloqueo AV completo Systemic sclerosis complicated with syncope and complete AV block

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    Francisco Femenía

    2010-10-01

    Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.Systemic sclerosis is a complex disease that affects the connective tissue, the vascular system and the immune system. It typically produces skin and organ fibrosis. Cardiac bundle branch blocks and fascicular blocks occur in 25-75% of the cases and were found to be independent predictors of mortality. Second and third degree atrioventricular block are very rare. We present the case of a 47 year-old female with diagnosis of systemic sclerosis, presented with syncope secondary to complete atrioventricular block requiring permanent pacemaker implantation.

  13. Relationship between human evolution and neurally mediated syncope disclosed by the polymorphic sites of the adrenergic receptor gene α2B-AR.

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    Tomoyoshi Komiyama

    Full Text Available The objective of this study was to clarify the effects of disease on neurally mediated syncope (NMS during an acute stress reaction. We analyzed the mechanism of the molecular interaction and the polymorphisms of the alpha-2 adrenoreceptor (α2B-AR gene as the potential psychiatric cause of incentive stress. We focused on the following three genotypes of the repeat polymorphism site at Glu 301-303 in the α2B-AR gene: Glu12/12, Glu12/9, and Glu9/9. On the basis of our clinical research, NMS is likely to occur in people with the Glu12/9 heterotype. To verify this, we assessed this relationship with the interaction of Gi protein and adenylate cyclase by in silico analysis of the Glu12/9 heterotype. By measuring the difference in the dissociation time of the Gi-α subunit twice, we found that the Glu12/9 heterotype suppressed the action of adenylate cyclase longer than the Glu homotypes. As this difference in the Glu repeat number effect is thought to be one of the causes of NMS, we investigated the evolutionary significance of the Glu repeat number. Glu8 was originally repeated in simians, while the Glu12 repeats occurred over time during the evolution of bipedalism in humans. Taken with the Glu12 numbers, NMS would likely become a defensive measure to prevent significant blood flow to the human brain.

  14. Síncope em pacientes com extra-sístoles de via de saída de ventrículo direito e sem cardiopatia estrutural aparente Syncope in patients with right ventricle outflow tract premature beats and no apparent structural cardiopathy

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    Ana Cristina Ludovice

    2006-11-01

    Full Text Available OBJETIVO: Estudar a prevalência de síncope neurocardiogênica em pacientes com síncope inexplicada e extra-sístoles ventriculares (EV, com morfologia de via de saída de ventrículo direito (VSVD sem cardiopatia estrutural aparente. MÉTODOS: Noventa pacientes (66 mulheres, idade média de 40,2 ± 16,95 anos com EV monomórficas com origem na VSVD foram avaliados prospectivamente. Cinqüenta e quatro pacientes apresentavam síncopes ou pré-síncopes associadas ou não a palpitações; 27 apresentavam palpitações sem pré-síncope ou síncope, e 9 eram assintomáticos. Todos foram submetidos a ecocardiograma, ECG de alta resolução, ressonância magnética cardíaca e teste de esforço para afastar cardiopatia estrutural e taquicardia ventricular adrenérgico-dependente, e a monitorização com Holter e monitor de eventos sintomáticos para correlacionar os sintomas com a arritmia. A investigação de suscetibilidade a síncope neurocardiogênica foi avaliada pelo teste de inclinação (TI. Os grupos foram comparados quanto a sexo, idade, freqüência e complexidade das extra-sístoles, com e sem esforço físico, resultado do TI e evolução clínica. RESULTADOS: No grupo com síncope e pré-síncope, o TI foi positivo em 38% dos casos e nos grupos com palpitações e assintomáticos, em 11% (p = 0,0257. Após orientação e tratamento da síncope neurocardiogênica, 85% dos pacientes com síncope e pré-sincope e TI positivo permaneceram assintomáticos durante seguimento médio de 40 meses. Dois pacientes com síncope e TI negativos apresentaram taquicardia ventricular sustentada espontânea durante a evolução clínica. CONCLUSÃO: A prevalência de síncope neurocardiogênica em pacientes com EV idiopáticas de VSVD é alta. Pacientes com síncope recorrente inexplicada e EV idiopáticas devem ser mantidos sob investigação.OBJECTIVE: Study the prevalence of neurocardiogenic etiology in patients with unexplained syncope and

