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Syncope


Presentation

  • We discuss the possible pathophysiology, as well as the clinical relevance of this type of presentation.[ncbi.nlm.nih.gov]
  • The symptoms and presentation of syncope are similar to many other conditions, which can lead to difficulty in establishing a diagnosis in the ED.[ncbi.nlm.nih.gov]
  • We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc.[ncbi.nlm.nih.gov]
  • RESULTS: Among 1084 patients diagnosed with PE, 45 (4.2%) presented with syncope. Four patients which presented with cardiac arrest were excluded from the study.[ncbi.nlm.nih.gov]
  • In this case the presenting complaints were syncope and atrial fibrillation, illustrating the importance of performing a transthoracic echocardiogram in patients presenting with their first episode of atrial fibrillation.[ncbi.nlm.nih.gov]
Falling
  • You lose muscle control at the same time, and may fall down. Most people recover quickly and completely. Fainting usually happens when your blood pressure drops suddenly, causing a decrease in blood flow to your brain.[icd9data.com]
  • ‘Cardiac arrhythmias or syncope clearly associated with a fall should be treated with antiarrhythmics or a pacemaker in consultation with a cardiologist.’[en.oxforddictionaries.com]
  • There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85 beats per minute (BPM).[ncbi.nlm.nih.gov]
  • Indeed, the heart rate increases slowly as the arterial pressure falls.[courses.washington.edu]
Anemia
  • [G. synkopē, cutting short] syncope a temporary suspension of consciousness due to cerebral anemia; fainting. cardiac syncope sudden loss of consciousness due to cerebral anemia caused by ventricular asystole, extreme bradycardia or ventricular fibrillation[medical-dictionary.thefreedictionary.com]
  • The term syncope (or fainting) refers to cerebral anemia. Syncope causes collapse, which may last from seconds to minutes. Most fainting spells are due to low blood pressure or lack of oxygen delivery to the brain.[canine-epilepsy.com]
  • They include anemia (insufficient iron in the blood), blood clots, and heart defects or heart problems, such as: Arrhythmias: abnormal electrical signals that control the heartbeat (for example, long QT syndrome ) Structural abnormalities in the heart[chop.edu]
  • Other situations or illnesses that can cause syncope include, but are not limited to, the following: Head injury Seizure Stroke Inner ear problems Dehydration Low blood sugar Breath holding episodes in young children Pregnancy Anemia What are the symptoms[stanfordchildrens.org]
Pallor
  • In the second to minutes leading up to the fainting, the patient may feel weakness, nausea, pallor, and sweating.[courses.washington.edu]
  • […] libraries; pools, creeks top places to beat the searing heat," 2 July 2018 The first description of a tubal pregnancy does not appear until 1604, when an Italian physician’s notes describe a 31-year-old woman who presented with mysterious abdominal pain, pallor[merriam-webster.com]
  • In many cases, there is a characteristic preceding prodrome of dizziness, nausea, diaphoresis, and pallor.[healio.com]
Hypotension
  • Orthostatic intolerance has an expanding spectrum with three well-defined entities: orthostatic hypotension (OH), neurally mediated hypotension (NMH), and postural tachycardia syndrome (PoTS).[ncbi.nlm.nih.gov]
  • Syncope suspected of orthostatic hypotension (OH) can be mediated by neurogenic conditions, dehydration, or drugs.[acc.org]
  • Syncope (fainting), vasovagal Syncope (loss of consciousness, fainting) Syncope and collapse (fainting) Syncope due to orthostatic hypotension Syncope, cough Syncope, micturition Syncope, vasovagal Transient loss of consciousness Tussive syncope Vasovagal[icd9data.com]
  • In these patients, the cardiovascular consequences may include bradycardia, hypotension and cardiac arrest. We describe the case of a 40-year-old patient who presented with this rare association of glossopharyngeal neuralgia and syncope.[ncbi.nlm.nih.gov]
  • Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients.[ncbi.nlm.nih.gov]
Heart Disease
  • Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease.[ncbi.nlm.nih.gov]
  • Author information 1 Division of Pediatric Cardiology, Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, OH. 2 Division of Pediatric Cardiology, Center for Pediatric and Congenital Heart Disease, Cleveland Clinic[ncbi.nlm.nih.gov]
  • Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Sports and Exercise Cardiology, Valvular Heart Disease, Implantable Devices[acc.org]
  • For each heart disease we describe the role of the various imaging techniques and the possible diagnostic and prognostic information provided by these techniques.[ncbi.nlm.nih.gov]
Orthostatic Hypotension
  • hypotension Syncope (fainting), vasovagal Syncope (loss of consciousness, fainting) Syncope and collapse (fainting) Syncope due to orthostatic hypotension Syncope, cough Syncope, micturition Syncope, vasovagal Transient loss of consciousness Tussive[icd9data.com]
  • Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients.[ncbi.nlm.nih.gov]
  • Orthostatic intolerance has an expanding spectrum with three well-defined entities: orthostatic hypotension (OH), neurally mediated hypotension (NMH), and postural tachycardia syndrome (PoTS).[ncbi.nlm.nih.gov]
  • Abstract Orthostatic hypotension has a vast differential that has been previously described throughout the literature.[ncbi.nlm.nih.gov]
