جستجوی مقالات مرتبط با کلیدواژه « syncope » در نشریات گروه « پزشکی »

Syncope is among the most common paroxysmal disorders in children and adolescents. Vasovagal syncope is the most common syncope in children and adolescents. The aim of this study was to evaluate the impact of self‑care recommendations with and without tilt training on the Quality of Life (QoL) of children and adolescents with syncope.

This randomized controlled clinical trial was conducted in Isfahan, Iran, from April 2017 to June 2021 and included 120 patients with syncope. Eligible children and adolescents (aged 6–18 years) who met inclusion criteria were recruited by the simple sampling method and then assigned randomly into two groups. The intervention group (n = 60) received routine self‑care recommendations such as dietary advice, behaviors to prevent syncope, and counter‑pressure maneuvers along with tilt training, while the control group (n = 60) received self‑care recommendations without tilt training. The education training included two face‑to‑face sessions, each of which lasted for 45–60 min. Then, both groups were followed up by telephone (once a month) for six months. A researcher‑made self‑care questionnaire and Pediatric Quality of Life Inventory (PedsQL™ 4.0) were completed for both groups before and after the intervention. Data were analyzed using descriptive and inferential statistical methods.

The Wilcoxon test results showed a significant difference in the mean scores of physical functioning, emotional functioning, social functioning, school functioning, psychosocial functioning, understanding of health, and total QoL in the intervention and control groups before and after the intervention (p </em>< 0.05). Also, the paired t</em>‑test results showed a significant difference in the mean scores of self‑care domains and total self‑care in the intervention and control groups before and after the intervention (p </em>< 0.05).

Self‑care recommendations with and without tilt training can improve QoL in children and adolescents with syncope.

Vasovagal syncope (VVS), characterized by transient loss of consciousness, is among the most prevalent reasons for emergency visits worldwide. Although benign in nature, VVS can be accompanied by traumatic injury, leading to morbidity and decreased quality of life, especially in those with VVS recurrence. The management includes non-pharmacologic and pharmacologic therapies (if resistant), patient education and reassurance, salt and fluid intake increase, and physical counter-pressure maneuvers. Among medications, midodrine has shown promising results in reducing VVS recurrence and positive head-up tilt tests. Fluoxetine and atomoxetine also might be suitable candidates for VVS therapy. Permanent pacemakers, such as closed-loop stimulation, are under research and can be effective in cases unresponsive to medical treatment. In summary, while data are scarce regarding the definite treatment of VVS, there is a need for further research with novel, easy-to-use and cost-effective therapeutic methods to enhance quality of life and prevent traumatic injury.

Intracranial dermoid cysts (IDC) are rare cystic lesions that are present from birth. After rupture of these cysts, patientsmay present to the hospital with ischemic cerebral symptoms, headaches, seizures, syncope, and meningitis. Brain magnetic resonance imaging (MRI) is the most sensitive radiologic method in the diagnosis of IDC rupture, which has a high mortality rate. Patients should be rapidly evaluated for surgery if a symptomatic and ruptured cyst is detected. In this presentation, we aimed to describe the diagnosis and treatment of IDC in a 23-year-old male patient brought to the emergency department after syncope.

