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Syncope review

Nobuyuki Murakoshi, Kazutaka Aonuma
Drug treatment and/or implantable cardioverter defibrillator (ICD) implantation are the most widely accepted first-line therapies for channelopathic patients who have recurrent syncope, sustained ventricular tachycardia (VT), or documented ventricular fibrillation (VF), or are survivors of cardiac arrest. In recent years, there have been significant advances in mapping techniques and ablation technology, coupled with better understanding of the mechanisms of ventricular tachyarrhythmia in channelopathies. Catheter ablation has provided important insights into the role of the Purkinje network and the right ventricular outflow tract in the initiation and perpetuation of VT/VF, and has evolved as a promising treatment modality for ventricular tachyarrhythmia even in channelopathies...
October 2016: Journal of Arrhythmia
Balraj Singh, Jennifer M Treece, Ghulam Murtaza, Samit Bhatheja, Steven J Lavine, Timir K Paul
A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air...
2016: Case Reports in Cardiology
Münïre Kübra Özgök-Kangal, Iclal Karatop-Cesur, Gökhan Akcali, Senol Yildiz, Günalp Uzun
BACKGROUND: Carbon monoxide (CO) poisoning is common in Turkey. Our department is the main provider of emergency hyperbaric oxygen therapy (HBOT) in Ankara and neighboring cities. In this study, we analyzed the characteristics of CO-poisoned patients who were referred by phone to our department for emergency HBOT. METHODS: We retrospectively reviewed the records of phone consultations with emergency departments regarding the need for treatment of CO-poisoned patients with HBOT between 14 January 2014 and 14 January 2015...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Hunter M Ray, Christopher A Durham, Daniel Ocazionez, Kristofer M Charlton-Ouw, Anthony L Estrera, Charles C Miller, Hazim J Safi, Ali Azizzadeh
OBJECTIVE: Patients with uncomplicated acute type B aortic dissection (uATBAD) have historically been managed with medical therapy. Recent studies suggest that high-risk patients with uATBAD may benefit from thoracic endovascular aortic repair. This study aims to determine the predictors of intervention and mortality in patients with uATBAD. METHODS: All patients admitted with uATBAD from 2000 to 2014 were reviewed, and those with computed tomographic angiography imaging were included...
October 1, 2016: Journal of Vascular Surgery
Waseem Hindieh, Arnon Adler, Adaya Weissler-Snir, Dana Fourey, Sarah Harris, Harry Rakowski
Hypertrophic cardiomyopathy is a common genetic disorder with a prevalence of 1:500 in the general population. Amongst a varied spectrum of clinical presentations, the most feared complication of this cardiac disorder is sudden cardiac death. Although only a minority of patients with hypertrophic cardiomyopathy who suffer sudden cardiac death or resuscitated cardiac arrest do so during exercise, strenuous physical activity is regarded as an important trigger for these tragic outcomes. Furthermore, during exercise, patients with hypertrophic cardiomyopathy may develop augmentation of left ventricular outflow tract obstruction, myocardial ischemia, diastolic dysfunction and/or inappropriate vasodilation in non-exercising vascular beds...
September 20, 2016: Journal of Science and Medicine in Sport
Gloria María Novo Martínez, Marta Ballesteros Pomar, Elena Menéndez Sánchez, Eliezer Santos Alcántara, Inés Rodríguez Fernández, Andrés Manuel Zorita Calvo
INTRODUCTION: Rupture of abdominal aortic aneurysm is still a difficult challenge for the vascular surgeon due to the high perioperative mortality. The aim of our study is to describe the characteristics of the population as well as to compare morbidity and mortality in patients undergoing open surgery or endovascular repair in our center. METHODS: Database with 82 rAAA between January 2002-December 2014, studying two cohorts, open surgery and endovascular repair...
