1/33. syncope in the pediatric patient. The cardiologist's perspective.The evaluation of syncopal children or adolescents relies heavily on a thorough, detailed history and physical examination. All syncope associated with exercise or exertion must be considered dangerous. The ECG is mandatory, but other laboratory tests are generally of limited value unless guided by pertinent positives or negatives in the history and physical examination. The ECG allows screening for dysrhythmias, such as wolff-parkinson-white syndrome, heart block, and long qt syndrome, as well as hypertrophic cardiomyopathies and myocarditis. Tilt table testing can be useful in selecting therapy by demonstrating the physiologic response leading to syncope in an individual patient. The most common type of syncope in otherwise healthy children and adolescents is neurocardiogenic or vasodepressor syncope, which is a benign and transient condition. Because syncope can be a predictor of sudden cardiac death, it must be taken seriously, and appropriate screening must be performed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/33. A novel device in evaluating syncope.syncope may be a manifestation of many diseases. The etiology is often difficult to determine. Much effort, time, and expense have been required to determine a diagnosis. A thorough history and physical examination are essential (Table 3). Several clinical pearls may be of help in the diagnosis of syncope: (a) the most important elements in the evaluation of syncope are a detailed history and physical examination; (b) syncope is a common problem in young healthy adults and the elderly; (c) a heavy meal is a specific cause of syncopy in the elderly (postprandial), however this etiology often goes unrecognized; (d) syncope is caused by 1 of 3 mechanisms: decreased cardiac output, systemic vascular resistance, or cerebrovascular disease; (e) reflex-mediated syndromes (vasovagal) are common causes of syncope in young adults, and orthostatic hypotension is an important cause of syncope in the elderly; and (f) the 1-year mortality of cardiac syncope (18%-33%) is significantly higher than that from non-cardiac syncope (0%-12%). A proven and useful tool has recently been advanced to aid in the evaluation of syncope. The Reveal Plus insertable loop recorder has auto activation that allows automatic capture and recording of arrhythmic events. Patient activation is an option. The recorder lasts 12 to 14 months and has proven to be a valuable and reliable cost-effective asset in our quest to evaluate syncope.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/33. Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart.syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT) way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and catecholaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
4/33. exercise induced hypoglycaemic hyperinsulinism.BACKGROUND: hyperinsulinism in childhood is often caused by genetic defects involving the regulation of insulin secretion leading to recurrent episodes of hypoglycaemia. We report two patients with exercise induced hypoglycaemia. methods: Standardised short exercise tests with frequent blood glucose and plasma insulin measurements were performed in the patients and young healthy controls. RESULTS: Short term exercise resulted in insulin induced hypoglycaemia 15 to 50 minutes after the end of exercise. A massive burst of insulin secretion was observed within a few minutes of the start of exercise in both patients. By contrast glucose and insulin concentrations remained unchanged in healthy controls. CONCLUSIONS: Hyperinsulinaemic hypoglycaemia after moderate physical exercise represents a rarely described phenotype of hyperinsulinism with an as yet unknown defect in the regulation of insulin secretion. It should be suspected in individuals with recurrent exercise related syncope or disturbance of consciousness.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
5/33. syncope and neurologic deficits in a track athlete: a case report.exercise-related syncope may result from various underlying medical conditions, with vasovagal reactions being the most common cause in young athletes. However, psychological causes also need to be considered in the differential diagnosis of syncope. This case report presents an athlete who suffered a syncopal event with residual motor and sensory deficits. The athlete was diagnosed with a conversion disorder and was able to return to full competition following psychotherapy and physical therapy.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
6/33. subclavian steal syndrome: a rare but important cause of syncope.An elderly woman came to our emergency room for evaluation of a syncopal episode. While climbing a flight of stairs, she had turned her head to the left and abruptly passed out. Positive physical findings included blood pressure of 141/65 mm Hg (right arm) and 80/43 mm Hg (left arm), as well as nonpalpable left radial and brachial pulses that were detectable only by Doppler ultrasonography. Carotid duplex ultrasonography showed reverse flow in the left vertebral artery and an abnormal, stenotic distal left subclavian artery. magnetic resonance angiography confirmed complete occlusion of the left subclavian artery with classic subclavian steal. The patient had percutaneous transluminal angioplasty with stenting of the left subclavian artery and has remained asymptomatic through 2 years of follow-up with aggressive risk-factor modification.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