  15. Hyperventilation, cerebral perfusion, and syncope

    DEFF Research Database (Denmark)

    Immink, R V; Pott, F C; Secher, N H

    2014-01-01

    the contribution of a low PaCO2 to the early postural reduction in middle cerebral artery blood velocity is transient. HV together with postural stress does not reduce cerebral perfusion to such an extent that TLOC develops. However when HV is combined with cardiovascular stressors like cold immersion or reduced...... dioxide (PaCO2) and oxygen (PaO2) partial pressures so that hypercapnia/hypoxia increases and hypocapnia/hyperoxia reduces global cerebral blood flow. Cerebral hypoperfusion and TLOC have been associated with hypocapnia related to HV. Notwithstanding pronounced cerebrovascular effects of PaCO2...

  16. Síndrome de Brugada en un paciente con síncope: Presentación de un caso y revisión de la literatura Brugada syndrome in a patient with syncope: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Carlos J Jaramillo

    2010-08-01

    Full Text Available El síndrome de Brugada es una enfermedad autosómica dominante esporádica que afecta los canales de sodio de los miocardiocitos. Clínicamente se caracteriza por síncopes recurrentes y/o muerte súbita, que en el electrocardiograma simula un bloqueo de rama derecha, acompañado de elevación peculiar del segmento ST en las derivaciones precordiales derechas (V1, V2 y V3 sin alteración cardiaca estructural. Afecta principalmente a hombres en la cuarta década de la vida y tiene mayor prevalencia en el suroeste asiático. El caso que se describe corresponde a un paciente con antecedentes personales de síncopes, a quien se le encuentra un patrón electrocardiográfico tipo-2 de Brugada y quien además tiene un hermano con historia de síncopes. Con una prueba de mesa basculantes positivo para síncope mediado neuralmente se deja este diagnóstico, pero no se descarta la sospecha inicial de síndrome de Brugada.Brugada syndrome is a sporadic autosomal dominant genetic disease that affects cardiac sodium channels. It is clinically characterized by recurrent syncope and/or sudden death with electrocardiographic manifestations that simulate a right bundle branch block accompanied by ST-segment elevation in the right precordial leads (V1, V2 and V3 without structural cardiac changes. It mainly affects men in their fourth decade and is most prevalent in southwestern Asia. We present the case of a patient with history of syncope, type-2 Brugada electrocardiographic pattern and who has a brother also with history of syncope. The patient had a positive tilt test for neurocardiogenic syncope. He was diagnosed as neurocardiogenic syndrome, without discarding the initial suspicion of Brugada syndrome.

  17. A memória e o valor da síncope: da diferença do que ensinam os antigos e os modernos Memory and value of syncopation: on the difference between what the old and the modern teach

    Directory of Open Access Journals (Sweden)

    Sérgio Paulo Ribeiro de Freitas

    2010-12-01

    Full Text Available A síncope é um tema privilegiado nos estudos da música popular que reaparece aqui em um conjunto de considerações que, marcado pelo viés dos saberes das velhas disciplinas de Contraponto e Harmonia, sublinham a interação e, principalmente, a inseparabilidade entre métrica (divisão, ritmo, acentuação, prosódia, etc. e altura (notas, intervalos, relação dissonância-consonância, acordes, notas auxiliares, etc. na apreciação crítica das figurações sincopadas. Na primeira parte percorre-se uma mínima memória da arte e da teoria da síncope na tradição ocidental culta para, na segunda parte, observar-se que, em medida tácita e sutil, resíduos dessa tradição afetam juízos de valor em alguns dos sincopados cenários da música popular atual.Syncopation is a privileged issue in popular music studies that reappears here in a number of considerations that, marked by the bias of knowledge of the old disciplines of Counterpoint and Harmony, underline the interaction and, especially, the inseparability between metric (division, rhythm, accentuation, prosody, etc. and pitches (notes, intervals, dissonance-consonance relationship, chords, auxiliary notes, etc. in a critical analysis of the figures of syncopation. The first part covers up a minimum memory of the art and theory of syncopation in the Western erudite tradition, so that, in the second part, it can be noted that, in tacit and subtle manner, residues of this tradition can affect the value judgment in some of the syncopated worlds of popular music today.

