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Kishimoto N, Ujita T, Tran SD, Sanuki T, Seo K. Simulation training for medical emergencies: Evaluation of dentists' long-term learning skills and confidence. Eur J Dent Educ 2024; 28:689-697. [PMID: 38379393 DOI: 10.1111/eje.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/31/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION As the population ages and more patients experience medical emergencies during dental treatments, dentists must competently and confidently manage these situations. We developed a simulation training course for medical emergencies in the dental setting using an inexpensive vital sign simulation app for smartphones/tablets without the need for an expensive simulator. However, the duration for which this effect is maintained is unclear. This study was performed to evaluate the long-term educational effect at 3, 6, and 12 months after taking the course. MATERIALS AND METHODS Thirty-nine dental residents participated in this course. Scenarios included vasovagal syncope, anaphylaxis, hyperventilation syndrome, and acute coronary syndrome, each of which the participants had to diagnose and treat. The participants were evaluated using a checklist for anaphylaxis diagnosis and treatment skills immediately after and 3, 6, and 12 months after the course. The participants were also surveyed about their confidence in diagnosing and treating these conditions by questionnaire before, immediately after, and 3, 6, and 12 months after the course. RESULTS The checklist scores for anaphylaxis were significantly lower at 3, 6, and 12 months after the course than immediately after the course. The percentage of participants who provided a correct diagnosis and appropriate treatment for vasovagal syncope, hyperventilation syndrome, and acute coronary syndrome was lower at all reassessments than immediately after the course. CONCLUSION Because medical emergency management skills and confidence declined within 3 months, it would be useful to introduce a refresher course approximately 3 months after the initial course to maintain skills and confidence.
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Affiliation(s)
- Naotaka Kishimoto
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tomoaki Ujita
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Takuro Sanuki
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Kenji Seo
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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van Dijk JG, Sheldon R, Sutton R. Making certain that noninvasive therapy for vasovagal syncope has failed before proceeding to invasive interventions. Europace 2024; 26:euae081. [PMID: 38619827 PMCID: PMC11055496 DOI: 10.1093/europace/euae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
There is a perceived need to express concisely the advice of guidelines in the context of consideration of invasive management of highly symptomatic vasovagal syncope. In response to this need the table is presented as a checklist and the text adds explanation and details. It is anticipated that this will prove to be of value for clinicians.
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Affiliation(s)
- J Gert van Dijk
- Department of Neurology, University of Leiden Medical Centre, Leiden, Netherlands
| | - Robert Sheldon
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Richard Sutton
- Department of Cardiology, National Heart & Lung Institute, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
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Brignole M, Rivasi G, Fedorowski A. Mechanism-based therapy of non-cardiac syncope: a practical guide. Europace 2024; 26:euae073. [PMID: 38529800 PMCID: PMC10988836 DOI: 10.1093/europace/euae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 03/27/2024] Open
Abstract
The term non-cardiac syncope includes all forms of syncope, in which primary intrinsic cardiac mechanism and non-syncopal transient loss of consciousness can be ruled out. Reflex syncope and orthostatic hypotension are the most frequent aetiologies of non-cardiac syncope. As no specific therapy is effective for all types of non-cardiac syncope, identifying the underlying haemodynamic mechanism is the essential prerequisite for an effective personalized therapy and prevention of syncope recurrences. Indeed, choice of appropriate therapy and its efficacy are largely determined by the syncope mechanism rather than its aetiology and clinical presentation. The two main haemodynamic phenomena leading to non-cardiac syncope include either profound hypotension or extrinsic asystole/pronounced bradycardia, corresponding to two different haemodynamic syncope phenotypes, the hypotensive and bradycardic phenotypes. The choice of therapy-aimed at counteracting hypotension or bradycardia-depends on the given phenotype. Discontinuation of blood pressure-lowering drugs, elastic garments, and blood pressure-elevating agents such as fludrocortisone and midodrine are the most effective therapies in patients with hypotensive phenotype. Cardiac pacing, cardioneuroablation, and drugs preventing bradycardia such as theophylline are the most effective therapies in patients with bradycardic phenotype of extrinsic cause.
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Affiliation(s)
- Michele Brignole
- IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Department of Cardiology, S. Luca Hospital, Piazzale Brescia 20, 20149 Milano, Italy
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
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van Zanten S, Sutton R, Hamrefors V, Fedorowski A, de Lange FJ. Tilt table testing, methodology and practical insights for the clinic. Clin Physiol Funct Imaging 2024; 44:119-130. [PMID: 37839043 DOI: 10.1111/cpf.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.
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Affiliation(s)
- Steven van Zanten
- Department of Cardiology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Richard Sutton
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, London, UK
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Frederik J de Lange
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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He W, Fu X, Du X, Deng G. Diagnosis and treatment of recurrent syncope in a middle-aged women. Ann Noninvasive Electrocardiol 2024; 29:e13110. [PMID: 38339802 PMCID: PMC10858323 DOI: 10.1111/anec.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
A 50-year-old female patient, presented with repeated syncope for more than 2 years. Prior assessments were conducted at different hospitals, but no definite abnormalities were found. The patient's fear and anxiety about possible future attacks were escalating. Through a Head-up tilt test, the cause was finally identified as vasovagal syncope. Following a 5-min administration of nitroglycerin, the patient reported palpitations, nausea, and deep, rapid breathing. The electrocardiogram initially showed a first-degree atrioventricular block, progressing swiftly to a second-degree type I atrioventricular block-high atrioventricular block. Immediate intervention was undertaken, but blood pressure was not instantly ascertainable, coinciding with an abrupt loss of consciousness. Subsequent electrocardiographic findings included paroxysmal third-degree atrioventricular block, sinus arrest, and complete cardiac arrest, prompting the initiation of external cardiac compressions. The longest recorded ventricular arrest approximated 15 s, with sinus rhythm resuming post 10 s of cardiac compressions and the patient regaining consciousness. The patient underwent vagal ablation and no longer experienced syncope.
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Affiliation(s)
- Wenyi He
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xin Fu
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xinyue Du
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Guolan Deng
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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6
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Johansson M, Fedorowski A. Situational vs vasovagal syncope: one but different? Heart 2023; 110:3-4. [PMID: 37591689 DOI: 10.1136/heartjnl-2023-323180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Affiliation(s)
- Madeleine Johansson
- Department of Clinical Sciences, Lund University, Faculty of Medicine, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Faculty of Medicine, Malmö, Sweden
- Department of Medicine, Karolinska Institute, Solna, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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7
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Khan I, Scully TG, Teh AW, Wong GR. High spinal cord injury precipitating syncope: a rare indication for pacemaker insertion. BMJ Case Rep 2023; 16:e255020. [PMID: 37816572 PMCID: PMC10565321 DOI: 10.1136/bcr-2023-255020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
The current evidence for vasovagal syncope management is that cardiac pacing is only indicated in a highly select group of patients where symptoms can be linked to bradycardic episodes. High spinal cord injury can lead to autonomic dysfunction and sympathetic nervous system hypoactivity. A high spinal cord injury can theoretically precipitate profound bradycardia leading to haemodynamic instability and syncope. A patient in his 50s with a history of C2 spinal injury was admitted to our tertiary centre for management of what was initially thought to be septic shock causing hypotension and syncope. With evidence to suggest this patient's presentation may be profound reflex syncope in the context of unopposed parasympathetic signalling, consensus was reached to implant a permanent pacemaker. Remarkably, the patient's haemodynamics stabilised and there were no further episodes of syncope.
