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1.
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
3.
Int Heart J ; 60(5): 1206-1210, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484877

RESUMO

A 7-year-old female suffering from syncope attacks and deafness was genetically diagnosed with Jervell and Lange-Nielsen syndrome (JLNS). A transvenous-designed shock lead and implantable cardioverter-defibrillator (ICD) were atypically implanted subcutaneously, because the patient's body was small. Six years after implantation, we confirmed the patient's eligibility for a subcutaneous ICD (S-ICD) based on electrocardiogram screening. The implanted ICD system was replaced with a new standard S-ICD system. Implantation of the S-ICD may be considered a reliable and safe option in young patients with JLNS, even if their electrocardiograms show remarkable prolongation of the QT interval and T-wave alternans.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Eletrocardiografia/métodos , Síndrome de Jervell-Lange Nielsen/diagnóstico , Síndrome de Jervell-Lange Nielsen/terapia , Canal de Potássio KCNQ1/genética , Criança , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Predisposição Genética para Doença , Humanos , Síndrome de Jervell-Lange Nielsen/complicações , Linhagem , Retratamento , Síncope/diagnóstico , Síncope/etiologia , Síncope/terapia , Fatores de Tempo , Resultado do Tratamento
4.
Dtsch Med Wochenschr ; 144(15): 1040-1043, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31350745

RESUMO

Syncope is one of the most frequent mode of hospital visits in the emergency department. A broad range of causalities and healthcare economic efficiency have demanded reasonable road maps for diagnostic procedures and hospital admission of patients with syncope. Recent advances and multidisciplinary assessments provided the basis of the updated 2018 ESC Guidelines for the diagnosis and management of syncope. While the definitions of syncope remain unchanged these updates state risk stratification in the emergency department with clear diagnostic paths and monitoring in the current era with portable devices. The algorithm for reflex syncope therapy, indication for cardiac pacemakers and implantable cardioverter-defibrillators in high-risk patients for sudden cardiac death were modified. Finally, the updated guidelines recommend an establishment of "syncope-unit" with multidisciplinary involvement.


Assuntos
Síncope , Determinação da Pressão Arterial , Cardiologia/organização & administração , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Eletrocardiografia , Europa (Continente) , Humanos , Marca-Passo Artificial , Guias de Prática Clínica como Assunto , Síncope/diagnóstico , Síncope/etiologia , Síncope/fisiopatologia , Síncope/terapia
5.
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
6.
Am J Med ; 132(10): 1115-1116, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31108043
7.
Am J Ther ; 26(3): e301-e307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31082863

RESUMO

BACKGROUND: Syncope represents a common condition among the general population. It is also a frequent complaint of patients in the emergency department (ED). Pulmonary embolism (PE) considers a differential diagnosis, particularly in a case of syncope without chest pain. STUDY QUESTION: What is the prevalence of PE among patients who presented an episode of syncope to the ED and among those hospitalized for syncope in a tertiary care hospital? STUDY DESIGN: From January 2012 to December 2017, we conducted a prospective observational study among adult patients presenting themselves to the ED consecutively or admitted for syncope. MEASURES AND OUTCOMES: Syncope and PE were defined by professional guidelines. PE was ruled out in patients who had a low pretest clinical probability, as per Wells score and a negative D-dimer assay. In other patients, computed tomography pulmonary angiography was performed. RESULTS: Seventeen thousand eight-two patients (mean age 71.3 ± 13.24 years) visited the ED for syncope. PE was detected in 45 patients (mean age 65.75 ± 9.45 years): 4 with low risk, 26 with intermediate risk, and 15 with high risk. The prevalence of PE in those hospitalized with syncope was 11.47%, which is 45 of 392 (confidence interval 95% 8.48-15.04), and was 2.52%, 45 of 1782 (confidence interval 95% 1.8-3.3), in patients presenting with syncope to the ED. The location of the embolus was bilateral in 24 patients (53.33%), in a main pulmonary artery in 10 (22.22%), in a lobar artery in 10 (22.22%), and in a segmental artery in 1 (2.22%). CONCLUSIONS: The occurrence of syncope, if not explained otherwise, should alert one to consider PE as a differential diagnosis. PE rate, presenting as syncope, is the highest in patients with large thrombi, which is responsible for bilateral or proximal obstruction in a main or lobar pulmonary artery.


