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1.
Medicine (Baltimore) ; 99(11): e19510, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176097

RESUMO

Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration.We sought to investigate the outcome of a ten-minute active phase with Nitroglycerin in patients suspected of vasovagal syncope and determine the percentage of loss in the positivity rate, using this short duration approach.We consecutively enrolled patients presenting with syncope undergoing the head-up tilt test (HUTT), with a clinical suspicion of vasovagal syncope between the years 2009 to 2019. The HUTT consisted of 2 successive phases: passive and active. During the passive phase, the patients were tilted at 70° for 20 minutes. If negative, the test was continued after administration of 0.4 mg sublingual Nitroglycerin. Applying the (VASIS) Vasovagal Syncope International Study classification of the vasovagal syncope international study and comparing for age and gender, positive responses were categorized into 3 types.A number of 306 patients (age = 43.5 +/-20.3; male = 140 [45.7%]) with suspected vasovagal syncope, undergoing HUTT, were enrolled in the years of 2009 to 2019. Of those, 245 (80.2%) presented a positive test, with 200 patients (82.0%) during the being positive during the active phase of the test. The results were as follows: 116 subjects (47.2%) presented with a mixed response (VASIS I), 52 (21.3%) showed a cardio inhibitory response (VASIS II), and 77 (31.5%) displayed a vasodepressor response (VASIS III). We found no relationship between the type of syncope with neither gender, nor age of the patient. Three minutes represented the median time to positivity, after Nitroglycerine administration. The time distribution showed a peak incidence appearing between minutes 3 and 5, ranging from 1 to 20 minutes. Only 3 patients tested positive after minute 10.Shortening the active phase to 10 minutes would result in a positivity rate loss of 1.5%.


Assuntos
Nitroglicerina/administração & dosagem , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada , Vasodilatadores/administração & dosagem , Administração Sublingual , Adulto , Esquema de Medicação , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Fatores de Tempo
2.
Turk J Pediatr ; 61(1): 52-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559722

RESUMO

Lin J, Zhao H, Ma L, Jiao F. Body mass index is decreased in children and adolescents with postural tachycardia syndrome. Turk J Pediatr 2019; 61: 52-58. Our intent was to explore the predictive value of body mass index (BMI) in differentiating between vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) in children and adolescents. A total of 111 children and adolescents with POTS and 154 children and adolescents with VVS were included in our study. The control group included 82 healthy children and adolescents. Height and weight were measured in all participants. The headup tilt test was performed in participants in all groups (POTS, VVS, and control). BMI was significantly lower in children and adolescents with POTS (18.3±3.4) than in children and adolescents with VVS (20.3±4.2) and the control group (20.5±2.9). The receiver operating characteristic curve was performed to determine the predictive value of BMI differentiation between POTS and VVS and showed that a BMI of 19.30 was the cutoff value for the probability of distinction. However, the results (BMI of 19.30) produced unsatisfactory sensitivity (57.1%) and specificity (28.8%) rates of correctly discriminating between patients with POTS and patients with VVS. Children and adolescents with POTS have a lower BMI compared with healthy peers or children and adolescents with VVS.


Assuntos
Índice de Massa Corporal , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síncope Vasovagal/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Síndrome da Taquicardia Postural Ortostática/patologia , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Síncope Vasovagal/patologia , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada
3.
High Blood Press Cardiovasc Prev ; 26(4): 273-281, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31297720

RESUMO

Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the diagnosis. Although limited evidence is available regarding the efficacy of some treatments, a number of these can be successfully used in the clinical practice. It is, however, important to personalize the therapeutic approach in order to achieve an efficient reduction or suppression of syncopal episodes. Patients should be reassured about the benignity of these events and the possibility of reducing their frequency over time. They should be also educated on how to recognize and abort incoming syncopal episodes. Patients may be advised to increase their introit in water and salt, as well as to reduce vasoactive medications, if no contraindications exist. Orthostatic training may be beneficial but only in very motivated young patients capable of strictly adhering to the exercise plan. So far, any proposed pharmacological treatment has demonstrated very limited efficacy and, therefore, it should be tried in case of failure of non-pharmacological approaches. Pacemaker implantation is clearly indicated in patients with documented cardioinhibitory syncope in the absence of a vasodepressor component, which can compromise their quality of life. Despite the American and European guidelines for the treatment of syncope are similar, still some differences can be denoted. Aim of this study is to evaluate the management of patients with recurrent syncopal episodes focusing on pharmacological and non-pharmacological approaches.


