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1.
J Korean Med Sci ; 35(20): e134, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449321

RESUMO

Influenza is an epidemical acute respiratory disease caused by viral infection. Several complications in the respiratory tract, such as pneumonia can occur. However, rare but serious neurological complications are also observed. Here, we described the prevalence, characteristics and suggestive pathomechanism of syncope after influenza infection season. Of 2.2% of patients diagnosed as influenza experienced syncope. None of the patients had severe cough, low blood pressure (BP) or dehydration. Patients suffered with frequent dizziness before syncope. Patient with long duration of loss of consciousness was more observed in those with high fever or positive orthostatic BP drop.


Assuntos
Influenza Humana/complicações , Síncope/etiologia , Adulto , Idoso , Tontura/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
Circ Arrhythm Electrophysiol ; 13(4): 1-34, Apr., 2020. tab., ilus.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1102053

RESUMO

BACKGROUND: Vagal hyperactivity is directly related to several clinical conditions as reflex/functional bradyarrhythmias and vagal atrial fibrillation (AF). Cardioneuroablation provides therapeutic vagal denervation through endocardial radiofrequency ablation for these cases. The main challenges are neuromyocardium interface identification and the denervation control and validation. The finding that the AF-Nest (AFN) ablation eliminates the atropine response and decreases RR variability suggests that they are related to the vagal innervation. METHOD: Prospective, controlled, longitudinal, nonrandomized study enrolling 62 patients in 2 groups: AFN group (AFN group 32 patients) with functional or reflex bradyarrhythmias or vagal AF treated with AFN ablation and a control group (30 patients) with anomalous bundles, ventricular premature beats, atrial flutter, atrioventricular nodal reentry, and atrial tachycardia, treated with conventional ablation (non-AFN ablation). In AFN group, ablation delivered at AFN detected by fragmentation/fractionation of the endocardial electrograms and by 3-dimensional anatomic location of the ganglionated plexus. Vagal response was evaluated before, during, and postablation by 5 s noncontact vagal stimulation at the jugular foramen, through the internal jugular veins (extracardiac vagal stimulation [ECVS]), analyzing 15 s mean heart rate, longest RR, pauses, and atrioventricular block. All patients had current guidelines arrhythmia ablation indication. RESULTS: Preablation ECVS induced sinus pauses, asystole, and transient atrioventricular block in both groups showing a strong vagal response (P=0.96). Postablation ECVS in the AFN group showed complete abolishment of the cardiac vagal response in all cases (pre/postablation ECVS=P<0.0001), demonstrating robust vagal denervation. However, in the control group, vagal response remained practically unchanged postablation (P=0.35), showing that non-AFN ablation promotes no significant denervation. CONCLUSIONS: AFN ablation causes significant vagal denervation. Non-AFN ablation causes no significant vagal denervation. These results suggest that AFNs are intrinsically related to vagal innervation. ECVS was fundamental to stepwise vagal denervation validation during cardioneuroablation. Visual Overview A visual overview is available for this article.


Assuntos
Fibrilação Atrial , Síncope , Arritmias Cardíacas , Denervação Autônoma , Estimulação do Nervo Vago , Ablação por Radiofrequência
3.
R I Med J (2013) ; 103(3): 50-51, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32226962

RESUMO

SARS-CoV-2 is a novel virus that has now affected hundreds of thousands of individuals across the world. Amidst this global pandemic, maintaining a high index of suspicion, rapid testing capacity, and infection control measures are required to curtail the virus' rapid spread. While fever and respiratory symptoms have been commonly used to identify COVID-19 suspects, we present an elderly female who arrived to the hospital after a syncopal episode. She was afebrile with a normal chest X-ray and there was no suspicion of COVID-19. She then developed a fever and tested positive for COVID-19. Our unique case underscores the increasing diversity of COVID-19 presentations and potential for initial mis- diagnosis and delay in implementing proper precautions.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Radiografia Torácica , Síncope/etiologia , Idoso , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Erros de Diagnóstico , Feminino , Febre/etiologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico
5.
J Assoc Physicians India ; 68(3): 83-85, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32138494