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Affiliation(s)
- Isa Khan
- Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | | | - Andrew W Teh
- Cardiology, Austin Health, Heidelberg, Victoria, Australia
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Marques A, Caldeira D, Alegria S, Pereira AR, João I, Pereira H. Glossopharyngeal neuralgia with cardioinhibitory syncope: Is a permanent pacemaker required? Rev Port Cardiol 2023; 42:805-809. [PMID: 37019279 DOI: 10.1016/j.repc.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/21/2019] [Accepted: 12/01/2019] [Indexed: 04/05/2023] Open
Abstract
Glossopharyngeal neuralgia is a rare facial pain syndrome, which in more rare cases can be associated with syncope. We present the outcome of a case report that combines this rare association that received medical therapy with anti-epileptic medication and permanent dual chamber pacemaker implantation. In this case, syncope episodes were associated with both vasodepressor and cardioinhibitory reflex syncope types. The patient found relief from syncope, hypotension, and pain after initiation of anti-epileptic therapy. Although a dual chamber pacemaker was implanted, the pacemaker interrogation revealed no requirement for pacing at one-year follow-up. As far as we know, this is the first case that reports pacemaker interrogation during follow-up and, taking into account the absence of pacemaker activation at one-year follow-up, the device was not needed to prevent bradycardia and syncope episodes. This case report supports the current guidelines for pacing in neurocardiogenic syncope, by demonstrating a lack of requirement for pacing in the event of both cardioinhibitory and vasodepressor responses.
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Affiliation(s)
- Ana Marques
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Alegria
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Isabel João
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
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Kadado AJ, Gobeil K, Motta J, Chalhoub F. Transcatheter Leadless Pacemaker for the Treatment of Vasovagal Syncope. Crit Pathw Cardiol 2023; 22:88-90. [PMID: 37249900 DOI: 10.1097/hpc.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Vasovagal syncope (VVS) is largely a benign condition focused on patient education, lifestyle modification, and avoidance of triggers. However, a subset of patients may benefit from permanent pacemaker placement. Commonly, patients with VVS are younger and those requiring pacing have symptoms associated with severe cardioinhibitory syncope. With the advent of leadless pacemaker systems, a lot of the risks associated with traditional transvenous pacemaker systems are mitigated. In this article, we provide a comprehensive review of the data available for the treatment of cardioinhibitory vasovagal syncope using leadless pacemaker systems.
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Affiliation(s)
- Anis John Kadado
- From the Department of Cardiovascular Disease, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Kyle Gobeil
- Department of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT
| | - Jishu Motta
- From the Department of Cardiovascular Disease, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Fadi Chalhoub
- From the Department of Cardiovascular Disease, University of Massachusetts Medical School-Baystate, Springfield, MA
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10
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Fedorowski A, Kulakowski P, Brignole M, de Lange FJ, Kenny RA, Moya A, Rivasi G, Sheldon R, Van Dijk G, Sutton R, Deharo JC. Twenty-five years of research on syncope. Europace 2023; 25:euad163. [PMID: 37622579 PMCID: PMC10450792 DOI: 10.1093/europace/euad163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 08/26/2023] Open
Abstract
Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have been published in the journal. They undoubtedly improved our understanding of syncope. This symptom is now clearly differentiated from other forms of transient loss of consciousness. The critical role of vasodepression and/or cardioinhibition as final mechanisms of reflex syncope is emphasized. Current diagnostic approach sharply separates between cardiac and autonomic pathways. Physiologic insights have been translated, through rigorously designed clinical trials, into non-pharmacological or pharmacological interventions and interventional therapies. The following manuscript is intended to give the reader the current state of the art of knowledge of syncope by highlighting landmark contributions of the Europace journal.
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Affiliation(s)
- Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden
| | - Piotr Kulakowski
- Department of Cardiology, Medical Centre for Postgraduate Education, Grochowski Hospital, Ul. Grenadierow 51/59, 04-073 Warsaw, Poland
| | - Michele Brignole
- Department of Cardiology, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milan, Italy
| | - Frederik J de Lange
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, 152-160 Pearse St, Dublin, Ireland
- Mercer Institute for Successful Ageing, St. James Hospital, James St, Dublin 8, D08 NHY1Ireland
| | - Angel Moya
- Department of Cardiology, Hospital Universitari Dexeus, Carrer de Sabino Arana 5-19, 08028 Barcelona, Spain
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Robert Sheldon
- Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute, 3310 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Gert Van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Richard Sutton
- Department of Cardiology, Hammersmith Hospital, National Heart & Lung Institute, Imperial College, Du Cane Road, London, W12 0HS, United Kingdom
| | - Jean-Claude Deharo
- Assistance Publique − Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France and Aix Marseille Université, C2VN, 264 Rue Saint-Pierre, 13005 Marseille, France
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Prakash A, Sutton R. Prospective randomized study comparing permanent pacing with rate drop response and closed loop stimulation in patients with vasovagal syncope where permanent pacing is indicated and selected as the appropriate treatment option. J Cardiovasc Electrophysiol 2023; 34:1744-1749. [PMID: 37393604 DOI: 10.1111/jce.15991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Pacing for vasovagal syncope is established. Two pacing algorithms are available. The rate-drop-response (RDR-Medtronic) is triggered by falling heart rate acting with modified rate-hysteresis. The closed loop stimulation or system (CLS-Biotronik) is triggered by impedance changes in the right ventricle reflecting falling volume and rising contractility. These are very different physiologically. Both algorithms carry favorable reports in clinical use. METHODS A randomized-controlled superiority trial is proposed to compare the two algorithms for the control of vasovagal syncope in patients for whom pacing is indicated by current guidelines in North America and Europe. Available recent evidence may be seen as supporting superiority of CLS. No comparison between the two algorithms has been made. In this trial, patients will be centrally randomized to one or other algorithm on a 1:1 basis. Two-hundred-seventy-six patients in each group will be recruited. Sample size is determined using a confidence interval of 95%, a power of 90%, and a drop-out rate of 10% to detect an 11% difference between CLS and RDR. Recurrent symptom comparison will be made by an independent committee. The Co-primary endpoints will be recurrent syncope burden compared with that in 24-months preimplant, and occurrence of syncope in 24-months follow-up. Each outcome will be compared between the two algorithms. Secondary endpoints will be program and drug therapy changes over 24-months follow-up and quality of life by questionnaire at baseline,1 and 2 years. RESULTS AND CONCLUSIONS These are anticipated to clarify the device algorithm choice and, therefore, to improve patient care.
