1/17. Continuous haemodynamic monitoring in an unusual case of swallow induced syncope.A 69 year old man is described with a 12 year history of intermittent syncope associated with ingesting solid food, mainly after having fasted. He was taking enalapril, propranolol, bendrofluazide (bendroflumethiazide), omeprazole, finasteride, and aspirin. Detailed investigations, including gastrointestinal evaluation, measurement of various gut hormones, and autonomic testing, indicated no abnormality. A liquid meal, performed before fasting, failed to elicit an episode. However, a solid meal after an overnight fast provoked near-syncope. Continuous non-invasive haemodynamic monitoring (with a Portapres II) indicated a short lived rise in blood pressure and heart rate, followed by severe hypotension, a fall in stroke volume and cardiac output, and then bradycardia. This favoured an initial increase in sympathetic activity, followed by vasodepression due to sympathetic withdrawal or activation of humoral vasodilatatory mechanisms, with bradycardia secondary to impaired cardiac filling. Withdrawal of enalapril abolished the episodes. The unusual nature of this case, in which haemodynamic recordings continuously were made during and after swallow syncope, induced soon after food ingestion, is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/17. Ballooning posterior leaflet syndrome: syncope and sudden death.Two of four patients with ballooning posterior leaflet syndrome died suddenly and the remaining two developed a near-fatal arrhythmia. These four patients demonstrate the potentially fatal nature of the ballooning posterior leaflet syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/17. Transient nature of interference effects from heterophile antibodies: examples of interference with cardiac marker measurements.Two-site immunoassay methods have become the standard technique for measurement of a wide variety of drugs, hormones, and cell proteins. One limitation of these methods is their susceptibility to interference from heterophilic antibodies present in the sera of some patients. Human anti-murine antibodies represent a common heterophile antibody that can bind to mouse immunoglobulin and as well as to immunoglobulin from other species. While the mechanism of human anti-murine antibody interference has been well characterized, the time course over which this interference occurs and the susceptibility of different immunoassay procedures to human anti-murine antibody interference from patients with human anti-murine antibody have not been as well described. We report on the time course of interference in assays for cardiac markers for two patients with human anti-murine antibodies. We measured creatine kinase MB isoenzyme (CKMB) and troponins I and T using three different vendors' immunoassay procedures. Our results demonstrate that assay interference due to human anti-murine antibody interference is a transient phenomenon. In one of our patients, human anti-murine antibody interference appeared suddenly, peaked approximately 9 days following its appearance, and gradually resolved over the next 3 weeks. In addition, we found that immunoassay methods from different vendors can show highly variable interference effects when human anti-murine antibody-containing specimens are analyzed.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
4/17. Painless acute aortic dissection and rupture presenting as syncope.Acute aortic dissection is an emergency that may not only cause significant morbidity but often results in death. A timely diagnosis can prove difficult in the event of an atypical presentation. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature. This article reports on a case of a completely painless acute dissection and rupture in a middle-aged man who presented with syncope. The diagnosis was made by a combination of clinical suspicion, emergent bedside echocardiography, and computed tomography scan. This patient underwent immediate surgery, and ultimately had a successful outcome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/17. Familial occurrence of sinus bradycardia, short PR interval, intraventricular conduction defects, recurrent supraventricular tachycardia, and cardiomegaly.Four members of a family presenting with sinus bradycardia, a short P-R interval, intraventricular conduction defects, recurrent supraventricular tachycardia (SVT), syncope, and cardiomegaly had His bundle studies and were found to have markedly shortened A-H intervals (30 to 55 msec.) with normal H-V times (35 to 50 msec.). Right atrial pacing at rates as high as 170 to 215 per minute failed to increase the A-H or H-V intervals significantly. The data are compatible with the presence of an A-V nodal bypass tract (James bundle) or even complete absence of an A-V node. Ventricular pacing and spontaneous ventricular premature beats resulted in a short ventriculoatrial conduction time (110 msec.) suggesting that if A-V nodal bypass tracts exist, they are utilized in an antegrade and retrograde fashion. None of the features of WPW syndrome was present. The mechanism of syncope in the mother and daughter was intermittent third-degree heart block. Both went on to develop permanent complete heart block despite electrophysiologic studies demonstrating 1:1 A-V conduction at extremely rapid atrial pacing rates and both required implantation of permanent pacemakers. The mechanism of syncope in the two brothers was possibly marked sinus bradycardia, but transient complete heart block has not been ruled out. Permanent pacemaker therapy was recommended for both. The nature of the cardiomegaly, which was mild in three patients, is not known. Although not well documented, several maternal relatives have had enlarged hearts, SVT, complete heart block, and syncope.