ABSTRACT
Objetivo: Valorar los resultados de las pruebas de inclinación realizadas en un lapso de 2 décadas. Métodos: Este es un estudio observacional, descriptivo y retrospectivo. Se analizaron los resultados de las Pruebas de Inclinación (PI) realizadas entre 1997 y 2018 en forma consecutiva por una sola persona, inicialmente en el Hospital Clínica Bíblica, posteriormente en el Instituto del Corazón y finalmente en los últimos 17 años en el Centro Cardiológico Integral. Resultados: Se realizaron un total de 2705 pruebas entre los años de 1997 y el 2018. El 60% fue del sexo femenino. Se hicieron 245 pruebas a menores de 20 años (17.3%), 996 pruebas a personas entre 20 y 40 años (36.8%), 969 pruebas a pa cientes entre los 40 y 60 años (35.8%) y a 271 pacientes mayores de 60 años (10%). Del total de la muestra evaluada, 2316 pacientes presentaron un resultado positivo para alguna de los diferentes tipos de respuesta en la prueba de inclinación, equivalente al 85.6%, mientras que 389 pacientes obtuvieron un resultado negativo (respuesta normal), equivalente al 14.4%. En la mayor cantidad de pacientes la positividad de la prueba se presentó en la fase II, 72.7% (1683 pacientes), el 27.3% (633 pacientes) la manifestaron en la fase I. Se presentó una respuesta vasodepresora en 1120 pacientes (48.2%), respuesta mixta en 727 pacientes (31.3%), respuesta cardioinhibidora en 304 casos (13.1%). Además, 69 pacientes pre sentaron una respuesta sugestiva (2.9%) y 104 pacientes tuvieron otros tipos de respuestas (4.5%). De estos últimos, 48% correspondió al síndrome de taquicardia postural ortostática (POTS), 17% a incompetencia cronotrópica, 19% a hipoten sión ortostática y 16% a disautonomía. Un total de 43 pacientes (1,6%) presentaron hipersensibilidad del seno carotídeo. Conclusiones: La PI en nuestro medio tiene una adecuada sensibilidad en el diagnóstico del Síncope Neurocardiológico (SNCG) en los diferentes grupos de edad, es un método seguro, fácil de realizar y accesible a la mayoría de las personas que la requieran
Tilt Test: 20 years of experience in the diagnosis of the neurocardiogenic syncope Objective: To evaluate the results of the tilt tests carried out during 2 decades. Methods: This is an observational, descriptive and retrospective study. We analyzed the results of the tilt tests conducted between 1997 and 2018 consecutively by a single person, initially at the "Hospital Clínica Bíblica", later at the "Instituto del Corazón" and finally in the last 17 years at the "Centro Cardiológico Integral". Results: A total of 2705 tests were carried out between 1997 and 2018. Sixty percent were female. There were 245 tests for people under 20 years (17.3%), 996 tests for people between 20 and 40 years (36.8%), 969 tests for patients between 40 and 60 years (35.8%) and 271 patients older than 60 years (10%). Of the total sample evaluated, 2316 patients presented a positive result for some of the different types of response in the tilt test, equivalent to 85.6%, while 389 patients obtained a negative result (normal response), equivalent to 14.4%. In the largest number of patients, the positivity of the test was presented in phase II, 72.7% (1683 patients), and 27.3% (633 patients) manifested it in phase I. A vasodepressant response was presented in 1120 patients (48.2%), mixed response in 727 patients (31.3%), cardioinhibitory response in 304 cases(13.1%). In addition, 69 patients presented a suggestive response (2.9%) and 104 patients had other types of responses (4.5%). Of the latter, 48% corresponded to orthostatic postural tachycardia syndrome (POTS), 17% to chronotropic incompetence, 19% to orthostatic hypotension and 16% to dysautonomia. A total of 43 patients (1.6%) presented hypersensitivity of the carotid sinus. Conclusions: Tilt test in our environment has an adequate sensitivity in the diagnosis of the neurocardiogenic syncope in different age groups, it is a safe method, easy to perform and accessible to most people who require it.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Tilt-Table Test/statistics & numerical data , Syncope, Vasovagal/diagnosis , Costa RicaABSTRACT
