ABSTRACT
Objective: To analyze the clinical characteristics and risk factors of malignant vasovagal syncope (VVS) in children. Methods: This was a case-control study. The data of 368 VVS patients who were treated in the Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics from June 2017 to December 2021 was collected and analyzed. They were divided into malignant VVS group and non-malignant VVS group according to the presence of sinus arrest, and then their demographic characteristics were compared. The children with malignant VVS and complete clinical information were recruited into the case group and were matched by age and sex (1∶4 ratio) with non-malignant VVS patients during the same period.Their clinical characteristics and lab tests were compared. Independent sample t test, Mann Whitney U or χ2 test was used for comparison between groups.Logistic regression was used to analyze the risk factors for malignant VVS in children. Results: Eleven malignant VVS and 342 non-malignant VVS met the inclusion and exclusion critera. Eleven malignant VVS and 44 non-malignant children were recruited in the case-control study. Ten patients of the 11 malignant VVS had a cardiac arrest occurring at 35 (28, 35) minutes of the head-up tilt test, and the duration of sinus arrest was (9±5) s. One patient had syncope occurring while waiting for drawing blood, and the duration of sinus arrest was 3.4 s. The children with malignant vasovagal syncope were younger than non-malignant VVS patients (9 (7, 10) vs. 12 (10, 14) years old, P<0.05), and had higher mean corpuscular hemoglobin concentration (MCHC) and standard deviation of the mean cardiac cycle over 5-minute period within 24 hours ((347±9) vs. (340±8) g/L, (124±9) vs. (113±28) ms, both P<0.05). Logistic regression analysis showed that MCHC was an independent risk factor for malignant VVS in pediatric patients (OR=1.13, 95%CI 1.02-1.26, P=0.024). Conclusions: The onset age of malignant VVS was younger, with no other special clinical manifestations. MCHC was an independent risk factor for malignant VVS.
Subject(s)
Humans , Child , Adolescent , Syncope, Vasovagal/etiology , Case-Control Studies , Syncope , Risk FactorsABSTRACT
Introducción: Las urgencias médicas durante la atención estomatológica son eventos que pueden poner en peligro la salud de los pacientes. Objetivo: Caracterizar las urgencias médicas que se les han presentado a los estomatólogos durante su práctica profesional. Métodos: Se realizó un estudio descriptivo y transversal, de enero a marzo de 2019. El universo estuvo constituido por los estomatólogos de 12 de las 20 clínicas estomatológicas de subordinación docente a la Facultad de Estomatología de La Habana "Raúl González Sánchez". Variables utilizadas fueron: presencia de urgencias, tipo de especialidades, frecuencia de las urgencias médicas, tipo de urgencia médica, procederes estomatológicos y cantidad de urgencias. Resultados: El 61,2 por ciento de los encuestados refirió que eran eventos poco frecuentes, el 50,8 por ciento presentó dos urgencias médicas. Las urgencias más frecuentes fueron las lipotimias (29,9 por ciento) y los síncopes vaso vágales (25,2 por ciento). Conclusiones: Las urgencias médicas son eventos que pueden producirse durante la atención estomatológica. El presente estudio aborda un área del conocimiento poco estudiada en Estomatología en Cuba. Los profesionales, durante los procederes estomatológicos, juegan un papel protagónico en la prevención de las urgencias médicas y en su tratamiento inicial. Los datos epidemiológicos y clínicos de estos eventos, aportados por esta investigación, pueden servir de referencia a otros estudios(AU)
Introduction: Medical emergencies occurring during dental care may pose a risk to the health of patients. Objective: Characterize medical emergencies experienced by dentists in their professional practice. Methods: A descriptive cross-sectional study was conducted from January to March 2019. The study universe was the dentists of 12 of the 20 university dental clinics attached to the Dental School of Havana. The variables analyzed were occurrence of emergencies, specialty, frequency of medical emergencies, type of medical emergency, dental procedures and number of emergencies. Results: 61.2 percent of the respondents stated that medical emergencies were not frequent, and 50.8 percent reported two medical emergencies. The most common emergencies were loss of consciousness (29.9 percent) and vasovagal syncope (25.2 percent). Conclusions: Medical emergencies may occur during dental care. The study addresses an area of dental practice not much dealt with in Cuba. During the performance of dental procedures, professionals play a leading role in the prevention of medical emergencies and their initial treatment. The epidemiological and clinical data about these events contributed by this research may serve as reference for other studies(AU)
Subject(s)
Humans , Professional Practice , Dental Care/methods , Syncope, Vasovagal/etiology , Emergencies , Schools, Dental , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Abstract Introduction: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. Methods: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann-Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. Results: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). Conclusion: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.