  • In contrast, in patients with orthostatic hypotension due to autonomic failure, these cardiovascular homeostatic reflexes are chronically impaired.[accessmedicine.mhmedical.com]
Heart Failure
  • Independent predictors of cardiovascular events were systolic blood pressure CONCLUSIONS: Drug-induced syncope, hypotension, no indication for a pacemaker, and a history of congestive heart failure are risk factors post-discharge for patients with cardiovascular[ncbi.nlm.nih.gov]
  • Deceleration capacity (DC) is a strong risk predictor in postinfarction and heart failure patients.[ncbi.nlm.nih.gov]
  • Abstract Takotsubo syndrome is an acute reversible heart failure syndrome triggered by physical or emotional stress, especially in postmenopausal women.[ncbi.nlm.nih.gov]
  • He had history of chronic renal failure and heart failure, but denied neither taking digitalis nor having family history related to sudden death.On arrival, heart rate was 150 bpm and blood pressure (BP) by cuff was 91/81 mm Hg (non-invasive BP could[ncbi.nlm.nih.gov]
  • A history of congestive heart failure (CHF) and/or coronary artery disease (CAD) and age 65 were significantly associated with abnormal ECG and ECHO findings, but not with severe carotid stenosis.[ncbi.nlm.nih.gov]
Slow Pulse
  • Symptoms include deep and fast respiration, weak and slow pulse and respiratory pauses that may last for 60 seconds.[en.wikipedia.org]
Increased Sweating
  • Additionally, wearing heavy equipment (such as football pads or firefighter bunker gear) and a uniform increases sweating, resulting in dehydration.[ksi.uconn.edu]
Cutaneous Manifestation
  • It is a recessive disorder with cardio-cutaneous manifestations characterized by arrhythmogenic right ventricular cardiomyopathy, palmoplantar keratoderma and wooly hair.[ncbi.nlm.nih.gov]
Panic Attacks
  • Psychological conditions including panic attacks, hysteria, emotional distress, etc. Seizures caused by psychological conditions are often referred to as psychoseizures, pseudoseizures, or non-epileptic seizures.[wwwp.medtronic.com]
  • Metabolic causes of syncope include hypoxia (reduced oxygen in the blood, which almost always means some severe and obvious lung or heart disease is present); hyperventilation, which occurs in severe anxiety reactions or panic attacks; and severe hypoglycemia[heartdisease.about.com]
  • attacks Factitious or conversion disorders Environmental or exposures Extreme temperatures Intoxication or drug use Medications Cardiovascular Mechanical Left ventricular outflow tract obstruction Idiopathic pulmonary artery hypertension Myocarditis[healio.com]
Dizziness
  • We report a 55-year-old woman with systemic lupus erythematosus, who later developed episodes of syncope and dizziness along with diaphoresis and palpitations. She also had associated abdominal pain and vomiting.[ncbi.nlm.nih.gov]
  • Certain movements can also be done to keep dizziness from leading to fainting.[cincinnatichildrens.org]
  • […] syncope in a Sentence syncope has been reported in a small percentage of patients taking the drug Recent Examples on the Web According to the Harford County Health Department, heat illness takes many forms, including heat fatigue, heat syncope (sudden dizziness[merriam-webster.com]
  • You have a headache, fast heartbeat, or feel too dizzy to stand up. You have questions or concerns about your condition or care. Medicines: Medicines may be needed to help your heart pump strongly and regularly.[drugs.com]
Confusion
  • On the other hand, seizures are easily confused with syncope and remain in the differential diagnosis of the patient who appears to have had syncope (see Figure 31-1 ).[accessmedicine.mhmedical.com]
  • If you pass out, you will likely become conscious and alert right away, but you may be feel confused for a bit.[my.clevelandclinic.org]
  • […] consciousness breathing pattern (snoring) movements (tonic, clonic, tonic-clonic or minimal myoclonus, automatism) and their duration, onset of movement in relation to fall, tongue biting End of attack  Nausea, vomiting, sweating, feeling of cold, confusion[lifeinthefastlane.com]
  • Sometimes when people faint, their muscles twitch and their bodies make jerking movements; this can sometimes be confused with seizures but are not actual seizures. Fainting can happen after many types of vaccinations.[cdc.gov]
Drop Attacks
  • It has many causes, and is distinct from vertigo, seizures, coma, falls, psychogenic pseudosyncope, drop attacks, transient ischaemic attacks, and states of altered consciousness. [3] Strickberger SA, Benson DW, Biaggioni I, et al.[bestpractice.bmj.com]
  • Autonomic failure 8.1.2 Epilepsy and ictal asystole 8.1.3 Cerebrovascular disorders 8.1.4 Migraine 8.1.5 Cataplexy 8.1.6 Drop attacks 8.2 Neurological tests 8.2.1 Electroencephalography 8.2.2 Brain computed tomography and magnetic resonance imaging 8.2.3[escardio.org]
  • Conditions that can easily be mislabelled as syncope Disorders with impairment or loss of consciousness Metabolic disorders (hypoglycaemia, hypoxia) Intoxication TIAs of vertebrobasilar origin Disorders resembling syncope without LOC Cataplexy Drop attacks[emed.ie]
Altered Mental Status
  • mental status until treated, onset seldom abrupt, sweating, piloerection Usually history of diabetes or insulinoma Fingerstick glucose Response to glucose infusion Psychiatric disorders Not true syncope (patient may be partially or inconsistently responsive[merckmanuals.com]

