Syncope and Cardiac Arrhythmias Caused by a Paratracheal Mass.

Background: Syncope is a common complaint in clinical practice. The etiologies and mechanisms can be multiple and complex. Syncope caused by a mediastinal mass compressing the vagus nerve is rare. Case Report: We report the case of a patient who presented to the emergency department experiencing recurrent syncope. Imaging revealed a large, calcified mass in the right paratracheal region. After intracranial lesions, cardiac arrhythmias, and orthostatic hypotension were excluded, we suspected that the syncope was related to vagus nerve compression. The patient underwent surgical resection of a mediastinal mass and had complete resolution of syncopal episodes after surgery. Conclusion: This case outcome suggests that recurrent syncope could be the first symptom of an intrathoracic mass.

Progress in diagnosis and treatment of orthostatic intolerance / 中华老年医学杂志

Orthostatic intolerance is a syndrome characterized by a series of symptoms that occur when standing upright, resulting in the loss of ability to maintain an upright position.This condition can be further classified into orthostatic hypotension, postural orthostatic tachycardia syndrome, and vasovagal syncope.Some scholars suggest that orthostatic hypertension may also be considered a part of this syndrome.The most significant risk associated with orthostatic intolerance is falls, which can lead to physical injury and psychological distress.This article aims to review the advancements made in the diagnosis and treatment of orthostatic intolerance, so as to enhance the standardization of clinical diagnosis and improve the effectiveness of treatment.

Perfil Clínico, Autonômico e Escore de Calgary Modificado de Crianças e Adolescentes com Presumida Síncope Vasovagal Submetidos ao Teste de Inclinação / Clinical and Autonomic Profile, and Modified Calgary Score for Children and Adolescents with Presumed Vasovagal Syncope Submitted to the Tilt Test

Resumo Fundamento A síncope, na população pediátrica, tem como sua principal causa, a vasovagal (SVV). Sua avaliação deve ser feita por métodos clínicos e o teste de inclinação (TI) pode contribuir para seu diagnóstico. Objetivos Analisar o perfil clínico, os escores de Calgary e de Calgary modificado, a resposta ao TI e a variabilidade da frequência cardíaca (VFC) de pacientes ≤ 18 anos de idade, com presumida SVV. Comparar as variáveis entre pacientes com resposta positiva e negativa ao TI. Método Estudo observacional e prospectivo, com 73 pacientes com idades entre 6 e 18 anos, submetidos à avaliação clínica e ao cálculo dos escores, sem o conhecimento do TI. Este foi feito a 70º sob monitoramento para análise da VFC. Valor-p < 0,05 foi considerado como o critério de significância estatística. Resultados A mediana de idade foi de 14,0 anos, sendo que 52% eram no sexo feminino, 72 apresentaram Calgary ≥ -2 (média 1,80) e 69 com Calgary modificado ≥ -3 (média 1,38). Ocorreram pródromos em 59 pacientes, recorrência em 50 e trauma em 19. A resposta ao TI foi positiva em 54 (49 vasovagal, com 39 vasodepressora), com aumento do componente de baixa frequência (BF) e diminuição da alta frequência (AF) (p < 0,0001). Na posição supina, o BF foi de 33,6 no sexo feminino e 47,4 em unidades normalizadas no sexo masculino (p = 0,02). Aplicando-se a curva de operação característica para TI positivo, não houve significância estatística para VFC e os escores. Conclusões A maioria das crianças e adolescentes com diagnóstico presumido de SVV apresentaram um cenário clínico típico, com escore de Calgary ≥ -2, e resposta vasodepressora predominante ao TI. Verificou-se uma maior ativação simpática na posição supina no sexo masculino. Os escores de Calgary e a ativação simpática não permitiram predizer a resposta ao TI.