Subject(s)
Humans , Pacemaker, Artificial , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/etiology , Syncope, Vasovagal/therapy , Atrioventricular Block , Syncope/diagnosis , Syncope/etiology , Tilt-Table TestABSTRACT
El síncope es una pérdida transitoria de conciencia y tono postural debido a hipoflujo sanguíneo cerebral que se recupera espontáneamente sin maniobras de RCP. En esta actualización se plantea el síncope vasovagal con sus diagnósticos diferenciales y posibles etiologías, fisiopatología y métodos de estudios. También se presenta la experiencia sobre este tema en nuestro hospital su estudio, tratamiento y diagnostico (tilt test) (AU)
Syncope is a transient loss of consciousness and postural tone due to cerebral blood hypoflow that recovers spontaneously without CPR maneuvers. This update discusses vasovagal syncope with its differential diagnoses and possible etiologies, pathophysiology, and diagnostic methods. Additionally, the experience on this topic of our hospital regarding investigations, treatment, and diagnosis is presented. (AU)
Subject(s)
Humans , Child , Adolescent , Tilt-Table Test/instrumentation , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/etiology , Syncope, Vasovagal/physiopathology , Syncope, Vasovagal/therapy , Diagnosis, DifferentialABSTRACT
Abstract Background: It was aimed to investigate the relationship between preoperative anxiety and vasovagal symptoms observed during the administration of spinal anesthesia in patients undergoing surgery in the perianal and inguinal regions. Methods: The study included patients with planned surgery for inguinal hernia repair, anal fissure, hemorrhoid and pilonidal sinus excision. The study included a total of 210 patients of ASA I-II, aged 18-65 years. Patients were evaluated in respect of demographic characteristics, smoking and alcohol consumption, ASA grade and educational level. Correlations were evaluated between the number of attempts at spinal anesthesia and anesthesia history with vasovagal symptoms and educational level, gender, smoking and alcohol consumption and anesthesia history with anxiety scores. The instant (transient) state anxiety inventory part of the Transient State/Trait Anxiety Inventory (State Trait Anxiety Inventory - STAI) was used to determine the anxiety levels of the participants. Clinical findings of peripheral vasodilation, hypotension, bradycardia and asystole observed during the administration of spinal anesthesia were recorded. Results: Vasovagal incidences during the administration of spinal anesthesia were seen to increase in cases of high anxiety score, male gender, and an absence of anesthesia history. Educational level and the number of spinal needle punctures were not found to have any effect on vasovagal incidents. Conclusion: The determination of causes triggering vasovagal incidents seen during the application of spinal anesthesia, better patient information of regional anesthesia implementations and anxiety relief with preoperative anxiolytic treatment will help to eliminate potential vasovagal incidents.