Workup

  • In the absence of clinical suspicion, a routine diagnostic workup for APE in patients with syncope cannot be recommended.[ncbi.nlm.nih.gov]
  • A thorough diagnostic workup reasonably excluded a cardiac disorder as the cause of syncope.[ncbi.nlm.nih.gov]
  • Often diagnostic workup requires multiple and challenging investigations to determine whether the patient has a structural heart disease. Cardiac imaging tests should be used when baseline clinical findings raise the suspicion of a cardiac syncope.[ncbi.nlm.nih.gov]
  • This episode will focus on the definition of syncope, how to get a complete history, catch the red flags, perform a targeted workup that doesn’t keep the patient in the ED forever, and how to scrutinize an EKG for the deadly arrhythmias that we can’t[embasic.org]
  • Third, all participating hospitals used a standardized protocol for the diagnostic workup of syncope that was based on international guidelines, 1,2 but a specific workup was not mandated by the study protocol.[nejm.org]
Left Anterior Fascicular Block
  • At the gap of syncope, ECG showed complete right bundle branch block accompanied by alternation of left anterior fascicular block and left posterior fascicular block. The patient was implanted with a dual-chamber permanent pacemaker.[ncbi.nlm.nih.gov]

Treatment

  • It can serve as a warning symptom of OH as well as a parameter to gauge the benefit of treatment. Awareness of CHA avoids inappropriate tests. Headache type occurring in NMH has not been fully delineated.[ncbi.nlm.nih.gov]
  • This new "cardio-neuromodulation" approach could be useful for the treatment of patients with neurally mediated syncope. 2016 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • Psychogenic factors include: Fright Anxiety (due to the anticipation of discomfort or the fee) Stress Receipt of unwelcome news (treatment or the treatment fee) Sudden and unanticipated pain (injection or during treatment) The sight of blood (gauze, dental[dentalcare.com]
  • Propranolol in slow-release form has been the first-line treatment in long QT (LQT) until it was withdrawn from the market.[ncbi.nlm.nih.gov]
  • In this case, the patient declined pharmacological treatment with carbamazepine or with permanent pacing and so far has been in remission from symptoms for 3 months. 2016 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]

