1/35. suicide attempt by pure citalopram overdose causing long-lasting severe sinus bradycardia, hypotension and syncopes: successful therapy with a temporary pacemaker.In few cases, pure citalopram overdose at doses above 600 mg showed electro-cardiographic changes with prolonged QT intervals and sinus bradycardia gradually resolving within 12-24 hours after intoxication. We report on a 32-year-old patient with borderline personality disorder (BPD) who ingested a total of 800 mg citalopram to attempt suicide due to an interpersonal disappointment. She developed severe sinus bradycardia with a minimal pulse rate of 41/min within about 4 hours after intoxication lasting up to six days during intensive care unit (ICU) treatment. Further, hypotension and syncopes occurred. No QT interval prolongations were recorded. To our knowledge, this is the first case report of pure citalopram overdose-induced long-lasting sinus bradycardia associated with severe hypotension and intermittent syncopes that required therapy with a temporary pacemaker.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
2/35. Congenital sick sinus syndrome with breath holding and severe syncope episodes during infancy. A case report.sick sinus syndrome is a rare cause of bradycardia in children without structural heart disease. A case of profound sinus bradycardia, sinus arrest with junctional escape, and pauses in a two-year-old infant with breath-holding and syncope episodes is presented. As a result of these clinical symptoms and electrocardiographic findings, the patient with sick sinus syndrome underwent implantation of transvenous ventricular pacemaker. He has been well and asymptomatic since the insertion of the pacemaker. In the differential diagnosis of an infant with breath-holding and syncope episodes, when these symptoms in particular cannot be explained by other common reasons, sick sinus syndrome should be kept in mind. This case also illustrates the importance of electrocardiographic studies for the diagnosis.- - - - - - - - - - ranking = 338.53802852523keywords = sick (Clic here for more details about this article) |
3/35. Recurrent asystoles associated with vasovagal reaction during venipuncture.A 17-year-old high school student presented with a history of habitual faintings. On 24-hour Holter monitoring, cardiac asystoles were recorded, the longest lasting approximately 7 or 8 seconds during venipuncture procedures. The asystole associated with venipuncture demonstrated the cardioinhibitory effects of vasovagal reaction with blood-injury phobia. He also had a positive response during head-up tilt test showing hypotension and relative bradycardia after intravenous isoproterenol injection. After administration of oral beta blocker, he did not show further or recurrent cardiac asystole during blood injury procedure on electrocardiographic examination. Venipuncture is the most common invasive medical procedure performed in hospital settings. While venipuncture is considered to be reasonably safe, serious complication may occur even when only a small volume of blood is withdrawn. Therefore, medical personnel should be prepared to provide appropriate care.- - - - - - - - - - ranking = 0.5keywords = person (Clic here for more details about this article) |
4/35. citalopram-induced bradycardia and presyncope.OBJECTIVE: To report a case of symptomatic bradycardia and hypotension that resulted from the therapeutic use of citalopram and to review any previous reports in the literature, from the manufacturer, and the Australian Drug Reaction Advisory Committee (ADRAC). CASE SUMMARY: A 60-year-old white woman who had been taking citalopram 20 mg/d for two weeks presented to the hospital with a heart rate of 39 beats/min, mild hypotension (systolic BP 105 mm Hg), and a normal electrocardiogram (QTc < 440 msec), following a presyncopal episode. The patient was admitted for cardiac monitoring, and citalopram was discontinued. The bradycardia and hypotension resolved in the 48-hour period following cessation of citalopram. No other medical or pharmacologic cause was found for the adverse drug reaction. DISCUSSION: bradycardia has been reported rarely with citalopram in therapeutic doses, but this is the first detailed case with a dose of only 20 mg. The manufacturer reports bradycardia as an infrequent adverse effect (0.1-1%) of citalopram. There have been no reports to ADRAC or to the manufacturer in postmarketing surveillance. There is a case report of asymptomatic bradycardia in a patient whose dose was increased to 40 mg. In the case reported here, there was no QTc prolongation consistent with previous reports. The sinus bradycardia reported more often with therapeutic doses would appear to be distinct to QT abnormalities seen with citalopram overdose. CONCLUSIONS: citalopram should be used with care in the elderly and in persons with a history of heart disease. heart rate and blood pressure should be monitored in the first week of therapy and when doses are modified.- - - - - - - - - - ranking = 0.5keywords = person (Clic here for more details about this article) |
5/35. Spontaneous T wave alternans and premature ventricular contractions during febrile illness in a patient with brugada syndrome.A 69-year-old man who had experienced syncope and ventricular fibrillation was referred to our hospital. ECG showed a right bundle branch block pattern with ST segment elevation in the right precordial leads. When the patient presented to the hospital with febrile illness, spontaneous T wave alternans and premature ventricular contractions were observed. When the patient became afebrile, ST segment elevation improved, and T wave alternans and premature ventricular contractions disappeared.- - - - - - - - - - ranking = 0.024454499876541keywords = illness (Clic here for more details about this article) |