Assuntos
Embolia Pulmonar/epidemiologia , Síncope/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Fatores de Risco , Síncope/terapia , Adulto Jovem
8.
Hell J Nucl Med ; 22(1): 10-13, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30843004

RESUMO

This paper aims to describe how radial artery obstruction can support blood circulation in an ischemic area. A dramatic case is described. Furthermore aims to describe that fatigue, atherosclerosis and toxic substances like in alcoholism may reduce blood flow and energy supply in the cortex and other brain areas and thus unconsciously modify our usual civilized behavior. Intense mental and physical fatigue was described as: "vital exhaustion".


Assuntos
Circulação Cerebrovascular , Fadiga/diagnóstico , Isquemia/diagnóstico , Pós-Condicionamento Isquêmico/métodos , Artéria Radial/fisiologia , Síncope/diagnóstico , Idoso , Fadiga/terapia , Feminino , Humanos , Isquemia/terapia , Artéria Radial/fisiopatologia , Síncope/terapia
9.
West J Emerg Med ; 20(2): 250-255, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30881544

RESUMO

Introduction: In an age of increasing scrutiny of each hospital admission, emergency department (ED) observation has been identified as a low-cost alternative. Prior studies have shown admission rates for syncope in the United States to be as high as 70%. However, the safety and utility of substituting ED observation unit (EDOU) syncope management has not been well studied. The objective of this study was to evaluate the safety of EDOU for the management of patients presenting to the ED with syncope and its efficacy in reducing hospital admissions. Methods: This was a prospective before-and-after cohort study of consecutive patients presenting with syncope who were seen in an urban ED and were either admitted to the hospital, discharged, or placed in the EDOU. We first performed an observation study of syncope management and then implemented an ED observation-based management pathway. We identified critical interventions and 30-day outcomes. We compared proportions of admissions and adverse events rates with a chi-squared or Fisher's exact test. Results: In the "before" phase, 570 patients were enrolled, with 334 (59%) admitted and 27 (5%) placed in the EDOU; 3% of patients discharged from the ED had critical interventions within 30 days and 10% returned. After the management pathway was introduced, 489 patients were enrolled; 34% (p<0.001) of pathway patients were admitted while 20% were placed in the EDOU; 3% (p=0.99) of discharged patients had critical interventions at 30 days and 3% returned (p=0.001). Conclusion: A focused syncope management pathway effectively reduces hospital admissions and adverse events following discharge and returns to the ED.


Assuntos
Unidades de Observação Clínica/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Síncope/terapia , Boston , Unidades de Observação Clínica/organização & administração , Estudos de Coortes , Procedimentos Clínicos/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos
10.
Rinsho Shinkeigaku ; 59(3): 149-152, 2019 Mar 28.
Artigo em Japonês | MEDLINE | ID: mdl-30814449

RESUMO

A 73-year-old woman with Parkinson disease (PD) was admitted to our hospital because of aspiration pneumonia. She presented with recurrent episodes of loss of consciousness with bradycardia while swallowing solid foods or fluids. Upper endoscopy revealed a normal esophagus without hiatus hernia, cancer, diverticulum, stenosis, or achalasia. Balloon inflation at the cervical esophagus induced sinus arrest and bradycardia followed by a loss of consciousness. The diagnosis of swallow syncope (SS) was confirmed. Esophageal dilatation and an increase in the esophageal pressure induced by esophageal peristaltic disturbance associated with PD can cause SS by stimulating the vagal reflex. In addition, the head-up tilt test showed that she had orthostatic hypotension, and the coefficients of variations of the R-R intervals on electrocardiograms and the total number of beat-to-beat differences greater than 50 mseconds in the RR interval during a 24 hour ambulatory electrocardiogram were normal. The cardiovascular autonomic dysfunction characterized by the presence of sympathetic inhibition and a preserved parasympathetic function might be involved in the onset of SS. Permanent pacemaker implantation improved her clinical symptoms. The recognition of SS on the examination of a PD patient with loss of consciousness while eating is important, as PD patients might develop SS due to peristaltic disturbance and autonomic dysfunction caused by PD.