Resumo Justificativa: O objetivo deste estudo foi investigar a relação entre a ansiedade no período pré-operatório e os sintomas vasovagais observados durante a administração de raquianestesia a pacientes submetidos à cirurgia nas regiões perianal e inguinal. Métodos: O estudo incluiu pacientes com cirurgias agendadas para correção de hérnia inguinal, fissura anal, hemorroidas e excisão de fístula pilonidal. Foram incluídos 210 pacientes entre 18-65 anos e estado físico ASA I-II. A avaliação dos pacientes compreendeu história de tabagismo e consumo de álcool, classificação ASA e nível de escolaridade. As correlações foram avaliadas entre o número de tentativas de aplicação da raquianestesia e história de anestesia com sintoma vasovagal, nível de escolaridade, sexo, tabagismo e consumo de álcool, história anestésica e escores de ansiedade. O inventário do estado (transitório) de ansiedade, parte do Inventário de Ansiedade Traço-Estado (State Trait Anxiety Inventory - IDATE), foi usado para determinar os níveis de ansiedade dos participantes. Achados clínicos de vasodilatação periférica, hipotensão, bradicardia e assistolia observados durante a administração da raquianestesia foram registrados. Resultados: Observamos aumento dos incidentes vasovagais durante a administração da raquianestesia em casos com escores elevados de ansiedade, pacientes do sexo masculino e pacientes sem história anestésica. O nível de escolaridade e o número de punções com agulha espinhal não mostraram ter qualquer efeito sobre os incidentes vasovagais. Conclusão: Determinar as causas que desencadearam os incidentes vasovagais observados durante a aplicação da raquianestesia, fornecer boa informação ao paciente sobre a anestesia regional e promover alívio da ansiedade com tratamento ansiolítico no pré-operatório contribuirão para eliminar possíveis incidentes vasovagais.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Anxiety/complications , Syncope, Vasovagal/etiology , Intraoperative Complications/etiology , Anesthesia, Spinal , Anxiety/diagnosis , Bradycardia/etiology , Bradycardia/epidemiology , Syncope, Vasovagal/epidemiology , Preoperative Period , Intraoperative Complications/epidemiology , Middle AgedABSTRACT
A síncope é um problema médico comum e, se relacionada a distúrbio da condução atrioventricular (AV), pode indicar o implante de marcapasso definitivo. Por isso, a distinção entre o bloqueio AV devido a doença degenerativa e aquele induzido por aumento do tônus vagal tem importante implicação prognóstica e terapêutica. O mecanismo responsável pela síncope vasovagal é a perda abrupta e transitória da consciência decorrente de hipoperfusão cerebral global e transitória, com início rápido, curta duração e recuperação completa e espontânea. É uma causa comum de síncope e tem bom prognóstico. Em sua forma cardioinibitória, costuma ter como mecanismo a bradicardia sinusal ou a assistolia associada a queda da pressão sanguínea, porém podem ocorrer outras apresentações menos comuns, como o bloqueio AV (BAVT, BAV 2:1 BAV avançado). Descreve-se o caso de uma paciente do sexo feminino, com 54 anos, hipertensa, chagásica (megaesôfago) e vários episódios de síncope no último ano. Foi investigada com eletrocardiograma (BAV 1º grau), ecocardiograma (normal), Holter (BAV 2 grau Mobitz I durante o sono), teste ergométrico (resposta cronotrópica e condução AV normais durante o esforço) e tilt test sensibilizado positivo (BAVT) com manutenção de distúrbios da condução atrioventricular (BAVT, BAV avançado) associados a pré-síncope após retorno a zero grau, quadro que durou 25 minutos. Como parte da investigação, foi submetida a estudo eletrofisiológico com intervalo HV normal. Foi indicado marcapasso definitivo, porém a paciente recusou-se. Retornou após um ano com manutenção do quadro de síncope. Foi então submetida a implante de marcapasso definitivo de dupla-câmara e encontra-se há 15 meses sem sintomas.
Syncope is a common medical problem and if related to disorder of atrioventricular (AV) conduction may be indicative of permanent pacemaker implantation. Therefore, the distinction between AV block due to degenerative disease and that induced by increased vagal tone has important prognostic and therapeutic implications. The mechanism responsible for vasovagal syncope is a sudden and transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration, and spontaneous complete recovery. It is a common cause of syncope and has a good prognosis. When cardioinhibitory, usually has as a mechanism of syncope sinus bradycardia or asystole associated to drop in blood pressure, but other less common presentations may occur as AV block (AVB, advanced AVB, AVB 2:1). We describe the case of a female patient, 54 years old, with hypertension, Chagas disease (megaesophagus) and several episodes of syncope in the last year. She was investigated by electrocardiogram (1st degree AVB), echocardiogram (normal), holter (Mobitz I 2nd degree AVB during sleep), exercise testing (normal chronotropic response and AV conduction during exercise) and tilt test (complete AVB) with maintenance of atrioventricular block (complete AVB and advanced AVB) associated with pre-syncope after returning to zero degree. This situation last for 25 minutes. As part of the investigation she underwent electrophysiologic study with normal HV interval. Permanent pacemaker was indicated but the patient refused. After 1 year she returned with maintenance of syncope and then underwent implantation of a permanent dual chamber pacemaker. She is without symptoms in the last 15 months.