7/33. A rare cause of syncope in a patient with diabetes mellitus--a case report.INTRODUCTION: Hypoglycaemic episodes in patients with diabetes mellitus are mostly due to excess doses of exogenous insulin or oral hypoglycaemic agents, coupled with poor caloric intake and excessive unplanned physical exertion. Hypoglycaemia as a result of endogenous hyperinsulinaemia due to an insulinoma is extremely rare in such patients. CLINICAL PICTURE: This patient with type 2 diabetes mellitus presented with episodes of syncope. Investigations confirmed recurrent hypoglycaemia from endogenous hyperinsulinaemia, with localisation of a tumour in the tail of the pancreas. TREATMENT: Distal pancreatectomy and splenectomy. histology confirmed an insulinoma. OUTCOME: No further hypoglycaemic episodes were noted. The patient returned to his diabetic state with rather poor glycaemic control. CONCLUSIONS: Repeated hypoglycaemic episodes in a patient with diabetes mellitus despite complete withdrawal of hypoglycaemic agents should lead one to consider other causes of hypoglycaemia.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
8/33. syncope: a fall from grace.Falls by the elderly are not always what they appear to be on the surface. In the following paper, a woman must experience a long process of trial and error, as well as injury and suffering, before the underlying condition is finally uncovered by an astute nurse practitioner. The path to the diagnosis of syncope is a complex one, with economic, physical, and even social and psychological repercussions. Grace's "fall" not only contributes to burns and fractures, but damages her self-esteem and threatens her very independence. Armed with a thorough assessment, complete history, and the use of cardiac event recorders, a cardiovascular nurse has the unique opportunity to make a difference in the life of a patient suffering from suspicious falls and help her maintain a high quality of life.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
9/33. Fits, faints and funny turns. Could it be a mental disorder?BACKGROUND: patients who present to primary care with symptoms of fainting and dizziness, for which there is no adequate physical explanation, are frequently suffering from an undiagnosed psychiatric disorder. OBJECTIVE: This article aims to improve the recognition of common mental disorders presenting as 'fits, faints and funny turns' (FFFTs) and to encourage general practitioners to view these disorders as a positive diagnosis in need of treatment. DISCUSSION: Psychiatric disorders, particularly panic attacks and depression, are common in the setting of FFFTs and should be a positive diagnosis rather than a diagnosis of exclusion. A detailed description of the episode, with corroborating information from a witness if possible, and psychiatric rating scales can assist in this process. Identifying a physical cause for the episode does not exclude a psychiatric diagnosis and vice versa. Specific psychological and pharmacological therapies are effective for anxiety and depression.- - - - - - - - - - ranking = 0.14601971688944keywords = physical (Clic here for more details about this article) |
10/33. Pacemaker channel dysfunction in a patient with sinus node disease.The cardiac pacemaker current I(f) is a major determinant of diastolic depolarization in sinus nodal cells and has a key role in heartbeat generation. Therefore, we hypothesized that some forms of "idiopathic" sinus node dysfunction (SND) are related to inherited dysfunctions of cardiac pacemaker ion channels. In a candidate gene approach, a heterozygous 1-bp deletion (1631delC) in exon 5 of the human HCN4 gene was detected in a patient with idiopathic SND. The mutant HCN4 protein (HCN4-573X) had a truncated C-terminus and lacked the cyclic nucleotide-binding domain. COS-7 cells transiently transfected with HCN4-573X cDNA indicated normal intracellular trafficking and membrane integration of HCN4-573X subunits. Patch-clamp experiments showed that HCN4-573X channels mediated I(f)-like currents that were insensitive to increased cellular cAMP levels. Coexpression experiments showed a dominant-negative effect of HCN4-573X subunits on wild-type subunits. These data indicate that the cardiac I(f) channels are functionally expressed but with altered biophysical properties. Taken together, the clinical, genetic, and in vitro data provide a likely explanation for the patient's sinus bradycardia and the chronotropic incompetence.- - - - - - - - - - ranking = 0.073009858444719keywords = physical (Clic here for more details about this article) |
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