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Affiliation(s)
- Atul Prakash
- Rutgers Medical School, Newark, New Jersey, USA
- Prime Health Care, Newark, New Jersey, USA
- St Mary's General Hospital, Passaic, New Jersey, USA
| | - Richard Sutton
- Department of Cardiology, Hammersmith Hospital Campus of National Heart & Lung Institute, Imperial College, London, UK
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Sanuki T, Kishimoto N, Kuroda H, Kido K. Hypotension Without Skin Symptoms at Local Anesthesia in Dental Treatment: Anaphylaxis? Or Vasovagal Reaction? Anesth Prog 2023; 70:91-92. [PMID: 37379085 PMCID: PMC10328191 DOI: 10.2344/anpr-70-03-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/28/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Takuro Sanuki
- Professor and Chair, Department of Dental Anesthesiology, Kanagawa Dental University, Kanagawa, Japan
| | - Naotaka Kishimoto
- Associate Professor, Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hidetaka Kuroda
- Associate Professor, Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Kanta Kido
- Professor and Chair, Department of Dental Anesthesiology, Hokkaido University, Hokkaido, Japan
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Hatoum T, Raj S, Sheldon RS. Current approach to the treatment of vasovagal syncope in adults. Intern Emerg Med 2023; 18:23-30. [PMID: 36117230 DOI: 10.1007/s11739-022-03102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness. Although not associated with mortality, it causes injuries, reduces quality of life, and is associated with anxiety and depression. The European and North American cardiac societies recently published syncope clinical practice guidelines. Most patients with VVS do well after specialist evaluation, reassurance and education. Adequate hydration, increased salt intake when not contraindicated, and careful withdrawal of diuretics and specific hypotension-inducing drugs are a reasonable initial strategy. Physical counterpressure maneuvers might be helpful but can be of limited efficacy in older patients and those with short or no prodromes. Orthostatic training lacks long term efficacy and is troubled by non-compliance. Yoga might be helpful, although the biomedical mechanism is unknown. Almost a third of VVS patients continue to faint despite these conservative measures. Metoprolol was not helpful in a pivotal randomized clinical trial. Fludrocortisone and midodrine significantly reduce syncope recurrences with tolerable side effects, when titrated to target doses. Pacing therapy with specialized sensors appears promising in carefully selected population who have not responded conservative measures. Cardioneuroablation may be helpful but has not been studied in a formal clinical trial.
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Affiliation(s)
- Tarek Hatoum
- Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Satish Raj
- Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Robert Stanley Sheldon
- Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Furukawa T. [Vasovagal Syncope: Mechanisms and Treatments]. Brain Nerve 2022; 74:965-969. [PMID: 35941792 DOI: 10.11477/mf.1416202162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Syncope is defined as the transient loss of consciousness due to cerebral hypoperfusion. Reflex syncope (neurally mediated syncope) is among all syncope, vasovagal syncope is among reflex syncope in addition. We frequently treated several patients with vasovagal syncope in our clinical situation. We report here the mechanisms and treatments of vasovagal syncope. Although this syncope has a low risk, the diagnosis and the treatments are complicated. Therefore, invasive treatments are necessary in selected patients. This article discusses the management procedures of syncope according to the guidelines and our clinical experience.
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Tavolinejad H, Poopak A, Sadeghian S, Bozorgi A, Oraii A, Mollazadeh R, Emkanjoo Z, Kiarsi M, Shahabi J, Jalali A, Alaeddini F, Ariannejad H, Yadangi S, Oraii S, Kheirkhah J, Assadianrad M, Aminorroaya A, Tajdini M. Compression stockings for treating vasovagal syncope (COMFORTS-II) trial: Rationale and design of a triple-blind, multi-center, randomized controlled trial. Am Heart J 2022; 249:57-65. [PMID: 35405100 DOI: 10.1016/j.ahj.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Reduced venous return is an important trigger of vasovagal syncope (VVS). Elastic compression stockings (ECS) can modify venous return and be of therapeutic interest; however, evidence for ECS efficacy in VVS is scarce. This randomized controlled trial was designed to address the issue. METHODS COMFORTS-II is a multicenter, triple-blind, parallel design, randomized controlled trial aimed to assess the efficacy of ECS in preventing VVS recurrences. Using central online randomization, 268 participants will be allocated to 2 arms (1:1 ratio), wearing intervention ECS (25-30 mm Hg pressure) or sham ECS (≤10 mm Hg pressure). All participants will receive standard VVS treatment in the form of education, and lifestyle modification recommendations (drinking 2-3 l/d of fluids and consuming 10 g/d-roughly half a tablespoon-of table salt). Adherence to ECS treatment will be evaluated through diary sheets, and compared between study arms. Follow-up continues for 1 year, and is conducted via a 24/7 phone line available to patients and trimonthly visits. The co-primary outcomes are proportion of participants with any syncopal recurrence and time to first syncopal episode. Secondary outcomes include frequency of VVS spells, time intervals between recurrences, and incidence of any patient-reported adverse effects. CONCLUSION To the best of our knowledge, COMFORTS-II is the first clinical trial to assess ECS efficacy among patients with VVS, addressing an important gap in evidence for VVS treatments.
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Affiliation(s)
- Hamed Tavolinejad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Poopak
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bozorgi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Mollazadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamadreza Kiarsi
- Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Shahabi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Alaeddini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ariannejad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Yadangi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Jalal Kheirkhah
- Department of Cardiology, Healthy Heart Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Assadianrad
- Department of Cardiology, Healthy Heart Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arya Aminorroaya
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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van Dijk JG, Harms MPM, de Lange FJ, Rutten JHW, Thijs RD, van der Velde N. [Transient loss of consciousness]. Ned Tijdschr Geneeskd 2022; 166:D6615. [PMID: 35499679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although transient loss of consciousness (TLOC) is a common problem, hospital care for patients with TLOC is characterised by high rates of no diagnosis and misdiagnosis, accompanied by unnecessary hospital admissions and tests. We attribute these problems to increasing specialisation as well as to a blind spot for vasovagal syncope, a condition not claimed by any specialty. We suggest that all doctors seeing patients with TLOC, both in primary and secondary care, should be familiar with the presentations of the relatively harmless vasovagal syncope and the alarm symptoms of potentially life-threatening cardiac syncope. In this article we present some practical pointers to recognise these conditions and answer some frequently-asked questions regarding the diagnosis and treatment of TLOC.
