Faculty of 1000 evaluation for 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope (original) (raw)
Related papers
Circulation, 2006
Table of Contents S yncope, a transient loss of consciousness, is a common clinical problem. The most common causes of syncope are cardiovascular in origin and are associated with a high rate of mortality in patients with underlying heart disease, transient myocardial ischemia, and other less common cardiac abnormalities. 1 The primary purpose of the evaluation of the patient with syncope is to determine whether the patient is at increased risk for death. This involves identifying patients with underlying heart disease, myocardial ischemia, Wolff-Parkinson-White syndrome, and potentially life-threatening genetic diseases such as long-QT syndrome (LQTS), Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. If these diagnoses can be excluded, the goal then becomes identification of the cause of syncope in an attempt to improve the quality of the patient's life and to prevent injury to the patient or others. The purpose of this statement is to summarize the data that direct the evaluation of the patient with syncope (Figure 1). General Evaluation In the general population, the most common cause of syncope is neurocardiogenic, followed by primary arrhythmias. Other names for neurocardiogenic syncope include neurally mediated, vasodepressor, and vasovagal syncope. The causes of syncope are highly age dependent. 2 Pediatric and young The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on August 3, 2005. A single reprint is available by calling 800-242-8721
Pathophysiology and management of neurocardiogenic syncope
The American journal of managed care, 2003
To discuss the physiologic mechanisms underlying neurocardiogenic syncope in the context of several different management strategies. Neurocardiogenic syncope or the "common faint" is variously called neurally mediated hypotension, vasovagal syncope, or vasodepressor syncope. It is the most common type of syncope. The pathophysiology of neurocardiogenic syncope is complex and not completely elucidated. Individuals susceptible to neurocardiogenic syncope are unable to maintain the adaptive neurocardiovascular responses to upright posture for prolonged periods. These patients tend to have a modest reduction in central blood volume, which is aggravated by upright posture. It is often noted in individuals receiving sympathetic blocking agents and vasodilator drugs for hypertension, elderly patients receiving tranquilizers, patients with anemia, and individuals with tran- sient reductions in blood volume such as those that occur after a brisk diuresis or blood donation. The clas...
Europace, 2013
The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network. Responses were received from 43 centres. The majority of respondents (74%) had no specific syncope unit and only 42% used a standardized assessment protocol or algorithm. Hospitalization rates varied from 10% to 25% (56% of the centres) to .50% (21% of the centres). The leading reasons for hospitalization were features suggesting arrhythmogenic syncope (85% of respondents), injury (80%), structural heart disease (73%), significant comorbidities (54%), and older age (41%). Most widely applied tests were electrocardiogram (ECG), echocardiography, and Holter monitoring followed by carotid sinus massage and neurological evaluation. An exercise test, tilt table test, electrophysiological study, and implantation of a loop recorder were performed only if there was a specific indication. The use of a tilt table test varied widely: 44% of respondents almost always performed it when neurally mediated syncope was suspected, whereas 37% did not perform it when there was a strong evidence for neurally mediated syncope. Physical manoeuvres were the most widely (93%) applied standard treatment for this syncope form. The results of this survey suggest that there are significant differences in the management of patients with syncope across Europe, specifically with respect to hospitalization rates and indications for tilt table testing in neurally mediated syncope. The majority of centres reported using ECG, echocardiography, and Holter monitoring as their main diagnostic tools in patients with syncope, whereas a smaller proportion of centres applied specific assessment algorithms. Physical manoeuvres were almost uniformely reported as the standard treatment for neurally mediated syncope.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2001
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Update : Arrhythmias ( VIII ) Syncope
2019
Syncope, which can be defined as a transient loss of consciousness caused by transient global cerebral hypoperfusion and characterised by rapid onset, short duration, and spontaneous complete recovery, is a common condition. This definition is useful for differentiating syncope from other clinical conditions that also involve real or apparent transient loss of consciousness, but in which the mechanism is not global cerebral hypoperfusion, such as epilepsy, falls, or psychiatric pseudosyncope. We reviewed the etiological classification of syncope and found that reflex syncope is the most common etiology in the general population, with a good prognosis, whereas cardiac syncope increases with age and has a worse prognosis. We also reviewed the role and limitations of different tests, specifically referring to the interpretation of the results of carotid sinus massage, the role of tilt-table testing, the diagnostic strategy in patients with syncope and bundle branch block, the adenosine...
Unexpected Coexistence of Supraventricular and Ventricular Tachycardia in Patients with Syncope
Pacing and Clinical Electrophysiology, 1985
EZRI, M.D., ET AL.: Unexpected coexistence of supraventricular and ventricular tachycardia in patients with syncope. The incidence of multiple, inducible sustained arrhythmias during eleclrophysiologic studies is unknown. We have identijied jive paiients who had several sustained (achycardias, some of which were not previously recognized clinicaiiy. Three patients had documented sustained supraventricuiar tachycardia (one of these also had nonsustained ventricular tachycardia) and two had documented sustained ventricular tachycardia. The clinically documented tachycardia was successfully reproduced in all cases; hou'ever, the three cases 0/ supraventricular tachycardia also had sustained ventricular tachycardia initiated, and Ihe two cases of ventricular tachycardia also had sustained supravenlricular tachycardia, which had not previously been seen. The underlying common denominators for all five patients were poor left ventricular /unction due Io ischemic heart disease and a history of syncope. In one case 0/clinical supraventricular tachycardia, the second sustained tachycardia appeared following drug Iherapy fprocainamide), which seemed to convert nonsuslained to suslained venlricular tachycardia. In another patient with clinical venlricular tachycardia, the supravenlricular tachycardia was also initiated following drug therapy (indecainide). We conclude Ihat: (I) patienls with syncope may have multiple arrhythmic etiologies and (2) complete electrophysiologic evaluation, during control studies as well as serial drug studies, are important in the managemenl 0/these patienls.
Cardiovascular Evaluation of Patients with Syncope of
1997
Syncope is de~ned as a transient loss of consciousness with a loss of postural tone and associated spontaneous recovery. Syncope is a common clinical disorder. The etiology of syncope encompasses a wide range of disorders. The prognosis of patients is highly dependent upon the etiology of their syncopal episode(s), therefore, the ability to obtain an accurate diagnosis is of importance. However, despite often exhaustive and expensive evaluation, a cause for syncope is not established in upwards of 40% of patients. Due to the broad differential diagnosis of syncope a directed diagnostic evaluation is necessary. The purpose of this review is to examine the utility of various diagnostic modalities available to evaluate patients with syncope known or suspected to be of a cardiovascular etiology. In addition, a general framework for evaluation will be provided.