Assuntos
Transtornos de Deglutição/etiologia , Doença de Parkinson/complicações , Síncope/etiologia , Idoso , Doenças do Sistema Nervoso Autônomo/etiologia , Bradicardia/etiologia , Sistema Cardiovascular/inervação , Transtornos de Deglutição/diagnóstico , Eletrocardiografia , Feminino , Humanos , Marca-Passo Artificial , Pneumonia Aspirativa/etiologia , Recidiva , Reflexo , Síncope/diagnóstico , Síncope/terapia , Teste da Mesa Inclinada , Nervo Vago/fisiologia
11.
South Med J ; 112(3): 143-146, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30830226

RESUMO

OBJECTIVES: Previous work suggests that hospitals' teaching status is correlated with readmission rates, cost of care, and mortality. The degree to which teaching status is associated with the management of syncope has not been studied extensively. We sought to characterize the relation between teaching status and inpatient syncope management. METHODS: We created regression models to characterize the relation between teaching status and cardiac ischemic evaluations (cardiac catheterization and/or stress test) during syncope admissions. Admissions with a primary diagnosis of syncope in Maryland and Kentucky between 2007 and 2014 were included. RESULTS: The dataset included 71,341 syncope admissions at 151 hospitals. Overall, 15% of patients had an ischemic evaluation. There was a significantly lower likelihood of an ischemic evaluation at major teaching hospitals relative to nonteaching hospitals (adjusted odds ratio 0.75, 95% confidence interval 0.71-0.79), but a higher likelihood of an ischemic evaluation at minor teaching hospitals (adjusted odds ratio 1.21, 95% confidence interval 1.16-1.25). CONCLUSIONS: By definition, the syncope admissions included were unexplained or idiopathic cases, and thus likely to be lower-risk syncope cases. Those with a known etiology are coded by the cause of syncope, as dictated by coding guidelines. It is likely that many of these ischemic evaluations represent low-value care. Financial incentives and processes of care at major teaching hospitals may be driving this trend, and efforts should be made to better understand and replicate these at minor teaching and nonteaching hospitals.


Assuntos
Cateterismo Cardíaco/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Isquemia Miocárdica/diagnóstico , Síncope/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Síncope/terapia
12.
Int J Cardiol ; 283: 119-121, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30826198

RESUMO

The approach suggested by the 2018 ESC GL is the main road for achieving the ambitious goal "zero admission for syncope". This document has in fact introduced a clear-cut distinction between syncope associated with a definite diagnosis, which shall be managed according to the underlying condition, and the really undetermined cases, which shall be managed with prognostic stratification. ESC GL also emphasize the pivotal importance of managing patients in facilities such as ED observation syncope units or outpatient syncope clinics, as a safe alternative to admission. Moreover, they provide a table of non-syncopal causes of TLOC to be excluded, indicating the clinical features distinguishing them from syncope, clearly define the indications for additional examinations to be made after the initial evaluation and include a detailed table contains features for stratifying patients as being at high- and low-risk. However, we believe that this approach could be further improved, by especially defining criteria to identify patient neither high nor low risk, to be called at "intermediate-risk", making the prognostic stratification table easier to remember and use, by clarifying the role of laboratory tests to support the clinical judgment and by defining protocol for managing patients ED observation unit.


Assuntos
Cardiologia , Gerenciamento Clínico , Serviço Hospitalar de Emergência/normas , Guias de Prática Clínica como Assunto , Sociedades Médicas , Síncope/terapia , Europa (Continente) , Humanos , Prognóstico , Síncope/diagnóstico
14.
Circulation ; 139(11): 1396-1406, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30661373