Assuntos
Circulação Cerebrovascular , Estado de Consciência , Síncope Vasovagal/terapia , Pressão Sanguínea , Tomada de Decisão Clínica , Humanos , Guias de Prática Clínica como Assunto , Recidiva , Fatores de Risco , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiologia , Síncope Vasovagal/fisiopatologia , Resultado do Tratamento
4.
Lakartidningen ; 1162019 Feb 19.
Artigo em Sueco | MEDLINE | ID: mdl-31192373

RESUMO

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.


Assuntos
Síncope/diagnóstico , Cardiologia , Procedimentos Clínicos , Diagnóstico Diferencial , Gerenciamento Clínico , Europa (Continente) , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/terapia , Guias de Prática Clínica como Assunto , Medição de Risco , Sociedades Médicas , Síncope/etiologia , Síncope/terapia , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiologia , Síncope Vasovagal/terapia
5.
Med. infant ; 26(2): 205-210, Junio 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1021615

RESUMO

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)


Assuntos
Humanos , Criança , Adolescente , Teste da Mesa Inclinada/instrumentação , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiologia , Síncope Vasovagal/fisiopatologia , Síncope Vasovagal/terapia , Diagnóstico Diferencial
7.
Rev Invest Clin ; 71(2): 124-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056593

RESUMO

Background: Vasovagal syncope (VVS) is a frequent clinical condition in which a genetic background seems to be implicated. Considering that the adrenergic receptors (ARs) may play a role in VVS, the present study has as principal aim to determine if the α- and ß-AR (ADRA and ADRB) gene polymorphisms are associated with an increased risk to have a positive head-up tilt table (HUTT) test in patients with VVS. Methods: Nine polymorphisms in the ADRA1A (rs1048101, rs1383914, rs574584, and rs573542), ADRB1 (rs1801252 and rs1801253), ADRB2 (rs1042713 and rs1042714), and ADRB3 (rs4994) genes were analyzed using the 5' exonuclease TaqMan genotyping assay in a group of 134 patients with VVS. Results: Under different models, the rs1801252 (OR = 8.63, 95% CI: 0.95-78.72, Precessive = 0.02), rs1042713 (OR = 1.94, 95% CI: 1.02-3.66, Padditive = 0.04), and rs4994 (OR = 2.46, 95% CI: 1.01-6.01, Pdominant = 0.042 and OR = 2.62, 95% CI: 1.04-6.63, Pover-dominant = 0.03) polymorphisms were associated with increased risk for a positive HUTT. All models were adjusted for statistically significant covariates. Conclusion: These results suggest that some polymorphisms of the ß-AR genes could contribute to a positive tilt test in patients with VVS.


Assuntos
Receptores Adrenérgicos beta/genética , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada , Adulto , Feminino , Genótipo , Humanos , Masculino , Polimorfismo Genético , Síncope Vasovagal/genética , Adulto Jovem
8.
PLoS One ; 14(4): e0214733, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30998713

RESUMO

The study aims to clarify the mechanism in patients with neurally mediated syncope (NMS), focusing on the adenylate cyclase (AC) activity level in lymphocytes. This study included 40 subjects: 22 healthy volunteers and 18 NMS patients. We investigated the changes in AC activity that occur during of syncope at rest and during the head-up tilt (HUT) test. We obtained 8 mL of blood at rest time and four times during the HUT test. Then, we measured the AC activity and the test reagent was added to the lymphocytes (10,000) and reacted for 30 min at room temperature. We were able to determine the standard value of AC activity when adrenaline (AD) and isoproterenol (IP) were added to lymphocytes. The results of our study showed one of the causes of NMS has a difference in AC activity level and classification of the patients into two different types of NMS was possible: either the vasodepressor type (VT) or mixed type (MT). At rest time, VT patients showed significantly higher AC activity (AD; 100 µM: p = 0.005, IP; 50 µM: p = 0.02) and MT patients showed significantly lower AC activity (AD; 10 µM: p = 0.02, IP; 50 µM: p = 0.004) than the average AC activity in healthy volunteers. Moreover, VT patients had significantly higher AC activity than healthy volunteers at the four points of the HUT test. MT patients had significantly lower AC activity (AD: p = 0.04 and IP: p = 0.04) than healthy volunteers at the rest time of HUT. Our study showed a significant difference in AC activities between NMS patients and healthy volunteers at rest. Therefore, a detailed NMS diagnosis can be made by examining AC activity levels in blood taken at rest time.