  18. Síncope cardíaca reflexa por "nevralgia" do glossofaríngeo: rara apresentação dessa doença Cardiac syncope induced by glossopharyngeal "neuralgia": a rare presentation

    Directory of Open Access Journals (Sweden)

    Helio Korkes

    2006-11-01

    Full Text Available A primeira descrição de dor severa no trajeto do nervo glossofaríngeo foi realizada por Weisenberg, em 1910¹, em um paciente com tumor do ângulo ponto cerebelar. Entretanto, coube a Harris, em 1926², nomear como nevralgia do nervo glossofaríngeo esse raro quadro clínico, caracterizado por paroxismos de dor intensa, unilaterais, na região posterior da língua, no palato mole, na garganta e na região lateral e posterior da faringe, irradiando para o ouvido. A dor pode ser desencadeada por deglutição, tosse, bocejo ou mastigação e normalmente dura de segundos a minutos. A associaç��o de nevralgia do glossofaríngeo e síncope é muito rara e se deve a breves períodos de bradicardia, assistolia ou hipotensão, sendo a primeira descrição dessa associação, com essa fisiopatologia, realizada por Riley e cols., em 1942³.The first description of severe pain in the distribution of the glossopharyngeal nerve is credited to Weisenberg, in 1910¹, in a patient with cerebellopontine angle tumor. However, it was Harris, in 1926², who coined the term glossopharyngeal neuralgia to describe this rare condition characterized by paroxysms of excruciating pain located laterally at the back of the tongue, soft palate, throat, and lateral and posterior pharynx, radiating to the ear. Swallowing, coughing, yawning or chewing may trigger pain, which usually lasts from seconds to minutes. The association between glossopharyngeal neuralgia and syncope is very rare, being identified by brief episodes of bradycardia, asystole, and hypotension. Such an association, with this same pathophysiology, was first described by Riley et al³ in 1942.

  19. Avaliação da função autonômica em portadores de cardiomiopatia hipertrófica com e sem síncope Evaluation of the autonomic function in patients with hypertrophic cardiomyopathy with and without syncope

    Directory of Open Access Journals (Sweden)

    Milena Frota Macatrão-Costa

    2013-02-01

    .BACKGROUND: Several mechanisms may be involved in the trigger of syncope in patients with hypertrophic cardiomyopathy (HCM, including hemodynamic collapses that might be related to an autonomic imbalance. OBJECTIVE: To evaluate and compare the autonomic function of patients presenting HCM with unexplained syncope (US to those without syncope. METHODS: Thirty-seven patients were included, 16 with US and 21 without syncope. Their autonomic function was assessed by spontaneous and phenylephrine induced baroreflex sensitivity (BRS, by heart rate variability (HRV in time domain during 24-hour Holter and in frequency domain (spectral analysis, both in supine position and at 70º head-up tilt (HUT. RESULTS: The spontaneous BRS was similar in both groups (16,46 ± 12,99 vs. 18,31 ± 9,88 ms/mmHg, p = 0,464, as was phenylephrine-induced BRS (18,33 ± 9,31 vs. 15,83 ± 15,48 ms/mmHg, p = 0,521. No differences were observed in SDNN (137,69 ± 36,62 vs . 145,95 ± 38,07 ms, p=0,389. The group presenting syncope had a significantly lower RMSSD (24,88±10,03 vs. 35,58 ± 16,43 ms, p = 0,042 and a tendency to lower pNN50 (4,51 ± 3,78 vs . 8,83 ± 7,98%, p =0,085 and lower values of the high frequency component of HRV spectral analysis at rest (637,59±1.295,53 vs. 782,65±1.264,14ms2, p=0,075. No significant difference was observed in response to HUT (p = 0,053. HUT sensitivity, specificity and accuracy in identifying the etiology of US in HCM patients were 6%, 66% and 40%, respectively. CONCLUSIONS: A lower parasympathetic tone was observed in HCM patients with US, but the clinical relevance of this finding remains unclear. HUT is not a valuable tool for evaluating the origin of syncope in these patients, mainly because of its poor specificity.