PURPOSE: Neurocardiogenic syncope (NCS) is the most frequent cause of fainting during adolescence. Inappropriate cardiovascular autonomic control may be responsible for this clinical event. The head-up tilt test has been considered a diagnostic standard, but it is cumbersome and has a high false-positive rate. We performed a study to evaluate whether P-wave dispersion (PWD) could be a useful electrocardiographic parameter of cardiac autonomic dysfunction in children with NCS. METHODS: Fifty-four patients with NCS (28 boys and 26 girls; mean age, 12.3±1.4 years) and 55 age- and sex-matched healthy controls were enrolled. PWD was obtained as the difference between maximum and minimum durations of the P wave on standard 12-lead electrocardiography in all patients and controls RESULTS: The value of PWD was significantly higher in the syncope group than in the control group (69.7±19.6 msec vs. 45.5±17.1 msec, respectively; P<0.001). The minimum duration of P wave was shorter in the syncope group than in the control group (43.8±16.8 msec vs. 53.5±10.7 msec, respectively; P<0.001). Left atrial volume was not different between the groups on transthoracic echocardiography. CONCLUSION: PWD on echocardiography could be used as a clinical parameter in patients with NCS.
Subject(s)
Adolescent , Child , Female , Humans , Echocardiography , Electrocardiography , Syncope , Syncope, VasovagalABSTRACT
Fundamento: Caracterizada por perda súbita e transitória da consciência e do tônus postural, com recuperação rápida e espontânea, a síncope é causada por uma redução aguda da pressão arterial sistêmica e, por conseguinte, do fluxo sanguíneo cerebral. Os resultados insatisfatórios com o uso de fármacos permitiu que o tratamento não farmacológico da síncope neurocardiogênica fosse contemplado como primeira opção terapêutica. Objetivos: Comparar, em pacientes com síncope neurocardiogênica, o impacto do Treinamento Físico Aeróbico (TFA) de moderada intensidade e de uma intervenção controle, na positividade do Teste de Inclinação Passiva (TIP) e no tempo de tolerância ortostática. Métodos: Foram estudados 21 pacientes com história de síncope neurocardiogênica recorrente e TIP positivo. Esses foram aleatorizados em: Grupo Treinado (GT), n = 11, e Grupo Controle (GC), n = 10. O GT foi submetido a 12 semanas de TFA supervisionado, em cicloergômetro, e o GC, a um procedimento controle que consistia na realização de 15 minutos de alongamentos e 15 minutos de caminhada leve. Resultados: O GT apresentou efeito positivo ao treinamento físico, com aumento significativo do consumo de oxigênio-pico. Já o GC não apresentou nenhuma mudança estatisticamente significante, antes e após a intervenção. Após o período de intervenção, 72,7% da amostra do GT apresentou resultado negativo ao TIP, não apresentando síncope na reavaliação. Conclusão: O programa de treinamento físico aeróbico supervisionado por 12 semanas foi capaz de reduzir o número de TIP positivos, assim como foi capaz de aumentar o tempo de tolerância na posição ortostática ...
Background: Characterized as a sudden and temporary loss of consciousness and postural tone, with quick and spontaneous recovery, syncope is caused by an acute reduction of systemic arterial pressure and, therefore, of cerebral blood flow. Unsatisfactory results with the use of drugs allowed the nonpharmacological treatment of neurocardiogenic syncope was contemplated as the first therapeutic option. Objectives: To compare, in patients with neurocardiogenic syncope, the impact of a moderate intensity aerobic physical training (AFT) and a control intervention on the positivity of head-up tilting test (HUT) and orthostatic tolerance time. Methods: Were studied 21 patients with a history of recurrent neurocardiogenic syncope and HUT. The patients were randomized into: trained group (TG), n = 11, and control group (CG), n = 10. The TG was submitted to 12 weeks of AFT supervised, in cycle ergometer, and the CG to a control procedure that consisted in 15 minutes of stretching and 15 minutes of light walk. Results: The TG had a positive effect to physical training, with a significant increase in peak oxygen consumption. The CG did not show any statistically significant change before and after the intervention. After the intervention period, 72.7% of the TG sample had negative results to the HUT, not having syncope in the revaluation. Conclusion: The program of supervised aerobic physical training for 12 weeks was able to reduce the number of positive HUT, as it was able to increase tolerance time in orthostatic position during the HUT after the intervention period. .