RESUMO

BACKGROUND: The optimal duration of cardiac rhythm monitoring after emergency department (ED) presentation for syncope is poorly described. We sought to describe the incidence and time to arrhythmia occurrence to inform decisions regarding duration of monitoring based on ED risk stratification. METHODS: We conducted a prospective cohort study with enrolled adult patients (≥16 years old) presenting within 24 hours of syncope at 6 EDs. We collected baseline characteristics, time of syncope and ED arrival, and the Canadian Syncope Risk Score (CSRS) risk category. We followed subjects for 30 days, and our adjudicated primary outcome was serious arrhythmic conditions (arrhythmias, interventions for arrhythmias, and unexplained death). After excluding patients with an obvious serious condition on ED presentation and those with missing CSRS predictors, we used Kaplan-Meier analysis to describe the time to serious arrhythmic outcomes. RESULTS: A total of 5581 patients (mean age, 53.4 years; 54.5% females; 11.6% hospitalized) were available for analysis, including 346 (6.2%) for whom the 30-day follow-up was incomplete and who were censored at the last follow-up time. A total of 417 patients (7.5%) experienced serious outcomes, 207 of which (3.7%; 95% CI, 3.3%-4.2%) were arrhythmic (161 arrhythmias, 30 cardiac device implantations, 16 unexplained deaths). Overall, 4123 (73.9%) were classified as CSRS low risk, 1062 (19.0%) medium risk, and 396 (7.1%) high risk. The CSRS accurately stratified subjects as low risk (0.4% risk for 30-day arrhythmic outcome), medium risk (8.7% risk), and high risk (25.3% risk). One-half of arrhythmic outcomes were identified within 2 hours of ED arrival in low-risk patients and within 6 hours in medium- and high-risk patients, and the residual risk after these cut points were 0.2% for low-risk, 5.0% for medium-risk, and 18.1% for high-risk patients. Overall, 91.7% of arrhythmic outcomes among medium- and high-risk patients, including all ventricular arrhythmias, were identified within 15 days. None of the low-risk patients experienced ventricular arrhythmia or unexplained death, whereas 0.9% of medium-risk patients and 6.3% of high-risk patients experienced them ( P<0.0001). CONCLUSIONS: Serious underlying arrhythmia was often identified within the first 2 hours of ED arrival for CSRS low-risk patients and within 6 hours for CSRS medium- and high-risk patients. Outpatient cardiac rhythm monitoring for 15 days for selected medium-risk patients and all high-risk patients discharged from the hospital should also be considered.


Assuntos
Arritmias Cardíacas/diagnóstico , Serviço Hospitalar de Cardiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Serviço Hospitalar de Emergência , Síncope/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Canadá , Causas de Morte , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Síncope/mortalidade , Síncope/fisiopatologia , Síncope/terapia , Fatores de Tempo , Adulto Jovem
15.
Heart ; 105(8): 657-659, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514728

RESUMO

A 67-year-old man presented to the emergency department with sudden onset of severe presyncope. He reported that he had a permanent pacemaker implanted in 2006 following atrioventricular node ablation for persistent atrial fibrillation (AF). After suffering increasing shortness of breath, he underwent upgrade to cardiac resynchronisation therapy (CRT) in 2016. He denied any recent falls, interventions or changes in medication. ECG monitoring showed AF with a broad ventricular escape rhythm at around 25 bpm with pauses of up to 3 s. Placement of a magnet over the device resulted in pacing (figure 1A). The implanted device (Medtronic Syncra C2TR01) was interrogated (figure 1B), and a chest radiograph was obtained (figure 2). heartjnl;105/8/657/F1F1F1Figure 1(A) Twelve-lead ECG demonstrating intrinsic rhythm and pacing after application of magnet. (B) Device interrogation with right ventricular threshold test. heartjnl;105/8/657/F2F2F2Figure 2(C) Anteroposterior chest radiograph demonstrating lead position on admission. QUESTION: What was the cause of this presentation?Noise oversensing on the right ventricular (RV) lead due to lead fracture.The RV septal lead has displaced into the right atrial (RA).RA and RV leads were switched in the can during the CRT upgrade.Increase in threshold of RV and left ventricular (LV) leads resulting in loss of capture.


Assuntos
Fibrilação Atrial/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Falha de Prótese/efeitos adversos , Síncope , Idoso , Nó Atrioventricular/cirurgia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Análise de Falha de Equipamento , Humanos , Masculino , Radiografia Torácica/métodos , Síncope/diagnóstico , Síncope/etiologia , Síncope/terapia
16.
Emerg Med J ; 36(2): 108-116, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30470687

RESUMO

Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge.


Assuntos
Sistemas de Apoio a Decisões Clínicas/instrumentação , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Síncope/terapia , Idoso , Serviço Hospitalar de Emergência/organização & administração , Fidelidade a Diretrizes/normas , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Síncope/diagnóstico , Síncope/etiologia
17.
Am J Emerg Med ; 37(6): 1037-1043, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30177266

RESUMO

OBJECTIVES: To describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered "low-value", and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations. METHODS: We analyzed 2002-2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression. RESULTS: From 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: -3.1%; 95%CI -4.7, -1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: -2.2%; 95%CI -3.0, -1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: -0.6%; 95%CI -2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI -1.9, 2.0]; -0.9% [95%CI -3.1, 1.3]; and -1.2% [95%CI -5.3, 2.9], respectively). CONCLUSIONS: Before and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.