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17
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Affiliation(s)
- W R Xu
- Departemnt of Pediatrics, Peking Univcersity First Hospital, Beijing 100034, China
| | - H F Jin
- Departemnt of Pediatrics, Peking Univcersity First Hospital, Beijing 100034, China
| | - J B Du
- Departemnt of Pediatrics, Peking Univcersity First Hospital, Beijing 100034, China
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18
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Puel V, Godard I, Papaioannou G, Gosse P, Pepin JL, Thoin F, Deharo JC, Roche F, Zarqane N, Gagnadoux F, Suehs CM, Molinari N. Management of sleep apnoea syndrome (SAS) in patients with vasovagal syncope (VVS): a protocol for the VVS-SAS cohort study. BMJ Open 2020; 10:e038791. [PMID: 32998925 PMCID: PMC7528365 DOI: 10.1136/bmjopen-2020-038791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recurrent vasovagal syncope (VVS) is associated with decreased quality-of-life and frequent use of emergency services. The evidence base for causality, diagnostic procedures and potential VVS treatments is poor. Scattered observations in the literature suggest a link between respiratory disturbances during sleep and VVS. Empirical observations lead us to further hypothesise that the appropriate management of sleep apnoea syndrome (SAS) may help resolve comorbid recurrent VVS in certain patients. We therefore designed this pilot study to provide a framework for the observation of changes in outcomes accompanying the deployment of SAS treatments in patients with VVS. METHODS AND ANALYSIS This is a multicentre, registry-based study whose primary objective is to evaluate the effect of SAS management on the number of syncope/presyncope episodes in a population suffering from both VVS and SAS. To this effect, syncope rates prior to the treatment of SAS will be compared with those occurring after the initiation of the latter. In addition, yearly assessments will collect data for echocardiography, polysomnography, Holter monitoring, table tilt tests, multiple sleep latency tests, SAS management parameters and questionnaires describing fatigue, depression and quality-of-life. Sixty patients will be included with a minimum follow-up period of 12 months. The primary analysis will use comparisons of centrality for paired data to describe the changes in syncope rates before versus after the initiation of SAS management. Longitudinal data will be analysed using mixed models with patients set as a random effect. Subgroup analyses will be performed for SAS-treatment adherence and efficacy. ETHICS AND DISSEMINATION The VVS-SAS registry was approved by an ethics committee (Comité pour la Protection des Personnes Ile-de-France VI, Reference number CPP/2-18) in accordance with French law. The princeps publication will present before-after SAS management results and longitudinal analyses. TRIAL REGISTRATION NUMBER NCT04294524. Pre-results.
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Affiliation(s)
- Vincent Puel
- Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel-Air, Bordeaux, France
| | - Isabelle Godard
- Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel-Air, Bordeaux, France
| | - Georgios Papaioannou
- Department of Cardiology and Hypertension, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Philippe Gosse
- Department of Cardiology and Hypertension, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean Louis Pepin
- Department of Physiology, Sleep and Exercise, Univ Grenoble Alpes, CHU Grenoble, Grenoble, France
| | | | - Jean Claude Deharo
- Department of Cardiology, Hôpital de la Timone, C2VN, APHM, Marseille, France
| | - Frederic Roche
- Department of Clinical Physiology and Excercise, Hôpital Nord, Centre Hospitalier Universitaire St Etienne, St Etienne, France
| | - Naïma Zarqane
- Department of Cardiology, Princess Grace Hospital Centre, Monaco
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Centre Hospitalier Universitaire Angers, Angers, France
| | - Carey Meredith Suehs
- Departments of Respiratory Diseases and Medical Information, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, IMAG, CNRS, Univ Montpellier, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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19
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Sharudin SN, Huda Al Firdas AN, Hitam S, Hamid Z, Nordin NJ, Othman N, Abd Rahman H, Md Arepen SA, Hassan E. Lymphoma with superimposed tuberculosis and fungal infection mimicking parapharyngeal abscess complicated with recurrent neurocardiogenic syncope: a case report. Malays J Pathol 2020; 42:287-291. [PMID: 32860384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Lymphoma of parapharyngeal space (PPS) is a rare condition. The clinical presentations may vary and often masquerades as infection or an inflammatory condition. A misdiagnosis will lead to a delay in treatment of the disease. Due to the complex anatomy of PPS, any attributed pressure from masses can lead to a life-threatening event such as cardiac syncope. CASE REPORT We report a rare case of PPS B-cell non-Hodgkin lymphoma with superimposed Tuberculosis (TB) and fungal infection that presents with several episodes of syncope and hemodynamic depression. DISCUSSION The clinical entities in PPS lesions syncope and its associated syndromes, pathophysiology, and differential diagnosis together with possible managements are further discussed.
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Affiliation(s)
- S N Sharudin
- Hospital Ampang, Department of Otorhinolaryngology-Head Neck Surgery, Jalan Mewah Utara, Pandan Mewah, 68000 Ampang, Selangor. Malaysia.
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20
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Liao Y, Du J. Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update. Neurosci Bull 2020; 36:667-681. [PMID: 32367250 PMCID: PMC7271077 DOI: 10.1007/s12264-020-00497-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.
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Affiliation(s)
- Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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21
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Kalischer Wellander B, Mattsson G, Lundberg A, Magnusson P. [Syncope - contemporary management]. Lakartidningen 2019; 116:FF4P. [PMID: 31192373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as a short loss of consciousness with loss of awareness and responsiveness, and with subsequent amnesia for the event. Syncope is defined as TLOC due to cerebral hypoperfusion, with rapid onset and spontaneous complete recovery. The main categories of syncope are reflex syncope, orthostatic hypotension, and cardiac syncope. The 2018 guidelines by the European Society of Cardiology emphasizes the process of risk stratification in the initial management of suspected syncope. Risk stratification serves to separate the patients with likely orthostatic and reflex syncope with good prognosis from the patients with likely cardiac syncope and high short-term risk of an adverse outcome. It determines the appropriate next level of care. Further evaluation should be based on clinical suspicion and frequency of symptoms.
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Affiliation(s)
- Benjamin Kalischer Wellander
- Uppsala Universitet - Centrum för forskning och utveckling Uppsala, Sweden Uppsala Universitet, Region Gävleborg - Centrum för forskning och utveckling Gävle , Sweden
| | - Gustav Mattsson
- Uppsala Universitet, Centrum för forskning och utveckling, Region Gävleborg, Gävle, Sweden
| | - Anders Lundberg
- Region Gavleborg - verksamhetsområde Internmedicin Hudiksvall, Sweden Region Gavleborg - vo Internmedicin Gavle, Sweden
| | - Peter Magnusson
- Uppsala Universitet - Centrum för forskning och utveckling, Uppsala, Sweden, Region Gävleborg, Gävle Sweden Uppsala Universitet - Centrum för forskning och utveckling, Uppsala, Sweden Region Gävleborg, Gävle Sweden
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22
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Errouane B, Stieger G, Décosterd D, Damak H. [Syncope or palpitations during pregnancy]. Rev Med Suisse 2018; 14:1414-1418. [PMID: 30091334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Syncope and palpitations are common symptoms during pregnancy ; they are elicited by physiological changes. Although they are often benign, careful management is essential to eliminate a serious aetiology requiring specialized care. Syncope is often of vasovagal origin, but trauma with possible secondary lesions that compromise the life-threatening of the mother and foetus must be researched. Some palpitations are the manifestation of serious rhythm disorders whose therapeutic management depends on their severity and must consider the potential side effects on the foetus.