Assuntos
Adenilil Ciclases/análise , Síncope Vasovagal/diagnóstico , Adenilil Ciclases/metabolismo , Adulto , Idoso , Pressão Sanguínea , Estudos de Casos e Controles , Ativação Enzimática/efeitos dos fármacos , Epinefrina/farmacologia , Feminino , Humanos , Isoproterenol/farmacologia , Japão , Linfócitos/citologia , Linfócitos/metabolismo , Pessoa de Meia-Idade , Estações do Ano , Teste da Mesa Inclinada , Adulto Jovem
9.
J Interv Card Electrophysiol ; 55(1): 105-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30863907

RESUMO

PURPOSE: A proportion of patients with vasovagal syncope (VVS) experience recurrence despite appropriate management. Closed loop stimulation (CLS) pacing is a promising treatment for a subgroup of patients with cardioinhibitory response on head-up tilt table test (HUTT). Nonetheless, its efficacy remains uncertain. We sought to assess the efficacy of CLS pacing in patients with cardioinhibitory VVS. METHODS: We searched PubMed, Google Scholar, and the Cochrane Central Register of controlled trials for relevant studies (last search date April 23, 2018). Data were pooled using the Mantel-Haenszel fixed-effects model. For cohort studies, we used a Freeman-Tukey transformation to calculate the weighted summary proportion. Primary outcomes are syncope and presyncope. RESULTS: Eight studies were included in the final analyses (two single-blinded and one double-blinded RCT, two prospective observational studies, and three retrospective observational studies). Two hundred ninety-one patients included, with an average age of 57 years. Quality of evidence is moderate. Use of CLS pacing was associated with reduced risk of syncope (OR 0.08; 95% CI 0.03-0.18; I2 32%) and presyncope (OR 0.34; 95% CI 0.18-0.63; I2 0.00%). Using proportion meta-analysis, the summary estimate of the proportion of cases that developed syncope during CLS pacing was similar between RCTs and prospective studies (3.2% and 3.1%), respectively. This is much lower than the rate of recurrence in the control arm of RCTs at 33.7%. Sensitivity analyses yielded similar results. CONCLUSION: CLS pacing is beneficial for patients with recurrent vasovagal syncope who demonstrate a cardioinhibitory response on HUTT.


Assuntos
Estimulação Cardíaca Artificial/métodos , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/terapia , Teste da Mesa Inclinada , Humanos , Recidiva
10.
Am J Ther ; 26(2): e268-e275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30839375

RESUMO

BACKGROUND: Syncope is a symptom associated with a wide range of pathological conditions, ranging from benign to life threatening. The most frequent is the reflex syncope that may be challenging to treat because of the complex and partially unknown pathophysiological mechanism that has to be addressed by the chosen therapy. AREAS OF UNCERTAINTY: Head-up tilt testing is so far the only clinical test able to reproduce reflex syncope, but its diagnostic yield has been recently redefined. A new mechanism such as adenosine-sensitive syncope and idiopathic atrioventricular block have been recently described, and the appropriate therapy is not yet established. There is uncertainty on the efficacy of theophylline and on the use of cardiac pacing in these patients. DATA SOURCES: Clinical trial published data and position paper from the main expert groups on fludrocortisone, midodrine, etilefrine, beta-blockers, and cardiac pacing as useful therapies for patients affected by reflex syncope. THERAPEUTIC ADVANCES: Theophylline proved in observational trials to be efficient in preventing reflex syncope recurrences in patients with documented spontaneous paroxysmal conduction disorders comparable to cardiac pacing in a subgroup of patients. Reboxetine and sibutramine may elicit a significant pressor and tachycardic effect able to delay the onset of symptoms during head-up tilt testing. Droxidopa has short-term effects on improving the symptoms because of orthostatic hypotension. Cardiac pacing is effective in preventing reflex syncope recurrences with best results when the indication for pacemaker implantation was based on the documentation of bradycardia or asystole during the spontaneous event by a cardiac monitor. External compression using elastic bandage or compressive stockings is able to prevent the decrease in blood pressure in patients with orthostatic hypotension. CONCLUSIONS: The optimal management of the complex diagnostic and therapeutic options can be achieved following a standardized and evidence-based approach to the patient with syncope.


