Faint of Heart: A Case of Atrial Myxoma Presenting With Atypical Syncope.

Syncope is a frequent reason for elderly patients to present to an outpatient office. The underlying cause of syncope can range from benign to serious. Although serious cases of syncope are rare, appropriate workup can help detect and address potentially fatal pathologies. We present a case of a 74-year-old woman who presented with an episode of syncope with associated epigastric cramping. Sudden syncope without significant comorbidities prompted further diagnostic workup, which revealed a rare cardiac myxoma. This case underscores the importance of ruling out potentially fatal causes prior to favoring more conservative diagnoses when investigating syncope in the elderly population.

Hereditary Syndromes of Sudden Cardiac Death.

Sudden cardiac death (SCD) describes the unexpected natural death from a cardiac cause within a short time period, generally 1 hour or lesser from the onset of symptoms, often due to a cardiac dysrhythmia. Overall, the most common cause of SCD is coronary artery disease but for patients aged younger than 35 years, the most common cause of SCD is a dysrhythmia in the setting of a structurally normal heart. This article will review the background, diagnosis, and management of the common hereditary channelopathies and cardiomyopathies associated with an increased risk of SCD in patients without ischemic heart disease.

Syncope in a Patient With Giant Left Main Coronary Aneurysm: Is There a Link With Ventricular Arrhythmias?

Giant aneurysm of the left main coronary artery is exceedingly rare and accounts for less than 2% of patients undergoing coronary angiography. The etiology varies depending on the patient's age and geographic area, but half are of atherosclerotic origin. In most cases, coronary aneurysms are asymptomatic, however, symptomatic patients present with symptoms characteristic of coronary artery disease such as chest pain (angina pectoris), myocardial infarction, congestive heart failure, and even sudden death. Coronary angiography is considered the gold standard tool to determine the presence or absence of coronary artery disease, and if present, its size and location. Herein, we report a case of giant aneurysm of the left main coronary artery presenting as syncope and documented nonsustained ventricular tachycardia.

A Rare Presentation of Sick Sinus Syndrome: Generalized Seizures.

Cardiac and neurological disorders are the main broad etiologies for loss of consciousness. Ictal bradycardia syndrome refers to epileptic discharges that profoundly disrupt normal cardiac rhythm, resulting in cardiogenic syncope during the ictal event. Convulsive syncope is a well-described phenomenon in both adults and children in which abrupt cerebral hypoperfusion leads to brief extensor stiffening and non-sustained myoclonus. Sick sinus syndrome or tachycardia bradycardia syndrome is a common cause of arrhythmias in the elderly secondary to sinus node dysfunction. We present a case of a 91-year-old male who presented with generalized seizure with associated bradyarrhythmias with telemetry showing sinus rhythm, followed by severe bradycardia, followed by Ventricular tachycardia, followed by an episode of asystole, which likely precipitated seizures as a result of cerebral hypoperfusion. The patient had a permanent dual-chamber pacemaker. He was discharged on antiepileptics as his EEG was abnormal, which might indicate an underlying predisposition.

Widespread ST-segment elevation due to diffuse coronary artery spasm: A case report.

Coronary artery spasm (CAS) is considered an important mechanism of acute coronary syndrome but not very common in the clinical setting. We report a case of a 42-year-old woman with chest pain lasting for 4 h due to diffuse CAS, which led to widespread ST-segment elevation in multiple leads of the electrocardiogram and elevated cardiac troponin T. Emergency coronary angiography at admission showed significantly different morphological results from the second angiography during hospitalization, indicating the patient's discomfort was due to CAS rather than stenosis. Our case illustrates that diffuse CAS can cause widespread ST-segment elevation and severe ACS.

Familial Hypertrophic Cardiomyopathy: Late Potentials and Other Prognostic Markers.

Familial hypertrophic cardiomyopathy is an autosomal dominant genetic disease considered the most common cause of sudden cardiac death in individuals under 35 years old, especially the athletes. This study aimed to investigate the association between the presence of late potentials and a family history of sudden death, syncope, and complex ventricular arrhythmias on patients with hypertrophic cardiomyopathy. A case series study was carried out from March 2001 to December 2002, including 22 patients with hypertrophic cardiomyopathy according to transthoracic echocardiogram criteria. Patients on a cardiac pacemaker, right bundle branch block, cardiac transplant, and under no possibilities to realize the exams were excluded. The results showed that asymmetric septal hypertrophy was the most common type (73%), 63% had a positive familial history of hypertrophic cardiomyopathy, 55% sudden cardiac death, and 23% syncope. Also, complex ventricular arrhythmias were detected in 14% and late potentials in 23% of patients. According to this study, the presence of late potentials was not associated with familial sudden death, syncope, and complex ventricular arrhythmias.