Assuntos
Diagnóstico por Imagem/tendências , Síncope/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diagnóstico por Imagem/métodos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/normas , Tratamento de Emergência/estatística & dados numéricos , Tratamento de Emergência/tendências , Feminino , Guias como Assunto , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Síncope/terapia , Estados Unidos
18.
Pediatr Emerg Care ; 35(5): e86-e89, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29135903

RESUMO

Frequently, general pediatricians could face a patient with syncope, which represents approximately 1% to 3% of emergency visits. Micturition syncope is a transient loss of consciousness with onset immediately before, during, or after micturition. Literature evidence indicates that healthy young men are a population with major risk for presenting micturition syncope, with a peak of incidence around 40 to 50 years of age. Usually, this syncope occurs in the morning, after wake-up, or, more generally, when the male patients assume the orthostatic position after a period of supine position in a warm bed. No information on micturition syncope clinical presentation and prevalence in childhood is available in the literature, and probably, this kind of syncope is unrecognized in childhood. We describe 4 unreported pediatric patients with a diagnosis of micturition syncope and well-defined clinical presentation. In all patients, the syncope has been presented in the same conditions: in the morning; after wake-up; in an orthostatic position; just before, after, or during urinary bladder voiding; and with spontaneous recovery in few minutes. Interestingly, 1 patient presented with the syncope during urinary bladder voiding by autocatheterization. In our patients, all investigations made as the first approach in the pediatric emergency department did not show any abnormal results, possibly underlying the syncope episodes. By describing our experience, we want to underline the clinical presentation of micturition syncope and give to the clinicians the elements to recognize and manage it easily in children.


Assuntos
Síncope/diagnóstico , Adolescente , Terapia Comportamental , Criança , Diagnóstico Diferencial , Humanos , Masculino , Fatores de Risco , Síncope/terapia
19.
Cardiol J ; 26(1): 36-46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29399750

RESUMO

BACKGROUND: Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplainedsyncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. METHODS: One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. RESULTS: The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2-350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). CONCLUSIONS: Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation.


Assuntos
Estimulação Cardíaca Artificial/métodos , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Síncope/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Síncope/fisiopatologia , Síncope/terapia , Fatores de Tempo , Adulto Jovem
20.
J Vet Cardiol ; 22: 113-120, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30581086

RESUMO

A 5-year-old short-haired dachshund was referred with a history of repeated syncope associated with a third-degree atrioventricular block. A permanent transvenous pacemaker with an active-fixation lead was implanted. In the following 3 weeks, the syncopal episodes reappeared owing to a loss of ventricular capture. The pacemaker was reprogrammed to higher output, and effective pacing was re-established. Thoracic radiographs and echocardiography failed to identify any evidence of lead displacement. One month later, the patient presented a new episode of loss of capture. After fluoroscopy, cardiac perforation was suspected and subsequently confirmed by thoracotomy. An epicardial pacemaker lead was implanted without removing the perforating lead as there were no bleeding complications or damage to adjacent organs, and the length of time elapsed since implantation was assumed to have allowed for significant fibrotic adhesions to develop. Nineteen months after epicardial pacemaker implantation, endocardial lead dislodgement occurred. Simultaneously, the dog presented with gastrointestinal and respiratory abnormalities and severe thrombocytopenia. Once the dog was stabilized, the endocardial lead was percutaneously removed. One month later, loss of ventricular capture recurred. The owners declined any further treatment, and euthanasia was elected. Cardiac perforation after pacemaker implantation is an infrequent complication. In this case, the dog lived 22 months after subacute right ventricular perforation. Despite the poor prognosis associated with cardiac perforation by pacemaker leads, different approaches are possible to successfully manage this major complication. Extraction of the displaced lead remains controversial as, if the lead is not removed, late lead migration can occur.


Assuntos
Eletrodos Implantados/veterinária , Traumatismos Cardíacos/veterinária , Marca-Passo Artificial/veterinária , Animais , Bloqueio Atrioventricular/terapia , Bloqueio Atrioventricular/veterinária , Doenças do Cão , Cães , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Masculino , Marca-Passo Artificial/efeitos adversos , Síncope/terapia , Síncope/veterinária
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