Prognosis

  • Through the extensive Danish registries we examined the characteristics and prognosis of the patients hospitalized due to syncope in a nationwide study.[ncbi.nlm.nih.gov]
  • Patients presenting with neurally mediated syncope showed a prognosis similar to that of the asymptomatic and the role of EPS in this group is unproven. Copyright 2017 Elsevier B.V. All rights reserved.[ncbi.nlm.nih.gov]
  • Despite this benign prognosis, care must be made to find uncommon and potentially fatal causes.[ncbi.nlm.nih.gov]
  • Unprovoked PE (odds ratio [OR] 8.046, 95% confidence interval [CI] 3.073-21.069, p CONCLUSIONS: Although syncope is associated with a more severe form of PE, it does not influence the short-term prognosis of PE.[ncbi.nlm.nih.gov]
  • Abstract Syncope is a common symptom with a possibly unfavorable prognosis, especially when the cause is a cardiac disease.[ncbi.nlm.nih.gov]

Etiology

  • However, vascular etiologies can result in patient morbidity and mortality.[ncbi.nlm.nih.gov]
  • Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival.[ncbi.nlm.nih.gov]
  • Electrophysiologic study is reasonable in selected patients with syncope suspected of arrhythmic etiology (Class IIa).[acc.org]
  • BACKGROUND: Syncope is common and approaches to establishing etiology remain a matter of clinical and financial importance. Patients often undergo comprehensive neurologic investigations despite a lack of compelling indications.[ncbi.nlm.nih.gov]
  • Syncope is a common clinical presentation and establishing an etiology is often challenging. Pulmonary embolism (PE) has been thought to be an uncommon cause but a recent report suggested otherwise.[ncbi.nlm.nih.gov]

Epidemiology

  • Traditionally the data on epidemiology of syncope has been taken from smaller studies from different clinical settings with wide differences in patient morbidity.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada; Centre for Health Evaluation & Outcome Sciences, Vancouver[ncbi.nlm.nih.gov]
  • There are also some difficulties interpreting epidemiological estimates because of inconsistencies in methodology and definitions used between studies.[bestpractice.bmj.com]
  • Epidemiology Up to 3% of emergency department visits by adults and 6% of hospital admissions are due to syncope. Among children, only 0.125% of emergency department visits are due to syncope.[pedsinreview.aappublications.org]
Sex distribution
Age distribution

Pathophysiology

  • We also explored the pathophysiology leading to syncope in the setting of acute myocardial infarction including arrhythmias and exaggerated neurally mediated response.[ncbi.nlm.nih.gov]
  • Recognition of its various clinical presentations and knowledge of the underlying pathophysiology are essential for accurate diagnosis and successful management.[ncbi.nlm.nih.gov]
  • Abnormal reactions of esophageal mechanoreceptors to stimuli associated with food ingestion and/or dysfunction of afferent and efferent vagal fibers due to stretch injury and related neck trauma (acquired during the car accident) may be the leading pathophysiological[ncbi.nlm.nih.gov]
  • In addition, long sinus pauses were noted during carotid sinus massage, suggesting that the two distinct entities may be associated, and further supporting the mechanism of neurally mediated syncope in the pathophysiology of swallow-induced syncope.[ncbi.nlm.nih.gov]
  • We discuss the possible pathophysiology, as well as the clinical relevance of this type of presentation.[ncbi.nlm.nih.gov]

Prevention

  • […] invited to comment on preventative measures they had taken (if any) to prevent syncopal episodes reoccurring.[doi.org]
  • Avoidance of syncope may be more effective than anti-seizure medications in preventing reflex anoxic seizures.[ncbi.nlm.nih.gov]
  • Although fainting itself might or might not be preventable, it is important to prevent injuries when people do faint. Fainting and related injuries after immunization can be prevented.[cdc.gov]
  • Pharmacologic interventions may be appropriate for some patients but, in general, have limited evidence of efficacy in preventing syncope.[ncbi.nlm.nih.gov]

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