[On the problem of syncopal conditions in the neurological practice].

OBJECTIVE: Introduction: At present, syncopal conditions remain an interdisciplinary problem. Most often, syncope is a consequence of organic or functional damage to the central nervous system, the cardiovascular system, the endocrine system. Among the various types of paroxysmal states that are observed in the neurological practice, syncopal conditions rank the first position by frequency. The aim: The aim of the present paper is to study the scientific literature on the issue of the problem of syncopal conditions in the neurological practice. PATIENTS AND METHODS: Materials and methods: The subject under discussion was considered on the basis of 43 sources on this issue, using the method of content analysis, comparative and contrastive methods, analytical and bibliosemantic methods. CONCLUSION: Сonclusions: The article presents the analysis of the literature on the problem of syncopal conditions. It has been shown, that the pathology of the nervous system is not always the root cause of syncopes. They often develop from somatic pathology. The awareness of causes of these syncopal conditions enables the doctor to make correct diagnosis and prescribe pathogenetically substantiated treatment.

Risk factors of death in 30 days after syncope / 中华急诊医学杂志

Objective To investigate the risk factors of death in patients with syncope. Methods Clinical data of 516 patients experienced syncope admitted from June 2010 to June 2016 were analyzed retrospectively. Factors including gender, age, history of hypertension, diabetes mellitus, hyperlipidemia, smoking history, drinking history, and etiology of syncope (cardiogenic syncope, neuroreflex syncope, orthostatic hypotension, orthostatic syncope, unexplained syncope, and syncope caused by other special diseases) were analyzed as likely risk factors of death within 30 days after syncope happened. After adding the derived variables (over 22 new factors), analyses were done to investigate independent risk factors of death for patients with syncope. Results This study included 321 male (62.2％) and 195 females (37.8％), with mean age of (62.23±19.69) years. Logistic regression analyses showed that age (OR=1.033, 95％ confidence interval (95％CI):1.008-1.058, P =0.008 8),cardiac syncope (OR=19.704,95％CI:5.894-5.875,P＜0.01) were independent risk factors of death within 30 days after syncope occurred. Multiple-variate analysis with derived variables showed that cardiac syncope (OR=11.487, 95％CI:4.938-26.721,P＜0.01),age and age derived variables (OR=1.000, 95％CI:1.000-1.000,P=0.000 8),age and cardiogenic syncope derivative variables (OR=1.033, 95％CI:1.022-1.044, P＜0.01) were independent risk factors for death within 30 days after syncope. Conclusion Age and cardiogenic syncope were independent risk factors for death within 30 days after syncope occurred. And a derivative factor of age, and interactivity between age and cardiac syncope were independent risk factors of death in patients with syncope.

Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting with syncope.

BACKGROUND: In syncope patients, presence of coronary artery disease (CAD) is associated with poor prognosis. However, data concerning CAD prevalence in syncope patients without known cardiovascular disease are lacking. Therefore, the aim of this study was to investigate presence and extent of CAD in syncope patients. METHODS: We included 142 consecutive patients presenting with syncope at the outpatient cardiology clinic who underwent coronary computed tomography (CT) angiography. Syncope type was ascertained by two reviewers, blinded for coronary CT angiography results. Of the patients, 49 had cardiac syncope (arrhythmia or structural cardiopulmonary disease) and 93 had non-cardiac syncope (reflex [neurally-mediated], orthostatic or of unknown cause). Cardiac syncope patients were compared with matched stable chest pain patients regarding age, gender, smoking status, diabetes mellitus type 2 and systolic blood pressure. RESULTS: Distribution of CAD presence and extent in cardiac and non-cardiac syncope patients was as follows: 72% versus 48% any CAD; 31% versus 26% mild, 8% versus 14% moderate and 33% versus 7% severe CAD. Compared with non-cardiac syncope, patients with cardiac syncope had a significantly higher CAD presence and extent (p = 0.001). Coronary calcium score, segment involvement and stenosis score were also higher in cardiac syncope patients (p-values ≤0.004). Compared to the chest pain control group, patients with cardiac syncope showed a higher, however, non-significant, prevalence of any CAD (72% versus 63%) and severe CAD (33% versus 19%). CONCLUSION: Patients with cardiac syncope show a high presence and extent of CAD in contrast to non-cardiac syncope patients. These results suggest that CAD may play an important role in the occurrence of cardiac syncope.