Assuntos
Gerenciamento Clínico , Síncope Vasovagal , Humanos , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/terapia
11.
Circ Arrhythm Electrophysiol ; 12(1): e006884, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30636478

RESUMO

BACKGROUND: Several studies suggest that vasovagal syncope has a genetic origin, but this is unclear. We assessed whether plausible gene variants associate with vasovagal syncope. METHODS: We studied 160 subjects in 9 kindreds comprising 82 fainters and 78 controls. The diagnosis was ascertained with the Calgary Syncope Score. Common genetic variants were genotyped for 12 genes for vascular signaling, potassium channels, the HTR1A(serotonin 5-HT1A receptor), SLC6A4(serotonin reuptake transporter), and COMT(catecholamine O-methyltransferase). Sex-specific associations between genotypes and phenotypes were tested. RESULTS: In 9 out of 12 variants, there was no significant association between genotype and phenotype. However, the HTR1A(-1019) G alleles associated with syncope in males, but not in females ( P=0.005). CC and GG males had 9% versus 77% likelihoods of syncope. The SLC6A4 promoter L alleles associated with decreased syncope in males but increased in females ( P=0.059). The LL and SS males had 25% and 47% syncope likelihoods, whereas females had 75% and 50% syncope likelihoods. The COMT c.472 A alleles associated with decreased syncope in males but increased in females ( P=0.017). The GG and AA males had 50% and 15% syncope likelihoods, whereas females had 52% and 73% syncope likelihoods. CONCLUSIONS: There is a sex-dependent effect of alleles of serotonin signaling and vasovagal syncope, supporting the serotonin hypothesis of the physiology of vasovagal syncope.


Assuntos
Catecol O-Metiltransferase/genética , Polimorfismo de Nucleotídeo Único , Receptor 5-HT1A de Serotonina/genética , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Síncope Vasovagal/genética , Adulto , Alberta , Estudos de Casos e Controles , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Hereditariedade , Humanos , Masculino , Linhagem , Fenótipo , Medição de Risco , Fatores de Risco , Fatores Sexuais , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/fisiopatologia
12.
Korean J Intern Med ; 34(2): 315-323, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29240992

RESUMO

BACKGROUND/AIMS: The induction and recurrence of syncope is a concerning situation that could be unpredicted in the vasovagal syncope (VVS). We investigated a simple predictor for the induced and recurrent VVS during Head-Up table-tilt Test (HUT) and clinically follow-up. METHODS: The 143 consecutive patients with VVS (age 31 ± 19 years, 33 male) who referred by a cardiologist or neurologist and had undergone an echocardiogram, HUT, and a treadmill exercise test (TMT) were recruited and clinically follow-up. Patients were divided into two groups based on the result of HUT and TMT. The data was analyzed and compared between VVS patients and control 141 patients without VVS who were enrolled in the same study period (age 40 ± 5 years, 117 male). RESULTS: The heart rate recovery (HRR), recovery systolic blood pressure (RecSBP), recovery diastolic blood pressure (RecDBP), HRR/RecSBP and HRR/RecDBP were significantly different between controls and VVS during the TMT. Within VVS, even if, baseline characteristics were similar between negative and positive HUT (n = 92 vs. n = 51). HRR (31 ± 10 vs. 35 ± 10), HRR/RecSBP (0.24 ± 0.09 vs. 0.28 ± 0.09) and HRR/RecDBP (0.49 ± 0.18 vs. 0.58 ± 0.19) were significantly different between negative and positive HUT results. Especially, HRR/RecSBP and HRR/RecDBP were significantly correlated with induced syncope with a sensitivity and specificity ([60%, 83%] cut-off, 0.31; [72%, 80%] cut-off, 0.63). In the Cox regression, HRR/ RecDBP were significantly associated with recurrence of VVS with hazard ratio of 3.29 (confidence interval, 0.95 to 11.3; p = 0.049). CONCLUSION: HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.


