Syncope after effort

A 29-year-old man developed recurrent syncope following exertion. Cardiac investigations revealed no evidence of structural heart disease, but during exercise testing, in the recovery phase, he sustained a bradycardia and then asystole for a prolonged period. Before cardiac massage could be instituted a tonic-clonic fit occurred, and this initiated a return to sinus rhythm. His symptoms were abolished following the implantation of a dual-chamber pacemaker.     

Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.     

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??Abstracts?? Objective To investigate the changes of ventricular late potentials ??VLP?? in children with vasovagal syncope of vasodepressor response ??VVS-V??. Methods Totally 184 children ??aged from 4 to 14 years old??the average age being ??10.54±2.15?? years old?? had been diagnosed with VVS-V by head-up tilt table test ??HUTT?? ??study group?? from July 2006 to January 2013 in the Second Xiangya Hospital of Central South University?? male 85 cases?? the average age of ??10.85±2.01?? years old?? female 99 cases?? mean age ??10.27±2.24?? years old. Totally 105 healthy children were matched as controls. All subjects underwent VLP examination. Investigate the difference in HR?? TQRS?? LAS40 and RMS40 between the study group and the control group. Results Compared with the control group?? in the study group heart rate ??HR?? decreased ???83.96±12.27?? beats/min vs??87.28±13.75?? beats/min?? t = -2.113?? P??0.05???the total QRS time??TQRS?? ???84.89±12.05?? ms vs ??81.21±8.23?? ms?? t = 3.070?? P??0.05?? and high frequency and low amplitude limit??LAS40?? ???62.43±19.17?? ms vs ??56.79±1.83?? ms?? t = 2.442?? P??0.05?? were prolonged??and the root mean square plant??RMS40?? increased ???28.73±7.23?? μV vs ??26.89±7.36?? μV?? t = 2.059?? P??0.05??. Conclusions Compared to healthy controls??in VVS-V children HR reduces??TQRS and LAS40 prolong??and RMS40 increases. It suggests that VVS-V childrenare more likely to have cardiovascular incidents.     

Repetitive syncopal episodes in a child with documented ventricular tachycardia,early repolarization pattern in leads I an aVL,Brugada syndrome,and fever

We present a small child with febrile peaks and syncopal episodes secundary to ventricular tachycardia, in whom it was eventually possible to demostrate the Brugada Syndrome with a special presentation in the ECG; early repolarization pattern in lead I and a aVL and Brugada pattern during fever in V1‐V2. This is, to our knowledge, tha first case with this special ECG presentation in a small child.     

All is Not Lost: Utilizing Continuous Remote ILR Monitoring to Diagnose Syncope

A 63‐year‐old man with frequent unexplained syncope was implanted with a second generation remotely monitored implantable loop recorder for continuous electrocardiogram (ECG) monitoring. He had a subsequent syncopal episode and despite accidental destruction of his patient activator, vital ECG data from the event were transmitted wirelessly, enabling a cardiac arrhythmia to be excluded. This case highlights the benefit of remote monitoring in syncope assessment, as well as a transmission system that ensures prompt analysis of the ECG data and therefore rapid optimal patient management. (PACE 2010; 33:763–765)     

Use of the Implantable Loop Recorder in Evaluation of Patients with Unexplained Syncope

Syncope is a complex symptom with multiple potential etiologies that can be difficult to establish. The major obstacles to diagnosis are the periodic and unpredictable nature of events and the high spontaneous remission rate. Short-term ECG monitoring often is unproductive when initial noninvasive testing is negative due to the low probability of recurrence during the brief monitoring period. Implantable loop recorders extend the ability to monitor cardiac patients, enhancing the diagnostic yield to as high as 85% in difficult to diagnose syncope. Several recent studies suggest that prolonged monitoring with an implantable loop recorder has a role in patients with syncope and conduction disturbances, negative tilt testing, and unexplained seizures, and may be superior to conventional testing with tilt and electrophysiologic studies. (J Cardiovasc Electrophysiol, Vol. 14, pp. S70-S73, September 2003, Suppl.)     

Significance of tilt table testing in patients with suspected arrhythmic syncope and negative electrophysiologic study

BACKGROUND: The diagnostic significance of a tilt table test (TTT) in patients with a suspected arrhythmic etiology for syncope and negative electrophysiologic study (EPS) has not been previously assessed comparing the TTT results with the findings of prolonged monitoring using an implantable loop recorder (ILR). We sought to assess the diagnostic yielding of TTT in patients with suspected arrhythmic syncope and negative EPS. METHODS AND RESULTS: In 81 patients with suspected arrhythmic etiology for syncope and negative EPS, TTT was performed and an ILR implanted regardless the results of TTT. TTT was positive in 38 patients. During follow-up, syncope or presyncope recurred in 32 patients (39.5%). No differences were found in recurrence rates in patients with positive and negative TTT (31.5% vs 46.5%, P = ns). According to rhythm registered during ILR activation, mechanisms of syncopal events were classified as: arrhythmic (atrioventricular [AV] block and ventricular tachycardia; n = 18), neurally mediated (sinus bradycardia and sinus pause; n = 9), and indeterminate (normal sinus rhythm; n = 5). There was no statistical association between the results of TTT and the mechanism of syncope. CONCLUSIONS: In patients with a suspected arrhythmic etiology for syncope and a negative EPS, TTT is of little value to predict the mechanism of syncope and the ILR implantation seems to be a useful and safe diagnostic strategy.     

从《伤寒论》厥证探讨临床感染性休克与低血容量休克的证治

休克是临床危重病症,临床对感染性休克及低血容量休克患者的救治,往往遇到感染不能得到有效控制,体温持续或反复升高;液体复苏后,血压不能恢复或维持的情况。《伤寒论》厥阴病篇中热厥与寒厥的论述,与临床部分感染性休克与低血容量休克的临床表现有类似之处。通过对《伤寒论》热厥与寒厥理论与临床休克证治关系的探讨,有助于拓展中医药治疗感染性休克与低血容量性休克的临床新思路。