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Robert Sheldon
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...
January 2013: Progress in Cardiovascular Diseases
Ariel Izcovich, Carlos González Malla, Matias Manzotti, Hugo Norberto Catalano, Gordon Guyatt
OBJECTIVE: 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. METHODS: We searched multiple electronic databases without language restriction from their inception to June 2013...
September 23, 2014: Neurology
Kathleen Walsh, Kurt Hoffmayer, Mohamed H Hamdan
Syncope is defined as transient loss of consciousness due to global cerebral hypoperfusion. It is characterized by having a relatively rapid onset, brief duration with spontaneous and full recovery. The major challenge in the evaluation of patients with syncope is that most patients are asymptomatic at the time of their presentation. A thorough history and physical examination including orthostatic assessment are crucial for making the diagnosis. After initial evaluation, short-term risk assessment should be performed to determine the need for admission...
February 2015: Current Problems in Cardiology
Michele Brignole, Andrea Ungar, Ivo Casagranda, Michele Gulizia, Maurizio Lunati, Fabrizio Ammirati, Attilio Del Rosso, Massimo Sasdelli, Massimo Santini, Roberto Maggi, Elena Vitale, Alessandro Morrione, Giuseppina Maura Francese, Maria Rita Vecchi, Franco Giada
AIMS: 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. METHODS AND RESULTS: 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 <1 year before): 23 vs...
January 2010: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Chiara Mussi, Andrea Ungar, Gianfranco Salvioli, Carlo Menozzi, Angelo Bartoletti, Franco Giada, Alfonso Lagi, Irene Ponassi, Giuseppe Re, Raffaello Furlan, Roberto Maggi, Michele Brignole
BACKGROUND: 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. METHODS: 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...
July 2009: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
A Moya, M Brignole, C Menozzi, R Garcia-Civera, S Tognarini, L Mont, G Botto, F Giada, D Cornacchia
BACKGROUND: Because of its episodic behavior, the correlation of spontaneous syncope with an abnormal finding can be considered a reference standard. METHODS AND RESULTS: We inserted an implantable loop recorder in 111 patients with syncope, absence of significant structural heart disease, and a normal ECG; tilt-testing was negative in 82 (isolated syncope) and positive in 29 (tilt-positive). The patients had had >/=3 episodes of syncope in the previous 2 years and were followed up for 3 to 15 months...
September 11, 2001: Circulation
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