Subject(s)
Humans , Female , Middle Aged , Atrioventricular Block , Chagas Disease/physiopathology , Pacemaker, Artificial , Syncope, Vasovagal/etiology , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/therapyABSTRACT
Relatamos o caso de uma criança de nove anos de idade, com quadro de síncope há dois anos e eletrocardiograma revelando síndrome de Wolff-Parkinson-White (WPW). História familiar de irmã com síndrome vasovagal. A paciente foi submetida a estudo eletrofisiológico (EEF), para estratificação de risco e ablação da via anômala. Após a ablação, permaneceu com os mesmos sintomas que a fizeram procurar atendimento médico na primeira consulta, sendo então solicitado teste de inclinação (tilt test), que foi positivo para síndrome vasovagal do tipo mista. Conclui-se, portanto, que a causa dos desmaios foi a síndrome vasovagal, sendo as alterações eletrocardiográficas compatíveis com Wolff-Parkinson-White apenas um achado casual. Dois anos após a primeira consulta elaapresenta aumento dos intervalos entre os episódios de síncope.
We report a case of a child nine years old, presented with syncope about two years, with electrocardiogram Wolff-Parkinson-White (WPW) and family history of a sister with vasovagal syndrome. The patient underwent electrophysiological study (EPS) for risk stratification and ablation of the anomalous pathway. After ablation remained with the same symptoms that caused her to seek medical attention at the first consultation, and then asked the tilt test, which was positive for mixed type of vasovagal syndrome. Therefore concluded to be the syncope?s cause, the vasovagal syndrome and electrocardiographic changes compatible with Wolff-Parkinson-White, being just an incidental finding. Two years after the first consultation, she finds with increase interval between episodes of syncope.
Subject(s)
Humans , Child , Wolff-Parkinson-White Syndrome/physiopathology , Syncope, Vasovagal/etiology , Electrocardiography, Ambulatory/instrumentation , Electrocardiography/instrumentationABSTRACT
We report a 60 years old male presenting with a history of repeating syncopal episodes lasting seven days. The patient had a history of an intestinal lymphoma treated four years ago. Imaging studies showed a macro nodule in the left thyroid lobe. The pathological study disclosed a type B non Hodgkin lymphoma. The patient was treated with chemotherapy with a favorable outcome. The association of syncope and cervical tumors has been described previously.
Subject(s)
Humans , Male , Aged , Goiter, Nodular/etiology , Lymphoma, B-Cell/complications , Lymphoma, Non-Hodgkin/complications , Head and Neck Neoplasms/complications , Syncope, Vasovagal/etiology , Goiter, Nodular , Head and Neck Neoplasms , Mediastinal Neoplasms/complications , Mediastinal Neoplasms , Syncope/etiologyABSTRACT
El síncope es motivo de consulta frecuente y corresponde al médico tratar de hacer un diagnóstico etiológico rápido con elobjeto de distinguir los de origen neurocardiogénico de buen pronóstico de los cardíacos que pueden provocar la muerte. El diagnóstico inicial se puede basar en la historia clínica, el examen físico y el electrocardiograma, completando luego con otros estudios. No siempre se llega a un diagnóstico certero. En oportunidades se pueden tratar con drogas o marcapasos con buen resultado.
Subject(s)
Humans , Hypotension, Orthostatic/diagnosis , Hypotension, Orthostatic/etiology , Medical Records , Physical Examination , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/etiology , Syncope/diagnosis , Syncope/etiologyABSTRACT
Muitas dúvidas persistem acerca dos mecanismos das síncopes que ocorrem em indivíduos com coração estruturalmente normal. Atualmente, o teste de inclinação é o mais próximo de um padrão-ouro para estes casos. No entanto, a falta de estudos com níveis elevados de evidência e em número suficiente torna o teste ainda sujeito a muitas discussões quanto à melhor metodologia e à correta interpretação de seus resultados. Por outro lado, as informações disponíveis até então permitiram o estabelecimento de algumas indicações precisas para exame e, possivelmente, uma base para a formulação futura de estratégias eficazes de tratamento. Os autores descrevem um sumário do estado da arte deste promissor método diagnóstico.