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Affiliation(s)
- Baroudi Errouane
- Service de médecine d'urgence et de sauvetage, Fbg des Capucins 30, 2800 Delémont
| | - Géraldine Stieger
- Service de médecine d'urgence et de sauvetage, Fbg des Capucins 30, 2800 Delémont
| | - Dumeng Décosterd
- Service de médecine d'urgence et de sauvetage, Fbg des Capucins 30, 2800 Delémont
| | - Hassen Damak
- Service de médecine d'urgence et de sauvetage, Fbg des Capucins 30, 2800 Delémont
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23
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Abstract
Nussbaum L. You're the flight surgeon: loss of consciousness while exercising. Aerosp Med Hum Perform. 2018; 89(8):760-762.
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24
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Abstract
Syncope is defined as a sudden, self-limited loss of consciousness and postural tone followed by spontaneous and complete recovery without any neurological sequelae. It is one of the most common paroxysmal disorders in children and adolescents. The three major causes of syncope in children are neural, cardiovascular and other non-cardiovascular causes. The common unifying mechanism is transient global hypoperfusion of the brain. The diagnosis is primarily clinical and objective laboratory investigations add little to the diagnosis in children especially in neurocardiogenic subtype. Specific management depends on the underlying cause of syncope in children. For cardiac causes, management includes early referral to the pediatric cardiology specialist. When paroxysmal non-epileptic events are suspected, child psychology or psychiatry consultation should be sought to identify the stressors and counseling. For neurocardiogenic syncope, the main objective of treatment is to prevent recurrent events to improve the quality of life, psychological stress and school absenteeism by behavior and lifestyle modifications followed by drugs in refractory cases. The prognosis is excellent for neurocardiogenic syncope and is variable based on the underlying pathology in cardiogenic cases. As syncope is not a disease in itself but a symptom of an underlying disorder; hence, all children with syncope require assessment to exclude an underlying life-threatening cardiac or non-cardiac disorder.
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Affiliation(s)
- Pratibha Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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25
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Kishimoto N, Mukai N, Honda Y, Hirata Y, Tanaka M, Momota Y. Simulation training for medical emergencies in the dental setting using an inexpensive software application. Eur J Dent Educ 2018; 22:e350-e357. [PMID: 29120509 DOI: 10.1111/eje.12301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Every dental provider needs to be educated about medical emergencies to provide safe dental care. Simulation training is available with simulators such as advanced life support manikins and robot patients. However, the purchase and development costs of these simulators are high. We have developed a simulation training course on medical emergencies using an inexpensive software application. The purpose of this study was to evaluate the educational effectiveness of this course. MATERIALS AND METHODS Fifty-one dental providers participated in this study from December 2014 to March 2015. Medical simulation software was used to simulate a patient's vital signs. We evaluated participants' ability to diagnose and treat vasovagal syncope or anaphylaxis with an evaluation sheet and conducted a questionnaire before and after the scenario-based simulation training. RESULTS The median evaluation sheet score for vasovagal syncope increased significantly from 7/9 before to 9/9 after simulation training. The median score for anaphylaxis also increased significantly from 8/12 to 12/12 (P < .01). For the item "I can treat vasovagal syncope/anaphylaxis adequately," the percentage responding "Strongly agree" or "Agree" increased from 14% to 56% for vasovagal syncope and from 6% to 42% for anaphylaxis with simulation training. CONCLUSIONS This simulation course improved participants' ability to diagnose and treat medical emergencies and improved their confidence. This course can be offered inexpensively using a software application.
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Affiliation(s)
- N Kishimoto
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | - N Mukai
- Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - Y Honda
- Institute of Dental Research, Osaka Dental University, Osaka, Japan
| | - Y Hirata
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | - M Tanaka
- Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - Y Momota
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
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26
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Rivasi G, Rafanelli M, Ungar A. Usefulness of Tilt Testing and Carotid Sinus Massage for Evaluating Reflex Syncope. Am J Cardiol 2018; 122:517-520. [PMID: 29954601 DOI: 10.1016/j.amjcard.2018.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022]
Abstract
Thirty years ago Tilt Testing (TT) was described as a tool in the diagnostic work-up of vasovagal syncope; after its initial success, some flaws have become evident. The concept of hypotensive susceptibility has provided the test a new relevance, shifting from diagnosis only, to therapeutic management. Carotid Sinus Massage (CSM) was introduced at the beginning of the XX century; the technique has evolved over years, whereas the concept of carotid sinus syndrome (CSS) has remained unchanged and uncontested for more than half a century. Nowadays, CSS is a matter of debate, with new classifications and criteria coming on the scene. Recently, a common central etiological mechanism has been hypothesized for reflex syncope, manifesting as CSS, vasovagal syncope or both. In this context, TT and CSM acquire an important role in clinical practice, being essential for a complete diagnosis and treatment. Recalling their historical background, the present paper illustrates an actual interpretation of TT and CSM.
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Affiliation(s)
- Giulia Rivasi
- Syncope Unit, Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Martina Rafanelli
- Syncope Unit, Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Ungar
- Syncope Unit, Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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27
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Xu WR, Liao Y, Jin HF, Zhang QY, Tang CS, Du JB. [Progress in diagnosis and management of syncope in children]. Beijing Da Xue Xue Bao Yi Xue Ban 2017; 49:756-759. [PMID: 29045952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Syncope is a common emergency of children and adolescents, which has serious influence on the quality of life. Neurally-mediated syncope, including postural tachycardia syndrome, vasovagal syncope, orthostatic hypotension and orthostatic hypertension, is the main cause of syncope in children and adolescents. The main manifestations of neurally-mediated syncope are diverse, such as dizziness, headache, chest tightness, chest pain, pale complexion, fatigue, pre-syncope and syncope. Although the clinical manifestations are similar, each subtype of syncope has its hemodynamic feature and optimal treatment option. The diagnosis rate of syncope in children has been greatly improved on account of the development of the diagnostic procedures and methods. In recent years, with the promotion of head-up tilt test and drug-provocated head-up tilt test, the hemodynamic classification of neurally-mediated syncope gets continually refined. In recent years, with the effort of clinicians, an appropriate diagnostic protocol for children with syncope has been established. The initial evaluation consists of history taking, physical examination, standing test and standard electrocardiography. After the initial evaluation, some patients could be diagnosed definitely, such as postural tachycardia syndrome, orthostatic hypotension, and situational syncope. Those with a specific entity causing syncope need selective clinical and laboratory investigations. Patients for whom the cause of syncope remained undetermined should undergo head-up tilt test. The precise pathogenesis of neurally-mediated syncope is not entirely clear. In recent years, studies have shown that neurally-mediated syncope may be related to several factors, including hypovolemia, high catecholamine status, abnormal local vascular tension, decreased skeletal muscle pump activity and abnormal neurohumoral factors. Currently based on the possible pathogenesis, the individualized treatment of neurally-mediated syncope has also been studied in-depth. Generally, the management of neurally-mediated syncope includes non-pharmacological and pharmacological interventions. Patient education is the fundamental part above all. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta adrenoreceptor blockers, and alpha adrenoreceptor agonists. By analyzing the patient's physiological indexes and biomarkers before treatment, the efficacy of medication could be well predicted. The individualized treatment will become the main direction in the future researches.