RESUMO

Cough Syncope, a form of Neurocardiogenic Syncope, occurs immediately after coughing due to to arterial baroreflex-mediated vasodilatation. Cough syncope has been classically described in patients with obstructive pulmonary diseases. Pulmonary Vascular Diseases, though rare, also present with cough syncope. Malignant Syncope is defined as recurrent syncope with minimal warning, and often associated with self-injury. Here we describe how we managed a case of a young male presenting with recurrent attacks of Malignant Cough syncope.


Assuntos
Tosse , Síncope , Barorreflexo , Humanos , Masculino
6.
Rev Med Liege ; 75(3): 154-158, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32157839

RESUMO

Syncope is a frequent reason for admission to emergency department or consultations. The common pathophysiological mechanism is a drop in systemic blood pressure leading to cerebral hypoperfusion, and ultimately to total loss of consciousness. The causes are multiple, with varying degrees of severity, classified into three main types : reflex syncope, syncope due to orthostatic hypotension and cardiac syncope. Among these, orthostatic hypotension can be easily detected, particularly by performing an orthostatic challenge with active standing, which is recommended in the presence of any syncope. Simple measures can reduce the recurrence of this type of syncope, even if sometimes drug treatments are necessary. In this article, we will detail the characteristics, diagnostic methods and therapies recommended by the latest guidelines of the European Society of Cardiology.


Assuntos
Hipotensão Ortostática , Síncope , Serviço Hospitalar de Emergência , Humanos , Hipotensão Ortostática/complicações , Recidiva , Síncope/diagnóstico , Síncope/etiologia , Síncope/terapia
8.
N Engl J Med ; 382(20): 1883-1893, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32222134

RESUMO

BACKGROUND: The effect of vericiguat, a novel oral soluble guanylate cyclase stimulator, in patients with heart failure and reduced ejection fraction who had recently been hospitalized or had received intravenous diuretic therapy is unclear. METHODS: In this phase 3, randomized, double-blind, placebo-controlled trial, we assigned 5050 patients with chronic heart failure (New York Heart Association class II, III, or IV) and an ejection fraction of less than 45% to receive vericiguat (target dose, 10 mg once daily) or placebo, in addition to guideline-based medical therapy. The primary outcome was a composite of death from cardiovascular causes or first hospitalization for heart failure. RESULTS: Over a median of 10.8 months, a primary-outcome event occurred in 897 of 2526 patients (35.5%) in the vericiguat group and in 972 of 2524 patients (38.5%) in the placebo group (hazard ratio, 0.90; 95% confidence interval [CI], 0.82 to 0.98; P = 0.02). A total of 691 patients (27.4%) in the vericiguat group and 747 patients (29.6%) in the placebo group were hospitalized for heart failure (hazard ratio, 0.90; 95% CI, 0.81 to 1.00). Death from cardiovascular causes occurred in 414 patients (16.4%) in the vericiguat group and in 441 patients (17.5%) in the placebo group (hazard ratio, 0.93; 95% CI, 0.81 to 1.06). The composite of death from any cause or hospitalization for heart failure occurred in 957 patients (37.9%) in the vericiguat group and in 1032 patients (40.9%) in the placebo group (hazard ratio, 0.90; 95% CI, 0.83 to 0.98; P = 0.02). Symptomatic hypotension occurred in 9.1% of the patients in the vericiguat group and in 7.9% of the patients in the placebo group (P = 0.12), and syncope occurred in 4.0% of the patients in the vericiguat group and in 3.5% of the patients in the placebo group (P = 0.30). CONCLUSIONS: Among patients with high-risk heart failure, the incidence of death from cardiovascular causes or hospitalization for heart failure was lower among those who received vericiguat than among those who received placebo. (Funded by Merck Sharp & Dohme [a subsidiary of Merck] and Bayer; VICTORIA ClinicalTrials.gov number, NCT02861534.).