Syncope is defined as a sudden and transient loss of consciousness followed by complete spontaneous recovery. This study describes the syncope evaluation in patients referred to the Heart Clinic. This descriptive cross-sectional study was conducted on 60 syncope patients referred to Afshar Heart Clinic of Yazd, Iran, from September 2016 to March 2017. After performing clinical workups, the etiology of syncope was diagnosed in each patient. Electrocardiography and blood pressure measurements were done for all patients. Additional clinical tests, including echocardiography, Holter Monitoring, Head-Up tilt table test (HUTT), electroencephalography, and Magnetic Resonance Imaging, were performed for some patients based on the cardiologist's opinion. The distribution of patient's clinical records, such as age, sex, diabetes, hypertension, history of ischemic heart disease (IHD), duration of syncope, postdrome, prodromal symptoms, and clinical test results according to causes of syncope in patients, were reported. Sixty patients with a mean age of 50.7 ± 20.4 years were evaluated (55% male). Thirty-five patients (58.3%) had Neurally Mediated Syncope, 18 patients (30%) had arterioventricular (AV) Block induced syncope, and 7 (11.7%) patients had Sick Sinus Syndrome (SSS) induced syncope. Age, hypertension, prodromal symptoms, history of IHD, ECG, Holter monitoring, and HUTT results were associated with the cause of the syncope. Cardiac syncopes (AV-Block induced and SSS induced) were related to older age, hypertension, abnormal electrocardiogram, and abnormal Holter monitoring results. Neurally mediatedsyncope was associated with younger age, prodromal symptoms, and abnormal HUTT results.

Distinguishing between seizure and neurally mediated syncope is challenging because of similar consequences and medical history. A head-up tilt test (HUTT) is a non-invasive, simple, and easy test to distinguish between epilepsy and syncope besides detailed history taking.

This study aimed to differentiate between epileptic events and reflex syncope (any different type of syncope) using the head-upright tilt test.

We studied 59 patients (37 boys and 22 girls) between 4 to 18 years old (mean age, 10.5±3.7 years) with a previous diagnosis of seizure who did not respond well to treatment. All patients underwent HUTT, and the test was positive in 26 patients. There were no significant differences in sex, age, provocative factors, associated syndrome, and family history between negative and positive groups.

There was a history of actual syncope in 26.9% of the positive tilt test group compared to 15.15% of the negative test group. Also, there was a positive family history of syncope in the positive tilt test group. Among 26 patients with a positive tilt test, 17 were diagnosed with vasovagal syncope (VVS) vasodepressor type and 9 with mixed type. Antiepileptic drugs were tapered for patients diagnosed with VVS, and they did not show any seizures after 18 ± 6 months of follow-up. Overemphasizing positive family history and inattention to history taking are 2 crucial factors leading to the misdiagnosis of epilepsy.

Our study showed that HUTT is a non-invasive test that can be useful, especially for early and proper diagnosis in children with refractory epilepsy.

Autonomic changes play an essential role in the genesis of neurally mediated syncope (NMS). The aim of this study was to compare the changes of the autonomic nervous system (ANS) by measuring spectral indices of beat-to-beat systolic blood pressure and heart rate variability (SBPV and HRV) in ranges of low frequency (LF), high frequency (HF), and the LF/HF ratio during head-up tilt test (HUTT) in patients with and without a syncope response.

In this case-control study of 46 patients with a suspected history of unexplained syncope, data were recorded separately during the typical three phases of HUTT. Patients who developed syncope were designated as the case group and the rest as the control group.

Thirty one patients experienced syncope during HUTT. Resting HRV and SBPV indices were significantly lower in cases than controls. After tilting in the syncope group, both HF and LF powers of SBPV showed a significant and gradual decrease. LF/HF in HRV increased in both groups similarly during the test but in SBPV, mainly driven by oscilations in its LF power, it increased significantly more during the first two phases of the test in syncope patients only to paradoxically decrease during active tilt (P< 0.001).

Our findings show an abnormal autonomic function in patients with syncope, both at rest and tilting. Fluctuations of spectral indices of beat-to-beat SBPV, a potential noval index of pure sympathetic activity, show an exaggerated response during tilt and its withdrawal before syncope.

The significance of diagnosing the root reason for syncope and taking therequired preventive or treatment measures cannot be overlooked when it comes tooutcome prediction. This study endeavors to examine the role of proBNP in differentiatingcardiogenic and non-cardiogenic syncope in patients presenting to the emergencydepartment (ED).

We prospectively performed a cross-sectional study on patients presentingwith acute syncope. All the patients for this investigation were followed up until thedefinite cause of their syncope (cardiac or non-cardiac) was diagnosed and the screeningperformance characteristics of proBNP in differentiation of cardiogenic and noncardiogenic syncope were evaluated.