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Exercise Test/methods , Exercise Therapy/methods , Exercise Tolerance/physiology , Syncope, Vasovagal/therapy , Heart Rate/physiology , Reference Values , Tilt-Table Test , Time Factors , Treatment OutcomeABSTRACT
El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adaptativa común que a veces puede causar síncope cardioinhibitorio asociado con el ejercicio, cuya presentación puede variar desde bradiarritmias hasta asistolia, por lo cual constituye un reto diagnóstico.
Exercise-induced syncope is a condition that should alert the treating physician; structural cardiac abnormalities that predispose to sudden death should be discarded, and the presence of arrhythmias that may potentially cause this condition are evaluated. In patients over 35 years, coronary and valvular disease are ruled-out as a possible cause of syncope associated with exercise. In subjects who train frequently, increased vagal tone is a common adaptive condition that may sometimes cause cardio-inhibitory syncope associated with exercise, whose presentation may vary from bradyarrhythmia to asystolia, thereby providing a diagnostic challenge.
Subject(s)
Death, Sudden , Exercise , Exercise Test , Heart Arrest , Syncope, VasovagalABSTRACT
BACKGROUND AND OBJECTIVES: In patients with neurocardiogenic syncope or presyncope, symptoms developed unpredictably and intermittently. The purpose of this study was to determine whether there was any significant difference in the recurrence rate of symptoms during the follow-up period between patients with many episodes of symptoms and those with fewer episodes of symptoms before diagnosis, as well as to assess the clinical significance of previous episodes of symptoms during treatment. SUBJECTS AND METHODS: A total of 100 patients with neurocardiogenic syncope or presyncope were divided in two groups (high episode group, n=54; low episode group, n=46) according to the frequency of symptoms before the head-up tilt test. We retrospectively analyzed the recurrence of symptoms using telephone interviews and medical record reviews. RESULTS: The clinical characteristics were not significantly different between the two groups. However, the recurrence rate was significantly lower in the high episode group than in the low episode group (5.6% vs. 19.6%, p=0.001). In the high episode group, patients treated with medication showed higher recurrence of symptoms than those without medication. In the lower episode group, a similar result was observed. CONCLUSION: The frequency of previous symptoms at the diagnosis of neurocardiogenic syncope or presyncope did not predict the occurrence of symptoms during the follow-up period. Therefore, to continue drug treatment based on the frequency of symptoms in patients with neurocardiogenic syncope or presyncope may not be the best option.
Subject(s)
Humans , Follow-Up Studies , Interviews as Topic , Medical Records , Recurrence , Retrospective Studies , Syncope , Syncope, VasovagalABSTRACT
BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.
Subject(s)
Adult , Humans , Young Adult , Anemia , Brain , Creatine Kinase , Echocardiography , Electroencephalography , Hyperventilation , Korea , Magnetic Resonance Imaging , Medical Records , Meniere Disease , Police , Retrospective Studies , Syncope , Syncope, VasovagalABSTRACT
Objetivo: Comparar la eficacia de metoprolol versus clonazepam como tratamiento de primera intención en pacientes con síncope neurocardiogénico. Material y métodos: Se llevó a cabo estudio prospectivo, longitudinal y aleatorizado en el que se evaluó el efecto del metoprolol (50 mg dos veces al día) versus clonazepam (0.5 mg una vez al día) sobre la sintomatología asociada a los tres meses y la recurrencia de síncope a 12 meses. La distribución de los datos fue normal, el análisis estadístico se realizó por métodos paramétricos considerándose significancia estadística una p≤0.05. Resultados: De 54 pacientes, 32 fueron tratados con metoprolol y 22 con clonazepam. No hubo diferencias en las características basales entre ambos grupos. El número de síntomas por paciente se redujo en el grupo de metoprolol de 5.2±2.5 a 1.9±2.1 (p<0.001), y en el grupo de clonazepam de 5.5±2.5 a 1.5±2.2 (p<0.001). La recurrencia de síncope a los 12 meses fue de 10% en el primer grupo y de 5% en el grupo de clonazepam, sin diferencia estadísticamente significativa. Conclusiones: El tratamiento con metoprolol o clonazepam disminuye en forma significativa los síntomas de distonía neurovegetativa asociados y la recurrencia de síncope es similar con ambos tratamientos.