Subject(s)
Humans , Child , Isoproterenol , Nitrates , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/etiology , Guidelines as TopicABSTRACT
A síncope é uma manifestação que afeta predominantemente os pacientes idosos, determinando sérias complicações e elevada mortalidade. Pode ser causada por diversas afecções que se associam às alterações do envelhecimento. É importante a identificação do diagnóstico etiológico, para que seja instituída a terapêutica adequada
Subject(s)
Humans , Aged , Health of the Elderly , Syncope/physiopathology , Syncope/prevention & control , Syncope/therapy , Syncope, Vasovagal/etiology , Syncope, Vasovagal/therapyABSTRACT
A síncope na infância é uma manifestação clínica relativamente comum e corresponde a pelo 1 por cento dos atendimentos em salas de emergência pediátrica. Por outro lado, cerca de 15 por cento das crianças apresentarão pelo menos um episódio até a segunda década de vida. A síncope na infância pode ser definida como a perda súbita da consciência e do tônus postural, com recuperação espontânea. Em muitas crianças, o episódio de síncope é benigno, geralmente secundário a um distúrbio do controle autonômico (síncope neurocardiogênica, responsável por 50 por cento ou mais de todos os casos). No tratamento da síncope, a identificação das causas e, conseqüentemente, dos mecanismos é fundamental para seu sucesso. Muitas vezes uma investigação cara e prolongada não é necessária quando se tem uma história clínica consistente, o que dispensaria uma razoável quantidade de exames complementares. Neste artigo serão discutidas as abordagens diagnóstica e terapêutica da síncope em crianças.
Subject(s)
Humans , Child , Adolescent , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/epidemiology , Syncope, Vasovagal/etiology , Syncope, Vasovagal/therapy , Tilt-Table Test , ElectrocardiographyABSTRACT
Pacientes com extrassístoles ventriculares de via de saída de ventrículo direito, freqüentemente relatam síncopes e pré-síncopes, sem que se observe correlação destes sintomas com alterações eletrocardiográficas. O objetivo deste estudo foi investigar a prevalência de síncope vasovagal neste grupo de pacientes, pela realização do teste de inclinação. Os pacientes foram divididos em 4 grupos: com palpitações, síncopes, pré-síncopes e assintomáticos. A positividade do teste de inclinação nos pacientes com síncope e pré-síncopes foi significativamente maior quando comparada aos pacientes com palpitações e assintomáticos / Patients with premature beats originating in the right ventricular outflow tract, often refer syncope and near syncope, but frequently no correlation is observed between symptoms and arrythmia in the ambulatorial electrocardiogram. The aim of this study was to evaluate the prevalence of vasovagal syncope in these patients with tilt-table-test. The patients were divided in 4 groups: palpitations, syncope, near-syncope and assyntomatics. Positive response to tilt-table-test was significatly highter in pacients with syncope and near-syncope when compared to those with palpitation and assyntomatics...
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Syncope, Vasovagal/etiology , Tilt-Table Test , Ventricular Premature Complexes , Critical Pathways , Follow-Up Studies , Prevalence , PrognosisABSTRACT
Síncope es una disminución transitoria de conciencia y tono postural por una reducción global del flujo sanguíneo cerebral. Anormalidades en el control autonómico cardiovascular pueden comprometer el riego sanguíneo y producir síncope mediado por mecanismo neurogénico. Entre estos episodios el paciente tiene presión sanguínea y tolerancia ortostática normal. El síncope es un fenómeno médico muy frecuente y sus manifestaciones clínicas y evolutivas características. Un anamnesis cuidadosa aumenta el diagnóstico etiológico y permite efectuar diagnóstico diferencial con crisis epilépticas con las cuales se confunden en forma ocacional, al igual que con transtornos psiquiátricos los cuales pueden asociarse en forma secundaria (5,6,7)