Assuntos
Teste de Esforço , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada , Adolescente , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Síncope Vasovagal/fisiopatologia , Adulto Jovem
13.
Eur J Emerg Med ; 26(2): 100-104, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29465466

RESUMO

AIM: There is growing evidence of an overlap between unexplained falls and syncope in older adults. Our aim was to examine the prevalence and associated resource utilization of these conditions in an urban emergency department (ED). PATIENTS AND METHODS: A single-centre, prospective, observational study was carried out over a 6-month period. Consecutive patients older than 50 years who presented to the ED because of a fall, collapse or syncope were included. Univariate analysis of demographic data is presented as percentages, mean (SD), 95% confidence intervals (CIs) and medians (interquartile range). Logistic regression modelling was used to examine the association between falls and resource utilization. RESULTS: A total of 561 patients fulfilled the inclusion criteria during the study period. Unexplained fallers accounted for 14.3% (n=80; 95% CI: 13.3-15.3) and syncope for 12.7% (n=71; 95% CI: 11.7-13.6) of all fall presentations. Overall, 50% (n=282; 95% CI: 48.20-52.34) of patients required admission to hospital. Patients with syncope [odds ratio (OR)=2.48, 95% CI: 1.45-4.23], and unexplained falls (OR=2.36, 95% CI: 1.37-4.08) were more likely to require admission than those with an explained falls. Unexplained fallers were nearly five times more likely to suffer recurrent falls (OR=4.97, 95% CI: 2.89-8.56). CONCLUSION: One in four older fallers presenting to ED have symptoms suggestive of syncope or an unexplained fall. There are significant biological consequences of recurrent falls including greater rates of cognitive decline, gait and mobility disturbances, depression and frailty. Recognition that syncope can present as an unexplained fall in older adults is important to ensure that appropriate early modifiable interventions are initiated.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Síncope Vasovagal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irlanda , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Síncope/epidemiologia , Síncope Vasovagal/diagnóstico
14.
Am J Ther ; 26(3): e339-e343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28816725

RESUMO

BACKGROUND: Neurocardiogenic syncope (NCS) is a common form of syncope. Although selective serotonin reuptake inhibitors and other medications have been used to treat NCS with variable success, there is no consensus regarding a first-line therapy. STUDY QUESTION: To assess the effects of citalopram in NCS and to examine the effect of diagnostic use of the head-up tilt table (HUTT) versus empirical diagnosis on patient outcome. STUDY DESIGN: A retrospective case series of 1000 consecutive patients who were diagnosed with NCS and treated with citalopram. MEASURES AND OUTCOMES: The primary outcome measure was well-being score (WS) recorded at each outpatient visit. RESULTS: After excluding patients who had other comorbidities, were taking daily medication, or did not attend a follow-up visit within 1 month after treatment initiation, data from 186 patients were included. Thirty-five patients were diagnosed empirically, and 151 patients were diagnosed with the HUTT. All 186 patients were followed up within 1 month (early follow-up); of these, 92 patients attended a second follow-up after 1 month (late follow-up). The early follow-up group showed a significant improvement in mean WS (7.35 vs. 4.46, P < 0.001) and only 5 patients discontinued therapy because of intolerability. The late follow-up group also showed significant improvements in mean WS at the early follow-up (7.42 vs. 4.43, P < 0.001) and late follow-up (7.42 vs. 4.26, P < 0.001). Of 186 patients who were treated with citalopram, only 11 reported the development of undesirable side effects. There was no significant difference in the outcome of patients who were diagnosed empirically versus those who were diagnosed with the HUTT. CONCLUSIONS: Citalopram seems to have desirable effects on NCS and patient well-being. Diagnostic use of the HUTT is useful for confirming diagnoses of NCS but is not likely to improve patient outcome.


