ABSTRACT
Recognition of cardiac syncope masquerading as epilepsy may be difficult in the Emergency Department. We report a middle-aged man with recent onset convulsions who posed a diagnostic puzzle before it was found that he had paroxysmal ventricular standstill with complete atrioventricular block: he made a complete recovery after temporary pacemaker insertion. The main lessons from this case were (1) a convulsive seizure of only seconds duration and with an abrupt return of consciousness suggests syncope not epilepsy, (2) repeated, convulsive syncopes without provocation suggest cardiac syncope, (3) a 12-lead ECG should be recorded as soon as possible after such a series of episodes and should not be discontinued until an event is captured, and (4) Emergency Department clinicians should be familiar with any automatic gain on their ECG machine, lest fast, atrial activity be mistaken for narrow complex tachycardia. In summary, a good clinical history is of prime importance in differentiating convulsive syncope from epilepsy, and a simple, non-invasive cardiovascular evaluation may help to diagnose the condition as cardiac syncope.
Subject(s)
Adams-Stokes Syndrome/diagnosis , Electrocardiography/statistics & numerical data , Epilepsy/diagnosis , Heart Arrest/diagnosis , Adams-Stokes Syndrome/surgery , Cardiac Surgical Procedures/methods , Diagnosis, Differential , Diagnostic Errors , Emergency Service, Hospital , Heart Arrest/surgery , Heart Block/diagnosis , Heart Block/surgery , Humans , Male , Middle Aged , Pacemaker, ArtificialABSTRACT
Presentamos un caso de bloqueo A-V de 2º grado tipo II que desemboca en una asistolia de más de 20 segundos de duración, con recuperación espontánea de pulso y que fue registrado por un equipo de unidad móvil de emergencias del 061. La paciente fue tratada con un marcapasos definitivo y está asintomática. En las urgencias hospitalarias vemos síncopes a menudo. En la mayoría de los casos les tenemos que dar el alta sin llegar a conocer la etiología del cuadro (AU)
Subject(s)
Aged , Female , Humans , Pacemaker, Artificial , Adams-Stokes Syndrome/surgery , Severity of Illness IndexABSTRACT
El bloqueo cardíaco completo congénito es una alteración del sistema de conducción cardíaco a nivel del nodo aurículo-ventrícular. Es una entidad poco común y los pacientes que adolecen de la enfermedad suelen ser asintomáticos o bien tener sintomatología desde la vida fetal o en el nacimiento. Cuando desarrollan síntomas, estos pacientes necesitan ser tratados, en forma farmacológica o con el uso de marcapaso artificial. Reportamos los primeros 2 casos de bloqueo cardíaco completo congénito en niños tratados con la implantación de marcapaso permanente en Honduras
Subject(s)
Humans , Male , Female , Infant, Newborn , Child, Preschool , Pacemaker, Artificial , Adams-Stokes Syndrome/surgery , Adams-Stokes Syndrome/diagnosis , Heart Block/congenital , Heart Block/etiology , Heart Block/therapyABSTRACT
A clinical randomized investigation was undertaken to determine the value of midazolam as a narcotic adjuvant for anesthetic induction. Thirty ASA I-II adult patients undergoing selective surgery were allocated randomly into two groups to receive one of the following agents: midazolam 0.3 mg/kg, thiopental 5 mg/kg, or diazepam 0.4 mg/kg. The induction time as measured from the onset of injection to loss of the eyelash reflex was shortest in the case of thiopental; while a lower frequency of apnea, lesser suppression of circulation, and lack of venous irritation were points favoring midazolam. However, further study is needed to clarify the moderate cardiovascular response seen during intubation in some cases as well as to elucidate any patient population differences.