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Affiliation(s)
- W R Xu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Y Liao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - H F Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Q Y Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - C S Tang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - J B Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
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Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V. 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. Circulation 2017; 136:e123-e135. [PMID: 28280230 DOI: 10.1161/cir.0000000000000500] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS Of 3188 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. CONCLUSIONS 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.
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29
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Abstract
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.
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Affiliation(s)
- R A Kenny
- From the Mercers Institute, St James's Hospital, Dublin, Ireland
| | - T McNicholas
- From the Mercers Institute, St James's Hospital, Dublin, Ireland
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Bałczewska D, Kaczmarek K, Ptaszyński P, Wranicz JK, Cygankiewicz I. [Long-term prognosis in patients with vasovagal syncope after pacemaker implantation]. Pol Merkur Lekarski 2016; 41:243-247. [PMID: 27883352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patients with syncope, without presence of a structural or primary electrical disease, have a very good prognosis. On the other hand, recurring syncope has a negative impact on quality of life and involves a real risk of physical injuries. Vasovagal syncope usually requires no medical therapy and the most commonly recommended instruction include avoidance of fainting triggers, exercise that mainly provoke leg muscles tension, increase salt consumption and drink indicated amount of fluids. In the case cardioinhibitory type of vasovagal syncope the pacemaker implantation can consider. Unfortunately, not all patients benefit from this treatment. Medical society clearly highlights that proper qualification of VVS patients is the most important factor for cardiostimulator implantation. This article aims to summarize the most important research and guidelines concerning cardiac pacing for patients with vasovagal syncope.
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Radovanović NN, Kirćanski B, Raspopović S, Pavlović SU, Jovanović V, Milašinović G. Is pacemaker therapy the right key to patients with vasovagal syncope? SRP ARK CELOK LEK 2016; 144:597-601. [PMID: 29659218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Vasovagal syncope is the most common type of reflex syncope. Efficacy of cardiac pacing in this indication has not been the subject of many studies and pacemaker therapy in patients with vasovagal syncope is still controversial. OBJECTIVE This study aimed to assess the efficacy and safety of pacing therapy in treatment of patients with vasovagal syncope, to determine contribution of new therapeutic models in increasing its success, and to identify risk factors associated with a higher rate of symptoms after pacemaker implantation. METHODS A retrospective study included 30 patients with pacemaker implanted due to vasovagal syncope in the Pacemaker Center, Clinical Center of Serbia, between November 2003 and June 2014. Head-up tilt test was performed to diagnose vasovagal syncope. Patients with cardioinhibitory and mixed type of disease were enrolled in the study. RESULTS Mean age was 48.1 ± 11.1 years and 18 (60%) patients were men. Mean follow-up period was 5.9 ± 3.0 years. Primarily, implantable loop recorder was implanted in 10 (33.3%) patients. Twenty (66.7%) patients presented cardioinhibitory and 10 (33.3%) mixed type of vasovagal syncope. After pacemaker implantation, 11 (36.7%) patients had syncope. In multiple logistic regression analysis we showed that syncope is statistically more likely to occur after pacemaker implantation in patients with mixed type of vasovagal syncope (p = 0.018). There were two (6.7%) perioperative surgical complications. CONCLUSION Pacemaker therapy is a safe treatment for patients with vasovagal syncope, whose efficacy can be improved by strict selection of patients. We showed that symptoms occur statistically more often in patients with mixed type of disease after pacemaker implantation.
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Bałczewska D, Kaczmarek K, Ptaszyński P, Wranicz JK, Cygankiewicz I. [Technical options of electrotherapy in patients with vasovagal syncope]. Pol Merkur Lekarski 2016; 41:177-179. [PMID: 27760090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Yuge K, Ohya T, Shibuya I, Nagamitsu S, Yamashita Y. Pathological crying and emotional vasovagal syncope as symptoms of a dorsally exophytic medullary tumor. Brain Dev 2016; 38:609-12. [PMID: 26740075 DOI: 10.1016/j.braindev.2015.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/18/2022]
Abstract
A 3-year-old boy with a dorsally exophytic tumor arising from the rostral medulla presented with a chief complaint of a change in his emotional behavior, most notably anxiety and paroxysmal crying often followed by syncope. Magnetic resonance imaging revealed that the tumor pushed on the dorsal surface of the medulla and displaced the medulla anteriorly, and also displaced the cerebellar vermis upward and slightly posteriorly. Tissue from a partial resection was diagnosed as a pilocytic astrocytoma. The symptoms did not improved after surgery, but did improve clinically after chemotherapy with vincristine and carboplatin, at which time MR showed a reduction in tumor size. We diagnosed the paroxysmal crying as 'pathological crying' and the syncope with increased anxiety as 'emotional vasovagal syncope'. This case stresses the importance of recognition of this rare presentation as an indication of a medullary tumor.
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Affiliation(s)
- Kotaro Yuge
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
| | - Takashi Ohya
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
| | - Ikuhiko Shibuya
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
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Kanjwal K, Masudi S, Grubb BP. Syncope in Children and Adolescents. Adolesc Med State Art Rev 2015; 26:692-711. [PMID: 27282019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
MESH Headings
- Adolescent
- Aortic Valve Stenosis/complications
- Aortic Valve Stenosis/diagnosis
- Aortic Valve Stenosis/therapy
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Autonomic Nervous System Diseases/complications
- Autonomic Nervous System Diseases/diagnosis
- Autonomic Nervous System Diseases/therapy
- Breath Holding
- Cardiomyopathies/complications
- Cardiomyopathies/diagnosis
- Cardiomyopathies/therapy
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Diagnosis, Differential
- Electrocardiography
- Electrocardiography, Ambulatory
- Epilepsy/diagnosis
- Heart Diseases/complications
- Heart Diseases/diagnosis
- Heart Diseases/therapy
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/therapy
- Phobic Disorders/diagnosis
- Phobic Disorders/therapy
- Postural Orthostatic Tachycardia Syndrome/complications
- Postural Orthostatic Tachycardia Syndrome/diagnosis
- Postural Orthostatic Tachycardia Syndrome/therapy
- Syncope/diagnosis
- Syncope/etiology
- Syncope/therapy
- Syncope, Vasovagal/diagnosis
- Syncope, Vasovagal/therapy
- Tilt-Table Test
- Video Recording
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Abstract
The paper presents four examples of patients fainting. Although we all undergo yearly CPD updates, until you experience a medical emergency, you can never truly be ready for one.