OBJECTIVE: We compared the effects of a metoprolol and clonazepam in patients with neurocardiogenic syncope. METHODS: We compared the effects of a metoprolol and clonazepam in a prospective, randomised trial in 54 patients. Patients were randomly assigned to metoprolol (starting dose 50 mg bid) or clonazepam (starting dose 0.5 mg qd). We assessed a primary combined endpoint of syncope and pre-syncope on a follow-up of 12 months. RESULTS: The primary combined endpoint of syncope and presyncope occurred in the metoprolol group in 3, 4, and 10% of patients at 3, 6, and 12 months respectively. In the clonazepam group it was no recurrence in the first 6 months, and 5% recurrence at 12 months follow-up (nonsignificant differences between groups). Clinical symptoms commonly associated with neurally mediated syncope were decreased similarly in both treatment groups, in the metoprolol group from 5.2+/-2.5 to 1.9+/-2.1 (p < 0.001) and in the clonazepam group from 5.5+/-2.5 to 1.5+/-2.2 (p<0.001). CONCLUSIONS: Pharmacological treatment of neurocardiogenic syncope with metoprolol or clonazepam resulted in similar prevention of syncope and presyncope. Both treatments decreased clinical symptoms but complete symptomatic resolution was rarely observed.
Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Middle Aged , Clonazepam/therapeutic use , Metoprolol/therapeutic use , Syncope, Vasovagal/drug therapy , Adrenergic beta-Antagonists/therapeutic use , Prospective StudiesABSTRACT
PURPOSE: The purposes of this study were to determine short- and long-term fractal correlation behavior of heart rates during daily activity in patients with neurocardiogenic syncope. METHODS: Twenty five patients with histories of neurocardiogenic syncope episodes were included. Their analogue 24h ambulatory Holter electrocardiograms were analyzed. The tape was digitized and the digitized electrocardiograms were partioned into sections of one hour. Then their RR intervals were measured and 20,000 points of RRI were used. To quantify the fractal correlation behavior, we employed the detrended fluctuation analysis, and short-term(n16, alpha2) fractal scaling exponents were calculated. RESULTS: When compared to control, 24-hour average values of alpha1 and all alpha1 values at quarters of each day were significantly higher in patients with syncope. On the contrary, their 24-hour average value of alpha2 and all alpha2 values at quarters of each day were lower in patients with syncope. However, statistical significances were found in 24-hour average value of alpha2 and in alpha2 value at MN-6AM. CONCLUSION: In the syncope patients with neurocardiogenic syncope, short-term fractal scaling exponents of RR interval was significantly high throughout the day. Therefore, their RR intervals were smoother in the short term scale and had a tendency to continue in the same direction of increase or decrease, which may contribute to persistent decrease in heart rate during a syncopal attack.
Subject(s)
Child , Humans , Electrocardiography , Fractals , Heart Rate , Heart , Syncope , Syncope, VasovagalABSTRACT
Neurocardiogenic syncope is a relatively common cause of syncope and is diagnosed by head-up tilt test. A wide variety of medical treatment has been proposed, such as beta-blocker, vasoconstrictor, fludrocortisone, and serotonin re-uptake inhibitors. But there are some cases in which these therapies have failed to prevent syncope. Recent report has shown that tilt training is a very effective therapy for recurrent neurocardiogenic syncope. Thus, to determine whether tilt training could prevent symptoms in the patients with recurrent neurocardiogenic syncope, the following study was taken. Five patients diagnosed with neurocardiogenic syncope by head-up tilt test were included. After hospital admission, they were tilted daily until negative response occurred. Negative response was noted in four patients. But tilt training was stopped in one patient because of no response of tilt training. After hospital discharge, the four patients performed tilt training at home by leaning against wall. They were interviewed on the phone eight to eleven months later. They have not experienced any symptoms during the follow-up period. This is the first domestic report of tilt training in patients with neurocardiogenic syncope.