Three hundred patients with syncope were studied (64.7% male). In the end,the cause of syncope was determined to be cardiogenic in 133 cases (44.3%). The areaunder the ROC curve of proBNP in the differentiation of cardiogenic syncope from noncardiogenic was estimated to be 78.9 (95% CI: 73.5 – 84.3). The optimal cut-off point forproBNP in this regard was 143.5 pg/mL point. Sensitivity, specificity, positive and negativepredictive values, and positive and negative likelihood ratios of proBNP in the mentionedcut-off point were 75.39% (95% CI: 67.61–82.73), 75.44% (95% CI: 68.07–81.62), 71.12%(95% CI: 62.82–78.26), 79.74% (95% CI: 72.46–85.54), 2.46 (95% CI: 1.86–3.25), and 0.25(95% CI: 0.18–0.34), respectively.

The accuracy of proBNP in differentiation of cardiogenic and non-cardiogenicsyncope is fair. ProBNP concentration equals to or higher than 143.5 pg/mL can differentiatecardiogenic syncope from non-cardiogenic with 75% sensitivity and 76% specificity. Itseems that its use for this purpose should be considered with caution and along with othertools

Seizure and syncope have similar clinical symptoms but different etiologies. Hence, differential diagnosis is crucial prior to intervention. This study evaluates the diagnostic importance of neuron specific enolase (NSE), creatine phosphokinase (CPK), and serum lactate dehydrogenase (LDH) for admitting patients with seizure medical history to emergency department (ED) in order for differential diagnosis between syncope and seizure.

Patients with a short‑lasting loss of consciousness admitted to the ED were recruited. All patients with a short‑lasting loss of consciousness were eligible and EEG was conducted several times and was taken over a long period. Patients were then divided into two groups of seizure and syncope. The biochemical markers levels of all the eligible patients were measured by a reputable laboratory.

In order to define specificity and sensitivity of different levels of biomarkers and the optimal cut‑off points, ROC curves for each biomarker of syncope and seizure patients admitted to ED were performed. AUC for NSE, CPK, and LDH were 0.973 ± 0.023, 0.827 ± 0.047, and 0.836 ± 0.043 respectively in 95% confidence level. Cut‑off points for NSE, CPK, and LDH were determined 25.12, 218.09, and 193.88 respectively.

It was concluded that NSE, CPK and LDH levels were different significantly in seizure patients compared to syncope ones. The seizure group showed an increase in NSE, CPK and LDH level. Determining biomarkers level for differential diagnosis of seizure and syncope can be applied as a supplementary test in addition to tests like EEG.

Pulmonary artery hypertension (PAH) occurs when mean pulmonary artery pressure (PAP) is higher than 25 mmHg in rest or 30 mmHg during activity. Idiopathic pulmonary artery hypertension (IPAH) is defined as PAH without a definite reason. The IPAH is a rare disease with a high mortality rate if left untreated. To date, there has been no definite cure for this entity, and most treatments are for symptom relief or improvement in the quality of life. For many years, decompressing the right heart through a hole in the interatrial septum has been advised to alleviate some of their symptoms, specifically syncope. Atrial flow regulator (AFR) is a device to make an iatrogenic interatrial hole and finally a unidirectional shunt. It has been used for some PAH patients for symptom relief. Herein, we report a 36-year-old female case with diagnosed IPAH for 6 years. In the last 3 years, the case had frequent syncope with shortening intervals. The AFR was implanted for her without any complications. Then, within 6 months of follow-up, she had only one syncope episode. A significant change was observed in her 6-minute walk and PAP.

Fahr´s syndrome is a rare neurodegenerative entity, which consists of calcifications of the basal ganglia and cerebrospinal nuclei, which can be associated with neurological and neuropsychiatric symptoms. However, the difference between syndrome and Fahr’s disease is highlighted.