Assuntos
Citalopram/administração & dosagem , Inibidores de Captação de Serotonina/administração & dosagem , Síncope Vasovagal/tratamento farmacológico , Adulto , Citalopram/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inibidores de Captação de Serotonina/efeitos adversos , Índice de Gravidade de Doença , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada , Resultado do Tratamento , Adulto Jovem
16.
Medicine (Baltimore) ; 97(51): e13602, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572468

RESUMO

The purpose of this study was to assess the prevalence and the characteristics of seizure-like activities during head-up tilt test (HUT)-induced syncope, in patients with suspected vasovagal syncope (VVS). We also evaluated the differences in hemodynamic parameters between patients with and without seizure-like activities.A total of 71 patients with suspected VVS, who showed syncope during HUT between October 2010 and May 2013, were analyzed. Electrocardiogram and hemodynamic parameters were continuously monitored during HUT. We also performed video recording of patients during HUT to identify eyeball deviation or seizure-like limb movements.In all, 47 patients (66.2%) showed seizure-like activities at the time of syncope during HUT, 14 patients presented eyeball deviation, without abnormal limb movements, and 33 patients showed abnormal limb movements, such as myoclonic or tonic-clonic activities, as well as eyeball deviation. Upon comparison of the 2 groups with or without seizure-like activities, patients showing seizure-like activities presented a significantly lower heart rate at the time of syncope in HUT (38.51 ±â€Š16.81 vs 49.67 ±â€Š20.12, P < .05). Also, upon comparison within patients showing seizure-like activities, the patients who showed abnormal limb movements with eyeball deviation demonstrated a significantly lower systolic blood pressure and cardiac output at the time of syncope (34.30 ±â€Š12.24 vs 49.00 ±â€Š14.14, P < .05; 0.58 ±â€Š0.40 vs 1.32 ±â€Š0.97, P < .05).Seizure-like activities were observed in high percentage in about 66% of patients during HUT-induced syncope. The occurrence of seizure-like activities was associated with more severe transient hemodynamic changes, such as lower heart rate, systolic blood pressure, and cardiac output at the time of the HUT-induced syncope.


Assuntos
Convulsões/fisiopatologia , Síncope Vasovagal/diagnóstico , Síncope/etiologia , Teste da Mesa Inclinada/efeitos adversos , Adulto , Pressão Sanguínea , Débito Cardíaco , Eletrocardiografia , Extremidades/fisiopatologia , Movimentos Oculares , Feminino , Frequência Cardíaca , Hemodinâmica , Humanos , Masculino , Convulsões/etiologia , Síncope/fisiopatologia , Teste da Mesa Inclinada/métodos
17.
Pediatr. aten. prim ; 20(80): e117-e119, oct.-dic. 2018.
Artigo em Espanhol | IBECS | ID: ibc-180972

RESUMO

El síncope es una entidad clínica frecuente en Pediatría, sobre todo en la adolescencia. La etiología más frecuente la constituyen los síncopes neurocardiogénicos o vasovagales, de naturaleza benigna y causados por múltiples desencadenantes. Un grupo específico son los síncopes situacionales caracterizados por tener lugar en el contexto de una situación concreta, entre las cuales se encuentra el cuidado del cabello. El diagnóstico se basa principalmente en la historia clínica y la exploración física. Presentamos el caso clínico de una niña de 11 años que presenta un episodio de pérdida de conciencia breve y transitoria mientas le peinaban el pelo. Recuperación completa posterior y exploración normal. Nuestra labor como pediatras es saber reconocer esta entidad para llevar a cabo un tratamiento correcto basado en la educación e información al paciente y a la familia, con el fin de tranquilizarlos y evitar la realización de pruebas y derivaciones innecesarias


Syncope is a frequent clinical entity in Pediatrics, especially in adolescence. Vasovagal syncope is the most frequent type, of benign nature and caused by several triggers. Situational syncope is a special type which happen on concrete situations like hair care. Diagnosis is based on clinical history and physical exploration. We report the case of an 11 years old girl who suffered a brief loss of consciousness while her hair was combed, with later total recovery and normal physical exploration. Pediatricians must recognize this entity to make a correct treatment and inform patient and family, in order to reassure them and avoid unnecessary tests


