Postpartum postural orthostatic tachycardia syndrome in a patient with the joint hypermobility syndrome

Postural orthostatic tachycardia syndrome (POTS) commonly affects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS.

Psychogenic syncope? A cautionary note

INTRODUCTION

In some patients with recurrent syncope, the etiology may remain unclear despite extensive evaluation. These patients may sometimes be labeled as having a "psychogenic" cause for their syncope.

METHODS

We report on three patients with recurrent unexplained syncope (despite extensive evaluation) who were labeled as having a psychogenic cause for their events. In each patient following placement of an implantable loop recorder, their syncopal events were found to be due to periods of prolonged asystole and/or complete heart block. One patient had prolonged asystole for 44 seconds. In each patient, episodes of syncope were eliminated following permanent pacemaker implantation.

CONCLUSION

We conclude that physicians should exercise great caution before labeling any patient's syncope as psychogenic and that prolonged monitoring may be necessary to exclude a potential cardiac rhythm-related etiology.

Differentiation of convulsive syncope from epilepsy with an implantable loop recorder

INTRODUCTION

Not all convulsive episodes are due to epilepsy and a number of these have a cardiovascular cause. Failure to identify these patients delays the provision of adequate therapy while at the same time exposes the individual to the risk of injury or death.

METHODS

We report on three patients who suffered from recurrent convulsive episodes, thought to be epileptic in origin, who were refractory to antiseizure therapy. Although each patient had undergone extensive evaluation, no other potential cause of his or her seizure like episodes had been uncovered. In each patient placement of an implantable loop recorder (ILR) demonstrated that their convulsive episodes were due to prolonged periods of cardiac asystole and/or complete heart block. In all patients their convulsive episodes were eliminated by permanent pacemaker implantation.

CONCLUSION

In patients with refractory "seizure' like episodes of convulsive activity of unknown etiology a potential cardiac rhythm disturbance should be considered and can be easily evaluated by ILR placement.

Clinical symptoms associated with asystolic or bradycardic responses on implantable loop recorder monitoring in patients with recurrent syncope

BACKGROUND

Implantable loop recorders (ILR) have been found to be useful in the diagnosis and management of syncope of unclear etiology. The clinical symptoms of abnormalities seen during ILR monitoring have not been adequately studied.

AIM

The aim of this retrospective study was to determine the clinical symptoms which were the best predictors of asystolic or bradycardic responses during ILR monitoring.

METHODS

Patients with either asystole or bradycardia recorded during ILR monitoring were analyzed from our database. The clinical characteristics of these patients were compared to the patients with ILR's who did not have recorded bradycardic episodes. The episodes were characterized as being convulsive or nonconvulsive, brief (<5 minutes) or prolonged (> 5 minutes), and having had a prodrome or no prodrome.

RESULTS

Eleven patients (4 males and 7 females; age 39 +/-11 years) had asystole or bradycardia on ILR monitoring. Eleven patients (2 males and 9 females; age 46+/-23) had no bradycardiac events. Palpitations, convulsive syncope, prolonged episode, and prodrome were present in 37% vs. 74% (P = 0.125), 62% vs. 0% (P = 0.002), 87% vs. 0% (P=0), and 73% vs. 13% (P=0.009) patients, respectively, in the asystole/bradycardia and non-bradycardia groups. In the asystole/bradycardia group eight patients had bradycardia (HR < 20) for > 10 seconds and three patients had asystole >10 seconds.

CONCLUSION

Convulsive syncope, prolonged loss of consciousness during syncopal episode, and absence of prodrome or aura are clinical predictors of asystole or bradycardia on ILR monitoring.

Implantable Cardioverter-Defibrillators and Driving—Current Perspectives

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New onset postural tachycardia syndrome following lightning injury

Lightning injuries are one of the top three causes of death from environmental causes. Survivors of lightning injuries may be left with injuries, which may affect either the somatic or autonomic nervous systems. We report on two previously healthy patients who developed severe forms of postural tachycardia syndrome following a lightning injury, and review the literature on the subject.

Bilateral Inferior Vena Cava: A Vascular Abnormality Encountered During Electrophysiologic Study

In the course of clinical practice, the electrophysiologist may encounter a wide variety of vascular abnormalities, which are important to recognize, as they may potentially impact on the health and welfare of the patient. We describe a case of bilateral inferior vena cava and review its etiology, diagnosis, and significance to the cardiologist and electrophysiologist.

May-Thurner Syndrome: A Vascular Abnormality Encountered During Electrophysiologic Study

In the course of clinical practice the electrophysiologist may encounter a variety of vascular abnormalities which are important to recognize, as they may impact upon the health and welfare of the patient. We describe a case of iliac vein compression (May-Thurner) syndrome and review its etiology, diagnosis, significance, and treatment.

Evaluation of syncope

Syncope is not an uncommon condition. The evaluation can be as frustrating as the treatment. The role of a detailed history and physical examination cannot be underestimated and both remain a cornerstone in the evaluation of syncope. A systematic approach may not only lead to correct diagnosis in most cases, but also ultimately will be cost effective. This review emphasizes the systematic approach for the evaluation of this challenging problem.