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Carotid Sinus Syncope


Presentation

  • In this paper, we report a patient presenting with Horner syndrome and syncopal episodes who was finally diagnosed with nasopharyngeal carcinoma.[ncbi.nlm.nih.gov]
  • A new classification of Hypersensitive Carotid Sinus Syncope incorporating sinoatrial node (Type 1A) and atriaoventricular node (Type 1B) suppression in the Type 1 syndrome is presented.[ncbi.nlm.nih.gov]
  • The purpose of this book is to present a focused approach to the pathophysiology, diagnosis, and management of the most common autonomic disorders that may present to the clinical neurologist. Autonomic Neurology is divided into 3 sections.[books.google.com]
  • Malignant orthostatic syndrome was present in 4 pts, tussive syncope in one, sick sinus syndrome (SSS) in 6 pts, atrial fibrillation and flutter in 6 pts, AV block in 2 pts.[ncbi.nlm.nih.gov]
  • Presenting symptom. Of the 40 patients who had presented with near-syncope, mild carotid sensitivity was present in 6 (15%) and carotid sinus syndrome in 2 (5%).[eplabdigest.com]
Falling
  • Additionally, when an insurance underwriter looks at some of the common symptoms associated with having carotid sinus hypersensitivity such as: Dizziness, Nonaccidental falls, or unexplained falls.[termlife2go.com]
  • You lose muscle control at the same time, and may fall down. Fainting usually happens when your blood pressure drops suddenly, causing a decrease in blood flow to your brain. It is more common in older people.[icdlist.com]
  • The individual will simply report a fall – an important point in history taking. Prodromal symptoms are more common with vasodepressor carotid sinus syndrome, making it easier to take appropriate action.[syncope.co.uk]
  • Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a ‘syncope’ clinic. Age & Ageing 1993; 22 : 53–58. Google Scholar 14. Smith ML, Ellenbogen KA, Eckberg DL.[link.springer.com]
  • Abstract Syncope is a syndrome characterized by a relatively sudden, temporary and self-terminating loss of consciousness; the causes may vary, but they have in common a temporary inadequacy of cerebral nutrient flow, usually due to a fall in systemic[ncbi.nlm.nih.gov]
Pallor
  • Unlike the ordinary faint, this syncope is not preceded by pallor, nausea, and sweating.[britannica.com]
  • Metastatic cancer Commonly Associated Conditions Sick sinus syndrome Atrioventricular block Coronary artery disease Diagnosis History Syncope Unexplained falls Abnormal gait and balance Absence of postictal symptoms Physical Exam Bradycardia Hypotension Pallor[tipsdiscover.com]
  • It is characterized by diaphoresis, warmth, nausea and pallor. 1 There are 3 main types of syncope.[clevelandclinicmeded.com]
Failure to Thrive
  • Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more.[books.google.com]
Dyspepsia
  • Somatization Disorder Thrombotic Thrombocytopenic Purpura Trigger Finger (Digital Stenosing Tenosynovitis) Trochanteric Bursitis NEW ALGORITHMS INCLUDE Amenorrhea, Primary Amenorrhea, Secondary Back Pain, Acute Bleeding, Gastrointestinal Breast Mass Dyspepsia[books.google.com]
Blurred Vision
  • As defined by the Heart Rhythm Society, POTS is a clinical syndrome characterized by frequent symptoms that occur with standing (ie, lightheadedness, palpitations, tremor, blurred vision, weakness, fatigue), an increase in heart rate of greater than 30[clevelandclinicmeded.com]
Histrionic Personality Disorder
  • Personality Disorder Hot Flashes Hydrocephalus, Normal Pressure Hypercoagulable State Metabolic Syndrome Narcissistic Personality Disorder Nosocomial Infections Panic Disorder Peripheral Arterial Disease Pituitary Adenoma Plantar Fasciitis Pneumonia,[books.google.com]
Breast Mass
Primary Amenorrhea
  • Amenorrhea, Secondary Back Pain, Acute Bleeding, Gastrointestinal Breast Mass Dyspepsia Fatigue Hypernatremia Hypocalcemia Jaundice, Neonatal[books.google.com]
Dizziness
  • The episodes were characterised by hypotension, sharp pain in the right neck, dizziness, and bradycardia. A temporary pacemaker failed to prevent the symptoms, but ephedrine and fludrocortisone produced substantial improvement.[ncbi.nlm.nih.gov]
  • If you're about to faint, you'll feel dizzy, lightheaded, or nauseous. Your field of vision may "white out" or "black out." Your skin may be cold and clammy. You lose muscle control at the same time, and may fall down.[icdlist.com]
  • In this condition dizziness, pre-syncope or syncope may be precipitated by any manoeuvre which causes mechanical stimulation of the carotid sinus – such as turning the head, looking up, or wearing tight collars.[syncope.co.uk]
  • At 6-month follow-up the patient is still asymptomatic for syncope and dizziness.[termedia.pl]
  • Additionally, when an insurance underwriter looks at some of the common symptoms associated with having carotid sinus hypersensitivity such as: Dizziness, Nonaccidental falls, or unexplained falls.[termlife2go.com]
Drop Attacks
  • In an additional prospective, controlled cohort study of 1,149 subjects presenting with unexplained syncope and drop attacks, 19% had carotid sinus hypersensitivity and 31% of these had a positive response only with head-up tilt, giving the upright positive[onlinejacc.org]
  • The asymptomatic groups of community‐dwelling older individuals were not necessarily healthy controls but were individuals without the symptoms of syncope, falls, or drop attacks.[jaha.ahajournals.org]
  • CSH was also present in 35% of community-dwelling older individuals without any symptoms of syncope, falls or drop attacks ( 2 ). Etiology and Pathophysiology The exact mechanism of CSH remains unknown.[unboundmedicine.com]
  • As in this case, the “classic” CSS history of syncope associated with head turning and tight collars 9 is by no means essential; on the contrary, the majority of patients with CSS give no such history, often presenting with unexplained syncope, drop attacks[pmj.bmj.com]
  • Parry x Published: June 9, 2015 Abstract Background Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people.[journals.plos.org]
Vertigo
  • […] seal as soon as is possible Lay the diver down on any solid surface after surfacing Contact an emergency hotline for advice such as Divers Alert Network (DAN) Scuba Injuries Overview Drowning Shock Pulmonary Barotrauma Salt Water Aspiration Syndrome Vertigo[private-scuba.com]
  • Synonym(s): Charcot vertigo ; tussive syncope Charcot spine Charcot syndrome - a condition caused by ischemia of the muscles.[medical-dictionary.thefreedictionary.com]
  • Diagnosis of NMS The evaluation of a patient with syncope first involves excluding other disorders of consciousness (e.g. dizziness, vertigo, seizures, coma) then determining the cause for the syncope episode.[ww2.mc.vanderbilt.edu]
  • Do you have vertigo, or ear ringing? Based on data from reference 1. Physical exam A careful and comprehensive physical examination is essential. Blood pressure should to be checked in both arms, and in the supine and standing positions.[clevelandclinicmeded.com]
Irritability
  • Pacemaker therapy controlled the cardioinhibitory reflex with bradycardia, but the patients manifested varying episodes of hypotension due to a vasodepressor reflex that most likely resulted from persistent irritation of the carotid sinus by the tumor[ncbi.nlm.nih.gov]