  20. Risk Factors and Causes of Syncope

    Science.gov (United States)

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  1. Syncope: electrocardiogram and autonomic function tests

    OpenAIRE

    Adrián Baranchuk; Federico Botero

    2016-01-01

    Resumen El Síncope representa uno de los principales motivos de consulta en los servicios de urgencias. Su adecuada identificación permitirá además de la optimización de los recursos en la salud, un diagnóstico acertado de la causa o posibles causas del mismo. Teniendo clara su clasificación, será la historia clínica, basada en un adecuado interrogatorio, la que permitirá establecer cuáles de esos pacientes presentan un síncope neuralmente mediado y cuales un síncope de origen cardiaco. El...

  2. Approach to syncope and altered mental status.

    Science.gov (United States)

    MacNeill, Emily C; Vashist, Sudhir

    2013-10-01

    Children who present with an episode of altered mental status, whether transient or persistent, present a diagnostic challenge for practitioners. This article describes some of the more common causes of altered mental status and delineates a rational approach to these patients. This will help practitioners recognize the life-threatening causes of these frightening presentations as well as help avoid unnecessary testing for the more benign causes. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. SynCoPation: Interactive Synthesis-Coupled Sound Propagation.

    Science.gov (United States)

    Rungta, Atul; Schissler, Carl; Mehra, Ravish; Malloy, Chris; Lin, Ming; Manocha, Dinesh

    2016-04-01

    Recent research in sound simulation has focused on either sound synthesis or sound propagation, and many standalone algorithms have been developed for each domain. We present a novel technique for coupling sound synthesis with sound propagation to automatically generate realistic aural content for virtual environments. Our approach can generate sounds from rigid-bodies based on the vibration modes and radiation coefficients represented by the single-point multipole expansion. We present a mode-adaptive propagation algorithm that uses a perceptual Hankel function approximation technique to achieve interactive runtime performance. The overall approach allows for high degrees of dynamism - it can support dynamic sources, dynamic listeners, and dynamic directivity simultaneously. We have integrated our system with the Unity game engine and demonstrate the effectiveness of this fully-automatic technique for audio content creation in complex indoor and outdoor scenes. We conducted a preliminary, online user-study to evaluate whether our Hankel function approximation causes any perceptible loss of audio quality. The results indicate that the subjects were unable to distinguish between the audio rendered using the approximate function and audio rendered using the full Hankel function in the Cathedral, Tuscany, and the Game benchmarks.

  4. GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF SYNCOPE (2009

    Directory of Open Access Journals (Sweden)

    Angel Moya

    2010-01-01

    Full Text Available Внешние эксперты: Haruhiko Abe (Япония, David G. Benditt (США, Wyatt W. Decker (США, Blair P. Grubb (США, Horacio Kaufmann9 (США, Carlos Morillo (Канада, Brian Olshansky (США, Steve W. Parry (Великобритания, Robert Sheldon (Канада, Win K. Shen (СШАЧлены Комитета Европейского общества кардиологов по практическим рекомендациям (ESC Committee for Practice Guidelines: CPG: Alec Vahanian (Председатель (Франция, Angelo Auricchio (Швейцария,Jeroen Bax (Нидерланды, Claudio Ceconi (Италия, Veronica Dean (Франция, Gerasimos Filippatos (Греция, Christian Funck-Brentano (Франция, Richard Hobbs (Великобритания, Peter Kearney (Ирландия, Theresa McDonagh (Великобритания, Keith McGregor (Франция, Bogdan A. Popescu (Румыния, Zeljko Reiner (Хорватия, Udo Sechtem (Германия, Per Anton Sirnes (Норвегия, Michal Tendera (Польша, Panos Vardas (Греция, Petr Widimsky (ЧехияРецензенты: Angelo Auricchio (Координатор от CPG (Швейцария, Esmeray Acarturk (Турция, Felicita Andreotti (Италия, Riccardo Asteggiano (Италия, Urs Bauersfeld (Швейцария, Abdelouahab Bellou4 (Франция, Athanase Benetos6 (Франция, Johan Brandt (Швеция, Mina K. Chung3 (США, Pietro Cortelli 8 (Италия, Antoine Da Costa (Франция, Fabrice Extramiana (Франция, Jose´ Ferro7 (Португалия, Bulent Gorenek (Турция, Antti Hedman (Финляндия, Rafael Hirsch (Израиль, Gabriela Kaliska (Словакия, Rose Anne Kenny6 (Ирландия, Keld Per Kjeldsen (Дания, Rachel Lampert 3 (USA, Henning Mølgard (Denmark, Rain Paju (Эстония, Aras Puodziukynas (Литва, Antonio Raviele (Италия, Pilar Roman5 (Испания, Martin Scherer (Германия, Ronald Schondorf 9 (Канада, Rosa Sicari (Италия, Peter Vanbrabant 4 (Бельгия, Christian Wolpert1 (Германия, Jose Luis Zamorano (Испания.