6/35. Drop attacks and vertigo secondary to a non-meniere otologic cause.BACKGROUND: Tumarkin falls are sudden drop-attack falls that occur in a subset of patients with Meniere syndrome (endolymphatic hydrops), an inner ear disorder characterized by vertigo spells and hearing loss. OBJECTIVE: To describe the clinical features and quantitative audiovestibular testing results in a case series of patients with Tumarkin falls, episodic vertigo, and normal hearing. SETTING: University referral center for disorders of balance and hearing. methods: Case series (unselected) of all patients with Tumarkin falls and a normal audiogram at least 1 year after onset of vestibular symptoms (n = 6) from a retrospective analysis of the records of all patients with Tumarkin falls presenting to neurotology Clinic at UCLA Medical Center, los angeles, Calif, from October 1, 1975, to February 1, 2001 (N = 55). Quantitative audiologic and vestibular function testing, neurologic history, and examination were performed. RESULTS: Five of 6 patients had unilateral caloric paresis, and 1 had bilateral vestibulopathy. Five of 6 had a personal and/or family history of migraine headaches meeting International headache Society criteria. All patients had a subjective sensation of feeling pushed by an external force, and half of the patients had a subjective tilt of the environment concurrent with the fall. CONCLUSIONS: The incidence of migraine is high in this subgroup of patients with Tumarkin falls and normal hearing. The clinical description of the falls is similar to those associated with Meniere syndrome. Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.- - - - - - - - - - ranking = 0.5keywords = person (Clic here for more details about this article) |
7/35. Tilt-induced pseudosyncope.Using the head-up tilt test (HUTT) we evaluated 986 consecutive patients affected by unexplained syncope. In 266 patients the test induced bradycardia and/or hypotension resulting in syncope or presyncope, thus allowing a diagnosis of neurally mediated syncope. In three other patients (0.3% of the entire population and 1% of the all positive tests) HUTT provoked loss of consciousness despite no significant change in heart rate and/or blood pressure. In all three cases unconsciousness was prolonged and no pathological finding was present except lack of response. This phenomenon has been defined as 'pseudosyncope' and related to psychiatric illness. Pseudosyncope induced by HUTT reproduced the clinical events, so the test outcome was considered a true positive response. Our experience suggests that HUTT may contribute to the recognition of psychiatric disorder in some patients affected by unexplained syncope.- - - - - - - - - - ranking = 0.0048908999753082keywords = illness (Clic here for more details about this article) |
8/35. Aortic stenosis and autonomic dysfunction: co-conspirators in syncope.Autonomic dysfunction and aortic stenosis share several clinical characteristics, including, in severe cases, syncope. Both illnesses tend to manifest later in life, and most cases are idiopathic in origin. In a short period of 4 weeks, the authors noted that three patients out of 36 referrals for autonomic dysfunction also had histories of aortic valve replacement due to stenosis. In each case, similar presenting symptoms of fatigue, light-headedness, and syncope were attributed to aortic stenosis without mention of autonomic failure as a possible contributor. The authors propose that patients for whom symptoms of aortic valve stenosis are not relieved by surgical intervention may have concomitant autonomic dysfunction contributing significantly to their symptoms. Furthermore, the two conditions may comprise a dangerous combination, aortic stenosis causing physical obstruction of ventricular outflow, and autonomic dysfunction causing decreased venous return and insufficient cardiac filling. It may be beneficial for patients with aortic stenosis who present with syncope to be considered for possible autonomic dysfunction to address both potential pathophysiologies contributing to the syncope.- - - - - - - - - - ranking = 0.0048908999753082keywords = illness (Clic here for more details about this article) |
9/35. Chronotropic effect of the antithrombotic agent cilostazol in a patient with sick sinus syndrome and syncope.In this case report we describe an 80-year-old man with sick sinus syndrome (SSS) who developed syncope attacks. The diagnosis of SSS was based on electrocardiographic evidence of markedly prolonged sinus arrests associated with syncope attacks while in hospital. The patient was given cilostazol, an antithrombotic agent that selectively inhibits cyclic nucleotide phosphodiesterase type 3, at a dose of 100 mg twice daily. The syncope attacks ceased, and an electrocardiogram obtained 1 week after the start of cilostazol administration showed no evidence of sinus arrest. The outcome of this case suggests that cilostazol may be useful in patients with syncope attacks due to SSS, although the long-term chronotropic effects of cilostazol need to be evaluated.- - - - - - - - - - ranking = 282.11502377102keywords = sick (Clic here for more details about this article) |
10/35. Manifestation of brugada syndrome after pacemaker implantation in a patient with sick sinus syndrome.A 49-year-old woman experienced syncope 10 months after DDD pacemaker implantation for sick sinus syndrome. ECG revealed abnormal ST elevation in leads V1 to V3 during a paced rhythm. Multifocal premature ventricular contractions followed by ventricular fibrillation were documented. Saddleback-type ST elevation was confirmed after a mode change to AAI. The diagnosis of brugada syndrome was made, and the DDD pacemaker was upgraded to an implantable cardioverter defibrillator. brugada syndrome can be easily overlooked if the classic ECG findings are not initially noted but may be observed even during pacing therapy.- - - - - - - - - - ranking = 282.11502377102keywords = sick (Clic here for more details about this article) |
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