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Compostos Heterocíclicos com 2 Anéis/uso terapêutico , Pirimidinas/uso terapêutico , Administração Oral , Idoso , Doenças Cardiovasculares/mortalidade , Doença Crônica , Método Duplo-Cego , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Compostos Heterocíclicos com 2 Anéis/efeitos adversos , Hospitalização/estatística & dados numéricos , Humanos , Hipotensão/induzido quimicamente , Incidência , Masculino , Pessoa de Meia-Idade , Pirimidinas/efeitos adversos , Guanilil Ciclase Solúvel/metabolismo , Volume Sistólico , Síncope/induzido quimicamente , Disfunção Ventricular Esquerda/tratamento farmacológico
9.
Arq Bras Cardiol ; 114(2): 245-253, 2020 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32215492

RESUMO

BACKGROUND: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias. OBJECTIVE: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. METHODS: In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05. RESULTS: After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma-related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38). CONCLUSION: At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH.


Assuntos
Doenças das Artérias Carótidas/mortalidade , Doenças das Artérias Carótidas/fisiopatologia , Seio Carotídeo/fisiopatologia , Parada Cardíaca/mortalidade , Parada Cardíaca/fisiopatologia , Idoso , Eletrocardiografia , Feminino , Seguimentos , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Estatísticas não Paramétricas , Síncope/mortalidade , Síncope/fisiopatologia
11.
PLoS One ; 15(3): e0228725, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187195

RESUMO

BACKGROUND: Risk stratification is challenging in conditions, such as chest pain, shortness of breath and syncope, which can be the manifestation of many possible underlying diseases. In these cases, decision tools are unlikely to accurately identify all the different adverse events related to the possible etiologies. Attribute matching is a prediction method that matches an individual patient to a group of previously observed patients with identical characteristics and known outcome. We used syncope as a paradigm of clinical conditions presenting with aspecific symptoms to test the attribute matching method for the prediction of the personalized risk of adverse events. METHODS: We selected the 8 predictor variables common to the individual-patient dataset of 5 prospective emergency department studies enrolling 3388 syncope patients. We calculated all possible combinations and the number of patients in each combination. We compared the predictive accuracy of attribute matching and logistic regression. We then classified ten random patients according to clinical judgment and attribute matching. RESULTS: Attribute matching provided 253 of the 384 possible combinations in the dataset. Twelve (4.7%), 35 (13.8%), 50 (19.8%) and 160 (63.2%) combinations had a match size ≥50, ≥30, ≥20 and <10 patients, respectively. The AUC for the attribute matching and the multivariate model were 0.59 and 0.74, respectively. CONCLUSIONS: Attribute matching is a promising tool for personalized and flexible risk prediction. Large databases will need to be used in future studies to test and apply the method in different conditions.


Assuntos
Tomada de Decisão Clínica , Medicina de Precisão , Síncope/diagnóstico , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco
12.
Herz ; 45(3): 233-242, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32185419

RESUMO

Hypertrophic cardiomyopathy is the most common genetically determined cardiac disease with a prevalence of 0.2-0.6%. The most important pathophysiological phenomenon is dynamic obstruction predominantly of the left ventricular outflow tract in 70% of the patients. Clinical symptoms (e.g. dyspnea, angina pectoris and syncope) are extremely variable depending on changes in preload and afterload and an increased risk of sudden cardiac death particularly in younger patients. The diagnostic measures should be carried out with respect to a prognostic and symptomatic treatment with implantation of an implantable cardioverter defibrillator (ICD) in cases of increased risk of sudden cardiac death. When medication treatment fails, first-line treatment consists of septal ablation and surgical myectomy as a supplementary measure, depending on the underlying morphology and experience of the surgeon.