  5. Angiosarcoma of the Right Atrium Presenting as Syncope and Hemorrhagic Pericardial Tamponade

    Directory of Open Access Journals (Sweden)

    V. G. Sams

    2012-01-01

    Full Text Available Angiosarcoma of the heart is a rare malignancy that can present in many ways. It is an important diagnosis to consider in patients presenting with otherwise unexplained tamponade-type symptoms. Here we present a case of a young male who presented with hemorrhagic tamponade and underwent resection of a large angiosarcoma of the right atrium. In this case, we describe the rare presentation of angiosarcoma with its diagnostic approaches, hospital course, clinical management, and discussion.

  6. PECULIARITIES OF AUTONOMOUS REGULATION IN THE PATIENTS WITH SYNCOPE LIVING IN AN INDUSTRIAL CITY

    Directory of Open Access Journals (Sweden)

    Илья Дмитриевич Мартынов

    2017-09-01

    Conclusions. Taking into account the changes in the spectral indices of heart rate variability during an active orthostatic test, a pathogenetic approach to the early detection, treatment and prevention of cardiovascular diseases is possible.

  7. Sincope en la infancia y adolescencia Syncope in infants and adolescents

    OpenAIRE

    Sergio A. Antoniuk

    2007-01-01

    Objetivo. Revisar el Síncope en la infancia y adolescencia, su etiología, manifestaciones clínicas, fisiopatología, métodos diagnósticos y tratamiento. Desarrollo. El síncope es una entidad clínica caracterizada por una alteración o pérdida abrupta y transitoria de la conciencia y del tono postural, con recuperación espontánea y completa. El síncope es frecuente en niños y adolescentes. La causa más frecuente es el neurocardiogénico (vasovagal) que presenta una evolución benigna. Otras causas...

  8. Episodic syncope caused by ventricular flutter in a tiger (Panthera tigris).

    Science.gov (United States)

    DeLillo, Daniel M; Jesty, Sophy A; Souza, Marcy J

    2013-06-01

    A captive, 9-yr-old castrated male tiger (Panthera tigris) from an exotic cat sanctuary and rescue facility was observed to have three collapsing episodes within a 2-wk interval prior to being examined by veterinarians. No improvement in clinical signs was noted after empiric treatment with phenobarbital. During a more complete workup for epilepsy, ventricular flutter was observed on electrocardiogram (ECG). The arrhythmia resolved with a single intravenous bolus of lidocaine. Cardiac structure and function were unremarkable on echocardiogram and cardiac troponin I levels were within normal limits for domestic felids. No significant abnormalities were noted on abdominal ultrasound. Complete blood count and biochemistry panel were unremarkable, and heartworm antigen and Blastomyces urine antigen enzyme-linked immunosorbent assays were negative. Antiarrhythmic treatment with sotalol was initiated. On follow-up ECG performed 1 mo later, no significant arrhythmias were noted, and clinical signs have completely resolved.