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Occhetta E, Perego GB. [The new 2013 European guidelines on pacing and cardiac resynchronization therapy: between confirmation and novelty]. G Ital Cardiol (Rome) 2014; 15:215-20. [PMID: 24873809 DOI: 10.1714/1497.16495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
MESH Headings
- Arrhythmia, Sinus/therapy
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/therapy
- Atrial Fibrillation/therapy
- Bradycardia/therapy
- Bundle-Branch Block/therapy
- Cardiac Pacing, Artificial/adverse effects
- Cardiac Pacing, Artificial/methods
- Cardiac Pacing, Artificial/standards
- Cardiac Resynchronization Therapy/adverse effects
- Cardiac Resynchronization Therapy/standards
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/therapy
- Coronary Disease/complications
- Coronary Disease/therapy
- Female
- Heart Conduction System/physiopathology
- Humans
- Male
- Multicenter Studies as Topic
- Practice Guidelines as Topic
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Randomized Controlled Trials as Topic
- Syncope, Vasovagal/therapy
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37
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Etemadi AQ, Sunthorn H. [Vasovagal syncope: diagnosis and management]. Rev Med Suisse 2014; 10:1179-1185. [PMID: 24964525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Vasovagal syncope is the main cause of syncope. The mechanism behind this syncope has not been clearly identified, but the main hypothesis is a paradoxical reaction of the autonomic nervous system leading to hypotension and/or bradycardia. According to the recommendations of the European Society of Cardiology, the diagnosis can be made only on the basis of history. In patients where the diagnosis is not clear, we can offer to make a tilt test, which is, however, limited in terms of sensitivity and does not represent the gold standard. The initial management is primarily conservative. Pacing should still be revisit by future studies.
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Abstract
Vasovagal Syncope (VVS) can lead to a markedly diminished quality of life for some patients. While there are many treatments for this condition including physical, mechanical, pharmacologic, and device-based control of heart rate, there are few that have been shown to be effective in randomized clinical trials. In our local experience, we have achieved significant improvement in symptom frequency and quality of life using algorithms based on the data available and on clinical acumen for the majority of patients with VVS. Despite this, there are still many patients who suffer from treatment refractory VVS. Fortunately, there are a number of ongoing clinical trials that are likely to add to our knowledge. Ongoing clinical trials are reviewed to examine new treatment methods for VVS that were listed on public trial registries as of April 15, 2014. Data from these trials should inform future strategies in the care of patients with VVS.
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Affiliation(s)
- Samuel T Coffin
- Autonomic Dysfunction Center, Vanderbilt University School of Medicine; Departments of Medicine, Vanderbilt University School of Medicine
| | - Satish R Raj
- Autonomic Dysfunction Center, Vanderbilt University School of Medicine; Departments of Medicine, Vanderbilt University School of Medicine; Department of Pharmacology, Vanderbilt University School of Medicine.
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Takahagi VCM, Costa DC, Crescêncio JC, Gallo L. Physical training as non-pharmacological treatment of neurocardiogenic syncope. Arq Bras Cardiol 2014; 102:288-94. [PMID: 24714795 PMCID: PMC3987313 DOI: 10.5935/abc.20140021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 10/09/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Characterized as a sudden and temporary loss of consciousness and postural tone, with quick and spontaneous recovery, syncope is caused by an acute reduction of systemic arterial pressure and, therefore, of cerebral blood flow. Unsatisfactory results with the use of drugs allowed the nonpharmacological treatment of neurocardiogenic syncope was contemplated as the first therapeutic option. OBJECTIVES To compare, in patients with neurocardiogenic syncope, the impact of a moderate intensity aerobic physical training (AFT) and a control intervention on the positivity of head-up tilting test (HUT) and orthostatic tolerance time. METHODS Were studied 21 patients with a history of recurrent neurocardiogenic syncope and HUT. The patients were randomized into: trained group (TG), n = 11, and control group (CG), n = 10. The TG was submitted to 12 weeks of AFT supervised, in cycle ergometer, and the CG to a control procedure that consisted in 15 minutes of stretching and 15 minutes of light walk. RESULTS The TG had a positive effect to physical training, with a significant increase in peak oxygen consumption. The CG did not show any statistically significant change before and after the intervention. After the intervention period, 72.7% of the TG sample had negative results to the HUT, not having syncope in the revaluation. CONCLUSION The program of supervised aerobic physical training for 12 weeks was able to reduce the number of positive HUT, as it was able to increase tolerance time in orthostatic position during the HUT after the intervention period.
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Affiliation(s)
- Vanessa Cristina Miranda Takahagi
- Mailing Address: Vanessa Cristina Miranda Takahagi, Divisão de
Cardiologia HCFMRP-USP - Av. Bandeirantes, 3900, Monte Alegre. Postal Code 14049-900,
Ribeirão Preto, SP - Brazil. E-mail:
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40
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Abstract
Vasovagal syncope is a common disorder that affects at least 20% of people at some time in their lives. Probably half of these patients faint recurrently; for many this causes physical trauma, a substantial reduction in quality of life, and difficulties with driving, employment and education. The last 15 years have seen striking advances in diagnostic approaches and prognostic understanding. A number of physiological, pharmacological and electrical therapies have been developed and tested to various degrees in patients. These include counterpressure manoeuvres, salt and fluid recommendations, and attempted treatment with fludrocortisone, midodrine, beta-blockers, serotonin reuptake inhibitors, and permanent pacemakers. This review highlights the most important of these advances and suggests strategies for managing this often difficult problem.
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Affiliation(s)
- Robert Sheldon
- University of Calgary, Libin Cardiovascular Institute of Alberta, Faculty of Medicine, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada.
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41
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Abstract
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.
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Affiliation(s)
- Angel Moya
- Unitat d'Arítmies, Cardiology Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain.
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42
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Affiliation(s)
- S Hazeldine
- Department of Gastroenterology, Frenchay Hospital, Frenchay Park Road, Bristol, UK.
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43
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Ross PJ, Schneider PE, Helpin M. Neurocardiogenic syncope of child dental patient: a case review. Pediatr Dent 2013; 35:71-73. [PMID: 23635903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Neurocardiogenic syncope is a condition that frequently occurs in children. The purpose of this case report was to describe the clinical manifestations of a 7-year old child with neurocardiogenic syncope and the remedial management of loss of consciousness during dental treatment.