Assuntos
Cardiomiopatia Hipertrófica , Ablação por Cateter , Desfibriladores Implantáveis , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca , Humanos , Síncope , Resultado do Tratamento
15.
Am J Cardiol ; 125(6): 982-987, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31948664

RESUMO

Patients with intermediate-risk pulmonary emboli (PE) present a challenging clinical problem. Although syncope has been suggested as a marker for adverse outcomes in these patients, data remain scarce. We aimed to investigate the clinical outcomes of intermediate risk PE patients presenting with syncope. We performed a retrospective cohort study comprised of consecutive, normotensive, PE patients, with evidence of right ventricular involvement. The primary outcome of major adverse clinical events included either one or a combination of mechanical ventilation, hemodynamic instability and need for inotropic support, reperfusion therapy, and in-hospital mortality. Secondary outcomes included each of the above individual components including major bleeding and renal failure. Overall, 212 patients were evaluated, 40 (19%) presented with syncope, and had a higher prevalence of major adverse clinical events (29% vs 9.4%, p = 0.003), as well as each of the individual secondary end points: mechanical ventilation (10% vs 1.8%, p = 0.026), hemodynamic instability (18% vs 2.9%, p = 0.02), increased need of inotropic support (10% vs 0.6%, p = 0.005), and bleeding (15% vs 2.4%, p = 0.004). The prevalence of in-hospital mortality was very low (0.5%) with no significant difference between those with and without syncope. There was no significant difference in the need for reperfusion therapy. Upon multivariable analysis, syncope was found to be an independent predictor of adverse clinical outcomes (odds ratio 3.8, confidence interval 1.48 to 9.76, p = 0.005). In conclusion, in intermediate-risk PE patients with right ventricular involvement, the presence of syncope is associated with a more complicated in-hospital course.


Assuntos
Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Síncope/etiologia , Adulto , Idoso , Estudos de Coortes , Monitorização Hemodinâmica , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Embolia Pulmonar/mortalidade , Embolia Pulmonar/terapia , Respiração Artificial , Estudos Retrospectivos , Risco , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/mortalidade , Disfunção Ventricular Direita/terapia
20.
Am J Epidemiol ; 189(4): 277-285, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-31899791

RESUMO

Human papillomavirus (HPV) vaccination has been associated with subsequent diffuse symptoms in girls, reducing public confidence in the vaccine. We examined whether girls have nonspecific outcomes of HPV vaccination, using triangulation from cohort, self-controlled case series (SCCS), and population time trend analyses carried out in Denmark between 2000 and 2014. The study population consisted of 314,017 HPV-vaccinated girls and 314,017 age-matched HPV-unvaccinated girls (cohort analyses); 11,817 girls with hospital records (SCCS analyses); and 1,465,049 girls and boys (population time trend analyses). The main outcome measures were hospital records of pain, fatigue, or circulatory symptoms. The cohort study revealed no increased risk among HPV vaccine-exposed girls, with incidence rate ratios close to 1.0 for abdominal pain, nonspecific pain, headache, hypotension/syncope, tachycardia (including postural orthostatic tachycardia syndrome), and malaise/fatigue (including chronic fatigue syndrome). In the SCCS analyses, we observed no association between HPV vaccination and subsequent symptoms. In time trend analyses, we observed a steady increase in these hospital records in both girls and (HPV-unvaccinated) boys, with no relationship to the 2009 introduction of HPV vaccine to Denmark's vaccination program. This study, which had nationwide coverage, showed no evidence of a causal link between HPV vaccination and diffuse autonomic symptoms leading to hospital contact.


Assuntos
Fadiga/etiologia , Dor/etiologia , Vacinas contra Papillomavirus/efeitos adversos , Síncope/etiologia , Taquicardia/etiologia , Adolescente , Criança , Feminino , Humanos , Estudos Retrospectivos
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