  9. Syncopated Beats and the History of Sadness: The Affective Fusion of Audience and Film through Music

    Directory of Open Access Journals (Sweden)

    Kutter Callaway

    2016-03-01

    Full Text Available Recent developments in the disciplines of cinema studies, theology, and religion and film have generated renewed interest in the experiential dimensions of filmgoing. More specifically, those contributing to theological scholarship have begun to explore these cinematic experiences as theologically significant. With these developments in mind, this essay offers a close reading of the principal musical theme in the 2010 film Beginners, noting in particular the ways in which this music is distributed throughout the narrative. In doing so, it suggests that the music in this film expresses in concrete terms one of the key insights from emerging neuropsychological research, namely, that our affective, pre-cognitive, “wordless knowledge” of the world is the foundation upon which human consciousness is constructed. But the essay goes one step further by making an explicitly theological claim. That is, when located within the framework of a lived theology (i.e., a “poetic theology”, the film and its music shed light on the ways in which aesthetic modes of awareness (i.e., intuitive, embodied forms of knowledge open up spaces in the contemporary world where our affections, the goods of late-modern society, and our spiritual longings are able to meet and interact.

  10. Are nasal decongestants safer than rhinitis? A case of oxymetazoline-induced syncope.

    Science.gov (United States)

    Fabi, Marianna; Formigari, Roberto; Picchio, Fernando M

    2009-12-01

    Derivatives of Imidazoline usually act to stimulate peripheral alpha2 receptors causing vasoconstriction. In young children, however, they can also stimulate alpha2receptors in the cardiovascular and central nervous systems, possibly causing cardiovascular, neurological, and respiratory depression. These medications do not require medical prescriptions, so often parents use them, bypassing paediatricians. We report here a case of cardiovascular and neurological depression induced by oxymetalzoline in a toddler.

  11. A guide to disorders causing transient loss of consciousness: focus on syncope

    NARCIS (Netherlands)

    van Dijk, J. Gert; Thijs, Roland D.; Benditt, David G.; Wieling, Wouter

    2009-01-01

    Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing

  12. A study of ventricular contractility and other parameters possibly related to vasodepressor syncope

    Science.gov (United States)

    Hyatt, K. H.; Sullivan, R. W.; Spears, W. R.; Vetter, W. R.

    1973-01-01

    The effects of diminished orthostatic and exercise tolerance resulting from prolonged bedrest were studied by noninvasion methods to determine if alterations in myocardial contractility were induced by bedrest. These methods were apexcardiography, systolic time intervals, and echocardiography. It is concluded that bedrest causes detrimental alterations in the contractile state of the myocardium which accounts for the decreases in maximal oxygen uptaken during exercise after bedrest. Tabulated test data are included.

  13. Case report

    African Journals Online (AJOL)

    abp

    2013-02-19

    Feb 19, 2013 ... A 45-year old man with recurrent syncope: an unusual presentation of coronary artery disease. Abiodun ... Key words: Syncope, coronary artery disease, angiogram, Percutaneous Transluminal Coronary Angioplasty. Received: ... Hospital, Nigeria for evaluation of recurrent exercise induced syncope.

  14. Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors

    Directory of Open Access Journals (Sweden)

    Jorge Rafael Gómez-Flores

    2016-12-01

    Full Text Available Resumen El síncope vasovagal o neurocardiogénico es una situación clínica común, y así como en otras entidades asociadas con la intolerancia ortostática, la condición de base es una disfunción del sistema nervioso autónomo. En este artículo se revisan diversos aspectos sobre el síncope vasovagal, incluyendo su relación con la intolerancia ortostática y el papel que juega el sistema nervioso autónomo. Se da una breve reseña histórica del problema, así como una descripción de la forma en que han evolucionado los términos y conceptos asociados al mismo. Se hace un análisis sobre la respuesta del sistema nervioso simpático al estrés ortostático, la fisiología del sistema barorreflejo y los cambios neurohumorales que ocurren. Se muestra evidencia sobre el papel del sistema nervioso autónomo, incluyendo estudios sobre variabilidad de la frecuencia cardiaca, microneurografía, inervación cardiaca y estudios genéticos moleculares. Finalmente, se describen diferentes estudios sobre el uso de betabloqueadores e inhibidores del transportador de noradrenalina (sibutramina, reboxetina y la justificación de su uso en la prevención de este tipo de síncope.