Syncope: Case Studies.

Syncope, or the sudden loss of consciousness, is a common presenting symptom for evaluation by neurologists. It is not a unique diagnosis but rather a common manifestation of disorders with diverse mechanisms. Loss of consciousness is typically preceded by a prodrome of symptoms and sometimes there is a clear trigger. This article discusses several cases that illustrate the various causes of syncope. Reflex syncope is the most common type and includes neurally mediated, vasovagal, situational, carotid sinus hypersensitivity, and atypical forms. Acute and chronic autonomic neuropathies and neurodegenerative disorders can also present with syncope.

Evaluation of syncope: focus on diagnosis and treatment of neurally mediated syncope.

Syncope, defined as a transient loss of consciousness secondary to global cerebral hypoperfusion, is common in the general population. The single most helpful "test" in the evaluation of patients with syncope is a thoughtful history, with recent evidence that structured histories are remarkably effective in arriving at a diagnosis. In addition to the history, physical examination, and electrocardiogram, arriving at a diagnosis of syncope can involve monitoring and provocative strategies. The majority of patients with syncope have neurally mediated syncope and a favourable prognosis. The management of neurally mediated syncope continues to largely revolve around education, avoidance of triggers, reassurance, and counter-pressure maneuvers. The evidence surrounding medical therapy in vasovagal syncope is not strong to date. Pacemaker therapy is reasonable in older patients with recurrent, unpredictable syncope with pauses, but should be considered as a last resort in younger patients.

Syncope at altitude: an enigmatic case.

We report a case of a young boy with recurrent episodes of syncope at elevated altitude. While not conforming to common presentations of altitude sickness, the differential diagnoses and possible etiologies are discussed.

Sick Sinus Syndrome Mimicking Complex Partial Seizure

No abstract available.

Common cause of cardiogenic syncope and emergency treatment / 中国小儿急救医学

Cardiogenic syncope is the relatively common type of syncope in children. The state of illness is more serious at the onset,the prognosis of partial patients is very dangerous,even it can cause cardiac sudden death, so clinical doctors pay close attention to cardiogenic syncope. The common pathogeny of cardiogenic syncope in children includes serious arrhythmia, obstruction of the outflow tract of heart, restricted diastole of heart or weak systole of heart. Before the particular cause of disease is determined,some examinations and laboratory tests should be made. In this article, the writer introduces detailed methods of the emergent treatment.

Prognosis and Etiological Treatment of Cardiogenic Syncope in Children / 实用儿科临床杂志

Objective To explore the prognosis and etiological treatment of cardiogenic syncope in children.Methods The cause,clinical manifestation,treatment and prognosis of 45 children with syncope were made in affiliated hospital of Qingdao medical university were su mmarized and analyzed.They were divided into arhythmia group and other groups,the former included myocarditis,dilated cardiomyopathy,and post-operation of congenital heart disease and the latter included tetralogy of fallot,pulmonary stenosis,hypertrophic cardiomyopathy,pericarclial effusion,and right atrial myxoma.Results There were 29 cases(64.44%) with arrhythmia in this group,of which there were 18 cases with complete atrioventricular block(CAVB),2 cases with second degree type Ⅱ atrioventricular block,3 cases with ventricular tachycardia,2 cases with bradycardia,2 cases with atrial flutter,1 case with supraventricular tachycardia,and 1 case with nonconducting atrial premature.There were 16 cases(35.56%) with other etiologies,of which there 8 cases with tetralogy of Fallot,2 cases with pulmonary stenosis,hypertrop-hic cardiomyopathy,pericardial effusion,and right atrial myxoma,respectively.Children with CAVB,bradycardia,or ventricular tachycardia resulted from viral myocarditis were given anti-virus medicine,protecting myocardium,neoepinephrine,and intravenous vitamin C 100-200 mg/(kg?d).Dexamethasone 1-2 mg/(kg?d) was given in earlier period for short course,and some children were given human ?-globulin.Eight cases were placed temporary pacemaker because of unsatisfactory therapeutic efficacy,and 1 case was placed permanent pacemaker.In all,38 cases(84.44%)were cured,1 case(2.22%)was improved,and 4 cases(8.88%) died.Conclusions Cardiogenic syncope is pediatric emergency and shall be treated immediately.Temporary pacemaker shall be placed at the right moment.