Workup

  • The workup must exclude other causes of syncope as guided by the history and the physical examination.[encyclopedia.lubopitko-bg.com]
  • […] trialled with limited success 4 Midodrine, fludrocortisone and sertraline were previously trialled by Sharma et al without any success. 6 This case highlights the importance of high clinical suspicion and thorough clinical examination in the diagnostic workup[nzma.org.nz]
  • The workup of unexplained syncope depends on the presence or absence of heart disease: electrophysiologic study if the patient has heart disease, tilt-table testing in those without heart disease, and prolonged rhythm monitoring in both cases if syncope[mdedge.com]
  • He had extensive workup that included EEG (Electroencephalography), CT (computed Tomography) scan of head, echocardiography and cardiac stress test. All of these diagnostic studies performed were found to be unremarkable.[ispub.com]
  • Diagnostic workup After a thorough history and physical exam, an electrocardiogram (ECG) should be obtained. Blood work should be obtained when metabolic diseases or anemia are suspected.[clevelandclinicmeded.com]

Treatment

  • Combined drug treatment with a vasoconstrictor and plasma volume expander produced an improvement in symptoms but did not eliminate them.[ncbi.nlm.nih.gov]
  • Surgical treatment in resistant cases is a possibility.[ncbi.nlm.nih.gov]
  • Atrioventricular sequential pacing was shown to eliminate the hypotensive effect of ventricular pacing and is considered to be the treatment of choice for patients with carotid sinus syndrome who have both cardioinhibitory and significant vasodepressor[ncbi.nlm.nih.gov]
  • Many forms of treatment for cardioinhibitory Hypersensitive Carotid Sinus Syncope have been forthcoming but in our hands in these 89 patients over 17 years, there has been no single case of recurrence of syncope after implantation of a permanent VVI electronic[ncbi.nlm.nih.gov]
  • Generally, pacemaker implantation is the adequate treatment. Late results are very good after pacemaker implantation.[ncbi.nlm.nih.gov]