  15. PROLONGED MULTIPLE SPASMS OF SMOOTH CORONARY ARTERIES PRESENTING AS ACUTE MIOCARDIAL INFARCTION, COMPLETE AV BLOCK AND SYNCOPE

    Directory of Open Access Journals (Sweden)

    Franci Cesar

    2004-11-01

    Full Text Available Background. A variant form of angina pectoris (VAP is caused by coronary vessel spasm and occures in patients with and without varying degrees of obstructive coronary artery disease. Although the prognosis of VAP without significant organic stenosis is generally good, multivessel spasm is associated with a high risk of life-threatening abnormalities of rhythm and conduction.Patient and methods. We describe a patient who presented with prolonged chest pain, associated with hypotension, lost of consciousness, complete AV block and widespread ST segment elevations consistent with inferoanterior acute myocardial infarction. Urgent selective coronary angiography revealed spasms in right coronary artery and in left circumflex artery that were relieved by intracoronary injection of nitroglycerin. All coronary arteries were otherwise patient, without signs of atherosclerosis. The patient was treated with diltiazem and nitrates. She made a complete recovery and resumed her normal activities.Conclusions. Simultaneous multiple spasms of native coronary arteries represent a rare syndrome characterized by significantly higher incidence of potentially life-threatening arrhythmia. Less commonly, prolonged coronary spasm may mimic acute myocardial infarction. Modern management of acute coronary syndromes, including urgent coronarography, enables a prompt differentiation between prolonged coronary spasm and atherosclerotic coronary disease, warranting different treatment strategies. Medical treatment with nitrates and calcium channel blockers in most cases prevents recurrence of vasospasms and arrhythmias.

  16. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen

    DEFF Research Database (Denmark)

    Fanoe, Søren; Hvidt, Christian; Ege, Peter Preben

    2007-01-01

    Methadone is prescribed to heroin addicts to decrease illicit opioid use. Prolongation of the QT interval in the ECG of patients with torsade de pointes (TdP) has been reported in methadone users. As heroin addicts sometimes faint while using illicit drugs, doctors might attribute too many episodes...

  17. Síncope inducido por el ejercicio: Reporte de un caso Exercise-induced syncope: case report

    OpenAIRE

    Andrés Alvarado; Carlos Quiroz; Iván Melgarejo

    2011-01-01

    El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adap...

  18. Leg crossing with muscle tensing, a physical counter-manoeuvre to prevent syncope, enhances leg blood flow

    NARCIS (Netherlands)

    Groothuis, Jan T.; van Dijk, Nynke; ter Woerds, Walter; Wieling, Wouter; Hopman, Maria T. E.

    2007-01-01

    In patients with orthostatic intolerance, the mechanisms to maintain BP (blood pressure) fail. A physical counter-manoeuvre to postpone or even prevent orthostatic intolerance in these patients is leg crossing combined with muscle tensing. Although the central haemodynamic effects of physical

  19. Leg crossing with muscle tensing, a physical counter-manoeuvre to prevent syncope, enhances leg blood flow.

    NARCIS (Netherlands)

    Groothuis, J.T.; Dijk, N. van; Woerds, W. ter; Wieling, W.; Hopman, M.T.E.

    2007-01-01

    In patients with orthostatic intolerance, the mechanisms to maintain BP (blood pressure) fail. A physical counter-manoeuvre to postpone or even prevent orthostatic intolerance in these patients is leg crossing combined with muscle tensing. Although the central haemodynamic effects of physical

  20. Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors

    OpenAIRE

    Jorge Rafael Gómez-Flores; Jesús A. González-Hermosillo; Teresita de Jesús Ruíz-Siller; Manuel Cárdenas

    2016-01-01

    Resumen El síncope vasovagal o neurocardiogénico es una situación clínica común, y así como en otras entidades asociadas con la intolerancia ortostática, la condición de base es una disfunción del sistema nervioso autónomo. En este artículo se revisan diversos aspectos sobre el síncope vasovagal, incluyendo su relación con la intolerancia ortostática y el papel que juega el sistema nervioso autónomo. Se da una breve reseña histórica del problema, así como una descripción de la forma en que...