Subject(s)
Humans , Fludrocortisone , Follow-Up Studies , Serotonin , Syncope , Syncope, VasovagalABSTRACT
BACKGROUND: The changes of cerebral hemodynamics during syncope have not been fully evaluated. We investigated the changes in the cerebral blood flow velocity during head-up tilt test (HUT) using transcranial Doppler ultrasonogra-phy (TCD) in patients with neurocardiogenic syncope or presyncope. METHODS: Thirty-three patients with a history of recurrent syncope or presyncope of unknown origin were evaluated using HUT for 30 minutes (baseline tilt test), fol-lowed by an infusion of intravenous isoproterenol if needed. Systolic (SV) and diastolic velocities (DV) of middle cere-bral artery were continuously monitored by TCD. Positive responses were defined as presyncope or syncope with hypotension, bradycardia, or both. RESULTS: Five patients had positive responses during baseline tilt and 14 patients dur-ing the isoproterenol infusion. During the baseline tilt test, there was a 86 +/- 23% drop in DV and a 41 +/- 34% drop in SV in patients with positive responses, and mean changes in those were less than 10% in patients with negative responses (p=.00, p=.00). During the HUT with an isoproterenol infusion, the TCD showed an 80 +/- 18% drop in diastolic velocity in patients with positive responses, and a 47 +/- 10% drop in patients with negative responses (p=.00), However, the change in systolic velocity did not differ. TCD showed three patterns during positive responses: loss of all flow, loss of end-diastolic flow, and a decrease in diastolic velocity. Loss of consciousness occurred in patients with loss of all flow or end-diastolic flow during positive responses. CONCLUSIONS: TCD shows different patterns of changes in cerebral hemody-namics during HUT. TCD can be used to investigate the pathophysiology of neurocardiogenic syncope.
Subject(s)
Humans , Arteries , Blood Flow Velocity , Bradycardia , Hemodynamics , Hypotension , Isoproterenol , Syncope , Syncope, Vasovagal , Ultrasonography, Doppler, Transcranial , UnconsciousnessABSTRACT
BACKGROUND AND OBJECTIVES: Neurocardiogenic syncope is the major type of syncope and beta-blocker is initial drug of choice. However, the data generated from the studies so far could not represent the beneficial effects of beta-blocker, and the recurrence rate in the long term was not established. This study examined the long-term follow-up on patients with neurocardiogenic syncope with or without therapy and campared among the therapeutic strategies in preventing the relapse of syncope. MATERIALS AND METHOD: Among the 197 patients with neurocardiogenic syncope or presyncope, who underwent head-up tilt test (HUT) from Oct. 1994 to Sep. 1996, we investigated 125 patients (59 males and 66 females). They were either interviewed on the phone or answered the questionnaire. The mean age was 3916 years old and the mean duration of follow-up was 195.9 months. RESULTS: Out of the 125 patients, 85 patients (68%) turned out to be HUT-positive and 40 patients (32%), negative. In the course of the follow-up on the HUT-positive patients, the symptoms recurred in 2 (10%) of the 20 patients who continued medication, 4 (25%) of the 16 patients who had no medication, and 11 (22.4%) of the 49 patients who discontinued medication on the way. Out of the 20 HUT-positive patients who continued medication, the symptom recurred in 1 (7.1%) of the 14 patients who received head-up tilt guided therapy, and 1 (16.1%) of the 6 patients in empirical therapy group. CONCLUSION: The outcome of the group who had gone through the long-term treatment of neurocardiogenic syncope, was found to be more favorable than the one of no therapy group, and this implies that the tilt-guided therapy may be more effective than the empirical therapy in order to prevent neurocardiogenic syncope. However, there would be more radomized, placebo-controlled and larger scale research to be desired at this point.