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Affiliation(s)
- Peter J Ross
- Department of Pediatric Dentistry, Kornberg School of Dentistry, Temple University, Philadelphia, Pa., USA
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44
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Shen DT, Lin ZQ, Xie ZQ, Zhan YY, Luo Y, Zhong YX, Li ZL. [Impact of attack frequency and therapy strategies on outcome of patients with vasovagal syncope]. Zhonghua Xin Xue Guan Bing Za Zhi 2012; 40:1016-1019. [PMID: 23363716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To analyze the impact of attack frequency as well as therapy strategies on outcome of patients with vasovagal syncope (VVS). METHODS A total of 159 patients (aged from 15 - 59 years old) with VVS were included in this study. Patients were divided into low frequency (< 3) group (n = 95) and high (≥ 3) frequency group (n = 64) according to the attack frequency in the past 5 years at the primary survey. Patients received one of the three therapies: no treatment, physical therapy, and comprehensive treatment. All cases were followed up with telephone or outpatient visit for 24 months. RESULTS Incidence of syncope was significantly higher in the high frequency group and in the low frequency group [40.6% (26/64) vs. 11.6% (11/95), P < 0.01]. The overall improvement rate was significantly higher in the low frequency group than that of high frequency group (P < 0.01). Improvement rate was significantly higher in the physical therapy subgroup and the comprehensive treatment subgroup than no treatment subgroup for patients with low attack frequency [81.8% (27/33) vs. 47.1% (8/17), P < 0.05; 82.2% (37/45) vs. 47.1% (8/17), P < 0.05], and in comprehensive treatment subgroup than in physical therapy subgroups observed between and [62.2% (28/45) vs. 31.6% (6/19), P < 0.05] for patients with high attack frequency. CONCLUSION Outcome is related to previous attack frequency for patients with VVS, physical therapy is effective for reducing the recurrence rate of syncope in VVS patients with low attack frequency while physical therapy combined with pharmacotherapy should be applied for VVS patients with high attack frequency to improve outcome.
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Affiliation(s)
- Dan-tong Shen
- Geriatric Department of General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou 510010, China
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45
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Ostenson S. [Fainting school helps against troublesome vasovagal syncope. Experiences of the leg crossing method]. Lakartidningen 2012; 109:2282-2283. [PMID: 23367864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Skerk V, Pintarić H, Delić-Brkljacić D, Popović Z, Hećimović H. Orthostatic intolerance: postural orthostatic tachycardia syndrome with overlapping vasovagal syncope. Acta Clin Croat 2012; 51:93-95. [PMID: 22920009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.
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Affiliation(s)
- Vedrana Skerk
- Department of Cardiology, University Department of Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
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Dupliakov DV, Golovina GA, Sysuenkova EV, Glukhova VL, Liukshina NG. [Clinical features and history of vasovagal syncope]. Kardiologiia 2012; 52:48-55. [PMID: 22839586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aim of this investigation was to study special characteristics of natural course of vasovagal syncope (VVS). During 3 years we examined 212 patients (44% men) in accordance with recommendations of European Society of Cardiology using tilt tests according to Westminster or Italian protocols for confirmation of vasovagal genesis. Depending on results of initial investigation patients were divided into 2 groups: group 1 comprised 144 patients (68%) satisfying criteria of VVS; group 2 comprised other patients (n=41, 19%) with transitory loss of consciousness of unclear origin. Patients with VVS were significantly younger (mean age 35.1+/-13.6 and 44.4+/-13.,9 years, respectively; <0.01) with earlier appearance of first episode of fainting (16 vs. 39 years; <0,01). In most cases VVS appeared in the age younger than 35 years. Accuracy of anamnestic method for diagnosis of VVS was 99%. Forty one percent of patients with classical VVS had several potential causes of fainting (situational syncope, paroxysms of tachyarrhythmia, epilepcy). This could lead to mistakes at initial stage of diagnostics. Progressive clinical course was observed in 15% of patients and was associated either with syncopi of other, including nonvagal origin, or with increased frequency of previously stereotypical attacks. In every second patient with initially frequent recurrences of VVS we observed long spontaneous remissions. Nondrug methods of treatment were effective in 43% of these patients. Tilt test had high informative power for diagnostics of VVS. With this its informativity was low in patients with onset of fainting attacks in middle age and with atypical clinical picture.
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Wang XM, Gao XY. [Acupuncture-moxibustion at Baihui (GV 20) for 56 cases of vasovagal syncope]. Zhongguo Zhen Jiu 2011; 31:974. [PMID: 22136016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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49
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Abstract
BACKGROUND Neurally mediated reflex syncope is the most common cause of transient loss of consciousness. In patients not responding to non-pharmacological treatment, pharmacological or pacemaker treatment might be considered. OBJECTIVES To examine the effects of pharmacological therapy and pacemaker implantation in patients with vasovagal syncope, carotid sinus syncope and situational syncope. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2008), PubMed (1950 until February 2008), EMBASE on OVID (1980 until February 2008) and CINAHL on EBSCOhost (1937 until February 2008). No language restrictions were applied. SELECTION CRITERIA We included parallel randomized controlled trials and randomized cross-over trials of pharmacological treatment (beta-blockers, fludrocortisone, alpha-adrenergic agonists, selective serotonine reuptake inhibitors, ACE inhibitors, disopyramide, anticholinergic agents or salt tablets) or dual chamber pacemaker treatment. Studies were included if pharmacological or pacemaker treatment was compared with any form of standardised control treatment (standard treatment), placebo treatment, or (other) pharmacological or pacemaker treatment. We did not include non-randomized studies. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the risk of bias. Using a standardised data extraction form, they extracted characteristics and results of the various studies. In a consensus meeting they discussed any disagreements that had occurred during data extraction. If no agreement could be reached, a third reviewer was asked to make a decision. Summary estimates with 95% confidence intervals of treatment effect were calculated using relative risks, rate ratios or weighted means differences depending on the type of outcome reported. MAIN RESULTS We included 46 randomized studies, 40 on vasovagal syncope and six on carotid sinus syncope. No studies on situational syncope matched the criteria for inclusion in our review. Studies in general were small with a median sample size of 42. A wide range of control treatments were used with 22 studies using a placebo arm. Blinding of patients and treating physicians was applied in eight studies. Results varied considerably between studies and between types of outcomes.For vasovagal syncope, the occurrence of syncope upon provocational head-up tilt testing was lower upon treatment with beta-blockers, ACE-inhibitors and anticholinergic agents compared to standard treatment. For carotid sinus syncope, the occurrence of syncope upon carotid sinus massage was lower on midodrine treatment compared to placebo treatment in one study. AUTHORS' CONCLUSIONS There is insufficient evidence to support the use of any of the pharmacological or pacemaker treatments for vasovagal syncope and carotid sinus syncope. Larger studies using patient relevant outcomes are needed.
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Affiliation(s)
- Jacobus Jcm Romme
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Room J1B-207.1, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ
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Dupliakov DV, Golovina GA, Zemlianova ME, Khokhlunov SM, Poliakov VP. [Permanent cardiac pacing in vasovagal syncope and carotid sinus syndrome]. Kardiologiia 2011; 51:74-80. [PMID: 21627618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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