Case Report:

 a 55-year-old man with underlying thyroid disease undergoing treatment, debuted with syncope with posterior cranial trauma, which was admitted to the emergency service, performing imaging studies with findings compatible with Fahr´s syndrome.

syncope as a cardiac symptom in a patient with Fahr syndrome, metabolic and structural abnormalities ruled out must be.

Cutaneous T-cell lymphomas constitute a rare category of non-Hodgkin lymphomas, which may involve the heart in the timeline of their natural course as an infrequent picture with a poor prognosis. Syncope, either due to outflow obstruction or conduction block, is also an uncommon presentation of cardiac metastasis. We herein describe a 35-year-old man, who presented with weight loss, dyspnea of 6 months’ duration, an indolent skin ulcer in the left flank, lower limb deep vein thrombosis (DVT), and recurrent syncope. He underwent implantation of a permanent pacemaker due to a complete heart block and received anticoagulants for the DVT. Skin biopsy demonstrated a T-cell lymphoma. The syncopal episodes ceased thereafter. Echocardiography and computed tomography scan revealed cardiac metastasis, which responded to systemic chemotherapy. In the first follow-up visit after 3 months, he was still pacemaker-dependent. However, the DVT was partially resolved, and the symptoms had disappeared.

We report a case of ST elevation myocardial infarction (STEMI) during head-up tilt testing (HUTT). A 54-year-old man was admitted to our emergency department after four episodes of syncope. Treadmill test and electrophysiological study were normal. During passive HUTT, the patient had inferolateral ST elevation. Coronary angiography showed two severe lesions in the right coronary artery and circumflex artery

Since the 1950s, air travel has grown exponentially. In 2018, the number of international air passengers was estimated at 4.1 billion. Air travel exposes the passenger to a number of constraints (like physical constraints, stress) that can be correlated and lead to an inflight medical event, especially for passengers with chronic conditions or fragile health.

In June 2017, a mini review of the literature was conducted in order to summarize the data on inflight medical events and their frequency, types, and consequences.

The most frequent inflight medical events are syncope and lipothymic discomfort, followed by digestive disorders, cardiorespiratory symptoms, neuropsychiatric disorders, and trauma. In almost two-thirds of all cases, these medical events are linked to a pre-existing pathology. There is no reliable register of inflight medical events, but their number is estimated to be between 120 to 350 each day throughout the world.

The definition of an inflight medical event deserves to be specified, and the collection of these events needs to be standardized. This will help bring about a better understanding of the issue and maybe raise awareness among passengers with chronic diseases or fragile health and their general practitioners.

Long QT syndrome is a rare hereditary disorder that could be a potentially fatal condition. One of the symptoms of long QT caused by ventricular arrhythmia is seizure. The diagnosis of this syndrome might be delayed when an initial diagnosis of epilepsy is made.

The patient to be studied in this research was a 24-year-old right handed female. She had the spells since she was 14; which were characterized by uncomfortable anxiety, nausea, pallor, and palpitation followed by generalized weakness and occasionally generalized clonic jerks with obvious impairment of consciousness. She was treated with Depakine and Carbamazepine. During the video-EEG monitoring, she had one habitual attack accompanied with ventricular tachycardia and cardiac arrest for which cardiorespiratory resuscitation was immediately started, and fortunately the patient returned to normal condition. Cardiac evaluation was requested and diagnosis of long QT syndrome was confirmed. Implantable cardiac defibrillator was placed for her.

Long QT syndrome possesses considerable mortality decreased with proper therapy. Long QT syndrome imitates seizure disorders. Hence, taking electrocardiography is required for individuals with vague causes of seizure and uncommon semiology.

Syncope is the state of lack of consciousness and temporal loss of postural tone. Syncope might be in association with a variety of benign and life-threatening conditions. Pulmonary embolism (PE) has been shown to be associated with syncope in 13-30 percent of cases. This article presents a novel case report of PE whom syncope was his only manifestation.