October 1, 2016: Cirugía Española
Christopher C Cheung, Andrew D Krahn
Implantable loop recorders (ILRs) have become an important pillar in the diagnostic work-up of patients with unexplained syncope. The modern ILR is minimally-invasive and provides an extended-duration of monitoring with high diagnostic yield. These insertable cardiac monitors (ICMs) enable prolonged monitoring that extends the opportunity for symptom-rhythm correlation from days-weeks to years, with associated incremental diagnostic yield. Over the years, observational studies and randomized trials have supported a unique role for ILRs in the assessment of recurrent or high-risk unexplained syncope...
October 3, 2016: Expert Review of Medical Devices
Gianfranco Piccirillo, Federica Moscucci, Claudia Fiorucci, Claudia Di Iorio, Fabiola Mastropietri, Damiano Magrì
To seek possible differences in short-period temporal RR interval, P-wave and PR interval dispersion and spectral coherence in patients with a head-up tilt test positive for vasovagal syncope with or without prolonged asystole, severe symptoms and at high risk of trauma. We retrospectively reviewed 5 min ECG and blood pressure recordings obtained at baseline, at rest and during head-up tilt in 40 patients diagnosed as having recurrent vasovagal syncope confirmed at a head-up tilt test. We analysed autoregressive spectral power for all the ECG-derived variables, focusing on temporal P-wave and PR interval dispersion indexes as well as their spectral coherence calculated on the same 5 min recordings at rest and during tilt...
September 28, 2016: Physiological Measurement
Rose Mary Ferreira Lisboa da Silva
The most frequent cause of syncope is vasovagal reflex. It is associated with worse quality of life, depression, fatigue and physical injury. Recurrence of vasovagal syncope is an aggravating, reaching the rate of 69%. Initial step and pharmacological treatment may not work, especially in patients with recurrent syncope without prodrome. These patients can present cardioinhibitory response with asystole. Studies were designed to analyses the effectiveness of pacemaker for prevention of syncope. In this review, nonrandomized clinical trials, open-label randomized, double-blind randomized, placebo-controlled, and studies based on tilt test or Implantable Loop Recorder findings will be discussed...
2016: Open Cardiovascular Medicine Journal
Nichole Suzzanne Zuccarini, Tariq Yousuf, Daniel Wozniczka, Anis Abdul Rauf
Lactic acidosis is common and most often associated with disturbed acid-base balance. Rarely, it can be a life-threatening medication side effect. Hence, determining the etiology of lactic acidosis early in patients is paramount in choosing the correct therapeutic intervention. Although lactic acidosis as an adverse drug reaction of linezolid is a well-recognized and documented clinical entity, the occurrence of such mimicking an acute intracranial bleed has not been reported to our knowledge. The following case is presented as an example of such an occurrence...
October 2016: Journal of Clinical Medicine Research
Alessio Galli, Francesco Ambrosini, Federico Lombardi
Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages...
August 2016: Arrhythmia & Electrophysiology Review
Daniel R Felbaum, Joshua E Ryan, Andrew B Stemer, Amjad N Anaizi
Rotational vertebral artery occlusion (RVAO) or bow hunter's syndrome most commonly affects the C1-2 level due to its importance in regulating rotational movement. We present a 50-year old man who had undergone several prior sub-axial cervical spine operations with increasing neck pain and severe symptoms of vertebrobasilar insufficiency with bi-directional head rotation. Dynamic cerebral angiography demonstrated complete occlusion of left vertebral artery during head rotation to the right, and complete occlusion of the right vertebral artery during head rotation to the left...
September 5, 2016: World Neurosurgery
Ying Xu, Dennis Nguyen, Armin Mohamed, Cheryl Carcel, Qiang Li, Mansur A Kutlubaev, Craig S Anderson, Maree L Hackett
PURPOSE: To determine the frequency of false positive diagnoses of epilepsy and to explore its imitators and consequences. METHOD: A systematic review of all published observational studies (to November 2015) was conducted to determine the proportion of false positive diagnoses of epilepsy. We included studies of people of all ages receiving a diagnosis of epilepsy. All observational study designs were included with the exception of case-reports and case series with fewer than 3 participants...