Prognosis

  • In every case the goal should be to determine the cause of syncope with sufficient confidence to provide patients and family members with a reliable assessment of prognosis, recurrence risk, and treatment options.[ncbi.nlm.nih.gov]
  • Prognosis May be serious if syncope is associated with atheromatous narrowing of sinus artery or basilar artery Recurrence rate is difficult to quantify.[tipsdiscover.com]
  • Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (short-term prognosis of syncope) study. J Am Coll Cardiol 2008; 51:276–283. Vaddadi G, Guo L, Esler M, et al.[clevelandclinicmeded.com]
  • Prognosis The long-term mortality rate is similar to the general population and patients with unexplained syncope. Untreated symptomatic patients have a syncope recurrence rate as high as 62% within 4 years.[emedicine.medscape.com]
  • […] dell’introduzione di liquidi (almeno 2,5 l/die) e correzione di anemia e/o ipovolemia Fluoroidrocortisone a piccole dosi 102 Trattamento delle Sincopi Riflesse Neuromediate Raccomandazioni di classe I: Spiegazione dei rischi e rassicurazione circa la prognosi[slideplayer.it]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Table 3 lists clinical features suggesting specific etiologies. 2 Table 3: Clinical Features Suggesting Specific Etiologies Reflex syncope Absence of heart disease Longstanding and recurrent syncope After unexpected pain, smell or sight After prolonged[clevelandclinicmeded.com]
  • ETIOLOGY • Idiopathic • Head and neck tumors (e.g., thyroid) • Significant lymphadenopathy • Carotid body tumors • Prior neck surgery DIAGNOSIS • The diagnosis of CSS is made when carotid sinus hypersensitivity is diagnosed by CSM and no other cause of[encyclopedia.lubopitko-bg.com]
  • Etiology and Pathophysiology The exact mechanism of CSH remains unknown.[unboundmedicine.com]
  • Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation 2012; 125 :2566–71. 6. Yue AM, Thomas RD.[bjcardio.co.uk]

Epidemiology

  • SYNONYMS Carotid sinus syncope CSS EPIDEMIOLOGY & DEMOGRAPHICS • The incidence of carotid sinus hypersensitivity is 15% in the adult population. • The incidence increases with age. • Men are affected more often than women (2:1). • Carotid sinus syndrome[encyclopedia.lubopitko-bg.com]
  • ., shaving, tight collars, or tumors) Induced CSS: syncope diagnosed by CSM, although no mechanical trigger is found Epidemiology Disease of elderly; virtually unknown in people aged More prevalent in males by ratio of 4:1 Typical patient is an older[unboundmedicine.com]
  • System(s) affected: Cardiovascular; Nervous Synonym(s): Carotid sinus syncope; Carotid sinus hypersensitivity Epidemiology Predominant age: Elderly Predominant sex: Male Female (2:1) Geriatric Considerations More likely to occur in elderly Can be a cause[tipsdiscover.com]
  • Epidemiology United States data CSH is found in 0.5-9.0% of patients with recurrent syncope. International data CSH is observed in up to 14% of elderly nursing home patients and 30% of elderly patients with unexplained syncope and drop attacks.[emedicine.medscape.com]
  • Epidemiology The incidence of the syndrome (35-40:1 000 000 population per year) has been calculated from the data obtained in several studies performed in the first eighties of the last century. 2 The CSS has a prevalence lower than 4% among people younger[scielo.org.mx]
Sex distribution
Age distribution

Pathophysiology

  • Abstract The pathophysiology and therapy of the carotid sinus syncope were studied by means of electrophysiological investigations and clinical observations in 84 patients suffering from carotid sinus syncope.[ncbi.nlm.nih.gov]
  • Cerebral hemodynamic disturbances may play a crucial role in the pathophysiology of syncope with normal sinus rhythm and normotension. Moreover, direct depression of the CNS following carotid sinus distension is likely to be involved.[ncbi.nlm.nih.gov]
  • The purpose of this book is to present a focused approach to the pathophysiology, diagnosis, and management of the most common autonomic disorders that may present to the clinical neurologist. Autonomic Neurology is divided into 3 sections.[books.google.com]
  • Patients with an abnormal CSM result were older (p 1-5 The pathophysiology underlying postural neurally mediated syncope is still not fully understood. 6,7 One model describes an exaggerated sympathetic reaction to relative hypovolemia countered by a[eplabdigest.com]
  • Claydon e13448 First Published: 16 October 2017 Despite its high prevalence in the elderly, and reported association with devastating episodes of syncope and falls, the pathophysiology of carotid sinus hypersensitivity (CSH) remains unknown.[physreports.physiology.org]

Prevention

  • A temporary pacemaker failed to prevent the symptoms, but ephedrine and fludrocortisone produced substantial improvement.[ncbi.nlm.nih.gov]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • If you do the preventive measures, it will help prevent complications to the heart and lungs. Longevity, however, can have two implications; it can be a sign of good control or long-term damage to the other organs.[highrisklifeinsuranceagency.com]
  • If an underlying cause is found, treating it should help prevent further fainting episodes. Read more about diagnosing fainting .[nhs.uk]

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