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/17. Sudden death in wolff-parkinson-white syndrome combined with syncope: a case report.Electrocardiogram showing Wolff-Parkinson-White (WPW) pattern in an asymptomatic patient is common, but it is difficult to assess the potential risk of sudden death in such cases. Although the incidence of sudden death in these patients is extremely low, an interventional approach is suggested for all patients despite its controversial nature. syncope, despite being induced by various mechanisms, has been considered an alarming sign of sudden death of WPW syndrome. We describe a 16-year-old female patient with an electrocardiogram that demonstrated a WPW pattern combined with unexplained syncope. None of the examinations, including biochemical profiles, brain computed tomography, transthoracic echocardiography, head-up tilt table test and exercise electrocardiogram, clarified her syncope. Consequently, no further electrophysiologic study was performed for this patient. Unfortunately, the patient suffered sudden death while running. The case highlights the need for vigilance when unexplained syncope combined with WPW syndrome. Such cases have high risk of sudden death, and thus, further interventional study and treatment is indicated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/17. Recurrent syncope--a diagnostic challenge.Several disorders resemble syncope. According to the European Society of cardiology guidelines, certain key questions should be addressed during the initial evaluation of a patient presenting syncope. The physician should be alert to important clinical features that suggest the diagnosis and the evaluation strategy. However, syncope remains a diagnostic challenge. The authors report a case of a 60-year-old man admitted to the Emergency Department (ED) complaining of recurrent syncopal attacks that had begun one month before. He had daily transient, self-limited loss of consciousness lasting for seconds or even a few minutes, followed by prompt recovery. The attacks occurred mainly after exercise or urination. prodromal symptoms were sweating and a sensation of imminent death. He learned to recognize these symptoms, reporting that he could control the duration of the attack by sitting down and voluntarily hyperventilating. He reported no prior pain, palpitations, tongue-biting or urinary incontinence. The episodes were witnessed and no abnormal movements were reported. The patient had been healthy until two months before, when he was diagnosed with diabetes mellitus by his general practitioner after routine analyses. Glycemia was controlled with diet and subcutaneous Actrapid insulin. No history of cardiac, cardiopulmonary, neurological or psychiatric disease was found and he was taking no other medication. On admission to the Emergency Department he was asymptomatic. Clinical examination was normal. The ECG showed sinus rhythm, heart rate of 70 bpm, and left bundle branch block; (LBBB). The chest X-ray was normal. As some medical features suggested a cardiac etiology (post-exercise, LBBB) and others indicated a neurally-mediated reflex syndrome or even situational syncope (after urination), a diagnostic strategy to exclude cardiac cause was adopted, including echocardiogram, and 24-hour ECG monitoring and stress test. The echocardiogram was normal. During Holter monitoring, he reported a syncopal event, in supine position, immediately after urination, and a 50-second period of cardiac arrest with persistent P waves--P-wave asystole--was recorded. Cardiac bradyarrhythmia was thus established as the cause of the syncope and a permanent pacemaker was implanted, with no recurrence of symptoms. This example of an unusually long-lasting cardiac arrest with spontaneous recovery illustrates the non-specific nature of clinical features and how difficult it is to diagnose syncope in an Emergency Department setting. The authors briefly review the topic according to recent guidelines.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/17. syncope of obscure nature.One hundred and eleven cases of syncope or loss of consciousness are analyzed. Most are of obscure nature while some illustrate features of syncope that deserve further scrutiny. The cases are divided into six groups: Resembling cardiac syncope (30 cases); vasovagal syncope (22 cases); features of both cardiac and vasovagal syncope (12 cases); orthostatic hypotensive (29 cases); akinetic seizure? (12 cases); and miscellaneous (5 cases). Some groups are subdivided according to the circumstances surrounding the spells, for example, seated eating, nocturnal, associated with bowel movement, response to anticonvulsant therapy, etc. The following conclusions seem warranted: The evidence favors the existence of a type of akinetic seizure resembling cardiac syncope; loss of consciousness while seated eating (prandial syncope) may comprise a syndrome; syncope related to bowel movement or abdominal pain is a striking association; sporadic nocturnal syncope due to temporary hyporeactivity of baroreceptors is not sufficiently recognized; alcohol ingestion may precipitate orthostatic hyporeactivity of baroreceptors is not sufficiently recognized; alcohol ingestion may precipitate orthostatic hypotension. Familial syncope, syncope proneness and cold drink syncope are illustrated.- - - - - - - - - - ranking = 5keywords = nature (Clic here for more details about this article) |
9/17. An electroencephalographic study of glossopharyngeal neuralgia with syncope.In the case described, electroencephalography (EEG) proved valuable for determining the nature of spells of loss of consciousness with brief clonic jerks associated with ear and throat pain. A 70-year-old woman had a history of episodic brief attacks of pain below the right ear and deep in the neck that had started three years previously. The spells became more severe and progressed to loss of awareness associated with clonic jerks of the extremities. Because of a concern that the spells represented seizures, an EEG was performed, with electrocardiographic monitoring. Multiple spells were recorded; they began with profound bradycardia followed by generalized slow-wave activity and then by suppression of all EEG activity correlating with loss of consciousness and clonic jerking. The spells were thought to represent syncopal attacks associated with glossopharyngeal neuralgia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/17. Benign congenital intracardiac thyroid and polycystic tumor causing right ventricular outflow tract obstruction and conduction disturbance.A patient with a rare intracardiac tumor arising from the right side of the interventricular septum who developed conduction disturbances and symptoms of right ventricular outflow tract obstruction is reported. The patient was successfully treated with insertion of a permanent pacemaker and surgical removal of the tumor after two-dimensional echocardiography diagnosed the intracardiac mass. Pathologic examination confirmed the benign nature of the tumor and showed the unusual features of both ectopic thyroid and benign congenital polycystic tumor.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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