October 2016: Seizure: the Journal of the British Epilepsy Association
Agazi G Gebreselassie, Delamo I Bekele, Yonette Paul, Julius S Ngwa, Daniel A Larbi
BACKGROUND: Current guidelines do not support the routine use of computed tomography (CT) scan of the head in the diagnostic workup of syncope. There is a lack of research to support whether these guidelines apply to the Black population. AIMS: This study aims to evaluate the yield of neuroimaging in the evaluation of Syncope in a predominantly Black patient population and to test whether current guidelines based on studies conducted in other populations hold true in this group...
July 2016: North American Journal of Medical Sciences
Lalitha Sundararaman, Jennifer Hochman Cohn, J Sudharma Ranasinghe
Maternal complete heart block can pose significant challenges for the anesthesiologist in the antepartum, peripartum, and postpartum periods. Some patients may present for the first time in the puerperium with dizziness, weakness, syncope, or congestive heart failure as a result of the additional hemodynamic burden that accompanies pregnancy. Although there is an increase in permanent pacemaker placement in young symptomatic patients before pregnancy, prophylactic placement of pacemakers in asymptomatic parturients is not always indicated...
September 2016: Journal of Clinical Anesthesia
Natale Daniele Brunetti, Pier Luigi Pellegrino, Girolamo D'Arienzo, Rafel Sai, Luigi Ziccardi, Francesco Santoro, Antonio Gaglione, Matteo Di Biase
We report the case of a 38-year-old woman with history of syncope and polymorphic ventricular tachycardia; tachycardia was inducible at exercise stress test, not at electrophysiologic study. Phases of QT prolongation were found at ambulatory electrocardiogram monitoring. The woman came to our attention for periodic control of implantable loop recorder. Rest electrocardiogram at admission unexpectedly showed sinus bradycardia, junctional rhythm, and ventricular premature beats. Furthermore, loop recorder control revealed a short run of bidirectional tachycardia, not associated with syncope...
July 28, 2016: Journal of Electrocardiology
Jukka Mäenpää, Olavi Pelkonen
INTRODUCTION: It is generally believed that topical administration of eye drops safeguards against harmful systemic effects. However, about 80% of the drug in the ophthalmic products is systemically absorbed and the first-pass metabolism is avoided. Ophthalmic timolol is widely prescribed in the treatment of glaucoma either alone or in the combination eye drop products, many of which have been launched fairly recently. Ophthalmic timolol may cause serious adverse effects such as symptomatic bradycardia, various conduction disorders in the heart, orthostatic hypotension, syncope and falls...
August 18, 2016: Expert Opinion on Drug Safety
Anvesh Jackson, Louise Teo, Udaya Seneviratne
AIMS: (1) To delineate the challenges in seizure diagnosis in the first seizure clinic setting for adult patients of a teaching hospital, and (2) quantify the diagnostic accuracy of the referral source and the yield of routine investigations, including blood tests, EEGs, and neuroimaging. METHODS: We retrospectively reviewed medical records of patients referred by the emergency department to the adult first seizure clinic and seen by the same epilepsy specialist between June 2007 and June 2011...
September 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Susan O'Callaghan, Rose Anne Kenny
Neurocardiovascular instability (NCVI) refers to abnormal neural control of the cardiovascular system affecting blood pressure and heart rate behavior. Autonomic dysfunction and impaired cerebral autoregulation in aging contribute to this phenomenon characterized by hypotension and bradyarrhythmia. Ultimately, this increases the risk of falls and syncope in older people. NCVI is common in patients with neurodegenerative disorders including dementia. This review discusses the various syndromes that characterize NCVI icluding hypotension, carotid sinus hypersensitivity, postprandial hypotension and vasovagal syncope and how they may contribute to the aetiology of cognitive decline...
March 2016: Yale Journal of Biology and Medicine
Aarti Dalal, Richard J Czosek, Joshua Kovach, Johannes C von Alvensleben, Santiago Valdes, Susan P Etheridge, Michael J Ackerman, Debbie Auld, Jeryl Huckaby, Courtney McCracken, Robert Campbell
OBJECTIVES: To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). STUDY DESIGN: This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014...
October 2016: Journal of Pediatrics
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