Assuntos
Humanos , Feminino , Criança , Síncope Vasovagal/diagnóstico , Síncope/etiologia , Testes Diagnósticos de Rotina/métodos , Procedimentos Desnecessários , Anamnese/métodos
18.
Circ Arrhythm Electrophysiol ; 11(9): e006604, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30354289

RESUMO

Background Biatrial, extensive, and complex ablation strategies have been published for the treatment of neurally mediated syncope, sinus node dysfunction, and functional atrioventricular block. We have developed a less extensive and more specific approach compared with previously published cardioneuroablation strategies, called cardio-neuromodulation. It is based on tailored vagolysis of the sinoatrial node through partial ablation of the anterior right-ganglionated plexus, preferentially through a right-sided approach. Methods Patients with syncope were enrolled between December 2016 and December 2017. They were assigned to group A if they had a positive head-up tilt test and to group B if they presented with a pause ≥3 seconds. The area to target during cardio-neuromodulation was designed offline on a computed tomographic scan. Slow heart rates and pauses were compared during 24-hour rhythm registration at baseline, at 1-month follow-up, and 6-month follow-up. Syncope burden was assessed before the procedure and at 3- and 6-month follow-up. Results Twenty patients underwent cardio-neuromodulation through a right-sided approach (12 in group A, 8 in group B). The first application of radiofrequency energy led to a P-P interval shortening >120 ms in all 20 patients. After a mean±SD ablation time of 7±4 minutes and mean ablated surface area of 11±6 mm2, the P-P interval shortened by 219±160 ms ( P<0.001). The number of beats <50/min during 24-hour rhythm registration was reduced by a median of 100% at 6-month follow-up ( P<0.001). Syncope burden was reduced by 95% at 6-month follow-up ( P<0.001). Conclusions These data indicate that cardio-neuromodulation, through a right-sided and computed tomographic-guided procedure, is safe, fast, and highly reproducible in preventing inappropriate functional sinus bradycardia and syncope recurrence.


Assuntos
Ablação por Cateter/métodos , Radiografia Intervencionista/métodos , Síndrome do Nó Sinusal/cirurgia , Síncope Vasovagal/etiologia , Tomografia Computadorizada por Raios X , Potenciais de Ação , Adulto , Idoso , Bélgica , Bradicardia/etiologia , Bradicardia/fisiopatologia , Ablação por Cateter/efeitos adversos , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/fisiopatologia , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Congenit Heart Dis ; 13(6): 1064-1068, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30298977

RESUMO

INTRODUCTION: Reflex vasovagal-or cardioinhibitory syncope is known to be a major cause of recurrent syncope in children. The mechanism of vasovagal syncope (VVS) is an interaction between a vagally mediated bradycardia or asystole and a more or less manifest vasodilatory component. Although pacing is not advisable as a standard approach in patients with VVS, it remains a treatment option of last resort in exceptionally severe cases, or patients with contraindication or refractoriness to drug therapy and life style changes. To effectively avoid VVS in these patients, the pacemaker has to both prevent bradycardia and to compensate for the vasodilatory component. Therefore, this study aimed to evaluate a simple pacemaker setting (VVI pacing with hysteresis) with the potential to prevent VVS in affected children. METHODS: Clinical data of patients, who were presented to the Department for Pediatric Cardiology, Heart Center Leipzig, in the period of 2001-2017 for cardiac pacemaker implantation for cardioinhibitory syncope or pallid breath-holding spells, were collected retrospectively. RESULTS: Eleven pediatric patients, median age 2.7 (0.8-17) years, were included. Pacemaker settings are depicted. In 10 out of 11 patients, an entire abolishment of syncope could be achieved (P = .002). CONCLUSION: The presented VVI pacing with hysteresis seems to be a promising pacemaker setting in pediatric patients with cardioinhibitory syncope who need a pacemaker. Unnecessary ventricular stimulation is effectively avoided, while cardiac output is preserved during cardioinhibition, by providing a sufficient paced heart rate, compensating for the often present vasodilatory component.


Assuntos
Débito Cardíaco/fisiologia , Frequência Cardíaca/fisiologia , Marca-Passo Artificial , Síncope Vasovagal/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada , Resultado do Tratamento
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