Abstract Background In the pediatric population, syncope is mainly from vasovagal (VVS) origin. Its evaluation must be done by clinical methods, and the tilt test (TT) can contribute to the diagnosis. Objectives To analyze the clinical profile, Calgary and modified Calgary scores, response to TT and heart rate variability (HRV) of patients aged ≤ 18 years with presumed VVS. To compare the variables between patients with positive and negative responses to TT. Method Observational and prospective study, with 73 patients aged between 6 and 18 years, submitted to clinical evaluation and calculation of scores without previous knowledge of the TT. It was done at 70º under monitoring for HRV analysis. P-value < 0.05 was the statistical significance criterion. Results Median age was 14.0 years; 52% of participants were female, 72 had Calgary ≥ -2 (mean 1.80), and 69 had modified Calgary ≥ -3 (mean 1.38). Prodromes were observed in 59 patients, recurrence in 50 and trauma in 19. The response to TT was positive in 54 participants (49 vasovagal, with 39 vasodepressor responses), with an increase in the low frequency (LF) component and a decrease in the high frequency (HF) component (p < 0,0001). In the supine position, LF was 33.6 in females and 47.4 in normalized units for males (p = 0.02). When applying the operating characteristic curve for positive TT, there was no statistical significance for HRV and scores. Conclusion Most children and adolescents with a presumed diagnosis of VVS presented a typical clinical scenario, with a Calgary score ≥ -2, and a predominant vasodepressor response to TT. Greater sympathetic activation was observed in the supine position in males. Calgary scores and sympathetic activation did not predict the response to TT.

Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome.

Hydration with water and salt is the mainstay of treatment for autonomic nervous system disorders that impair orthostatic tolerance. The goal is to expand intravascular volume to compensate for the downward displacement of blood volume that occurs when standing and thereby sustain cerebral perfusion and restore quality of life. Despite strong consensus recommendations for salt supplementation as standard treatment of these disorders, published evidence of benefit is relatively weak, and no randomized clinical trials have occurred. This review summarizes the physiological rationale for hydration and evaluates the literature on oral and intravenous hydration in the treatment of neurogenic orthostatic hypotension, postural tachycardia syndrome, and recurrent vasovagal syncope. We conclude that oral salt replacement is indicated for treatment of neurogenic orthostatic hypotension because these patients have excessive renal sodium excretion, and for treatment of chronic orthostatic intolerance because these patients are often hypovolemic. As not all patients are able to tolerate sufficient oral hydration, there is also a role for intravenous volume-loading in severe cases of postural tachycardia syndrome. We offer guidance, based on review of the literature and the clinical judgment of a cardiologist and neurologist with experience treating autonomic disorders, regarding the option of ongoing intravenous hydration for treatment of severe, refractory cases of postural tachycardia syndrome.

Seguridad en procedimientos dermatológicos: anafilaxia, reacción vasovagal e hiperventilación / Safety in Dermatologic Procedures: Anaphylaxis, Vasovagal Reaction, and Hyperventilation

En el presente artículo de la serie «Seguridad en procedimientos dermatológicos» se aborda el diagnóstico, prevención, manejo y tratamiento de tres situaciones. Primeramente, se aborda la anafilaxia: una situación infrecuente, grave y potencialmente mortal, que requiere una identificación ágil para un manejo urgente coordinado por parte de médicos especialistas en anestesiología. En segundo lugar, la reacción vasovagal, que es la complicación médica más frecuente durante la cirugía dermatológica (una de cada 160 intervenciones), con una evolución habitualmente benigna autorresolutiva, pero que, en individuos muy sensibles, puede provocar una parada cardiaca por asistolia. En tercer y último lugar, el síndrome de hiperventilación aguda, que es una respuesta anómala de determinados individuos a un evento estresante, con un incremento de la ventilación que excede la demanda metabólica. En los tres casos se incluyen recomendaciones que se plasman de forma práctica y somera (AU)

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is the vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included (AU)

Safety in dermatologic procedures: anaphylaxis, vasovagal reaction, and hyperventilation.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is fainting due to a vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.

Atomoxetine as an adjunct to nonpharmacological treatments for preventing vasovagal attacks in patients with recurrent vasovagal syncope: A pilot randomized-controlled trial.

BACKGROUND: Despite the reduced quality of life in patients with recurrent vasovagal syncope (VVS), pharmacologic treatment options remain limited. Studies indicate that norepinephrine reuptake inhibition reduces tilt-induced syncope/pre-syncope. This study aimed to evaluate the effects of atomoxetine on syncopal/pre-syncopal episodes in patients with recurrent VVS. METHODS: In a placebo-controlled trial, we randomized patients with newly diagnosed VVS who experienced ≥3 syncopal episodes in the past three months to receive either atomoxetine (20 mg daily for two weeks followed by 40 mg daily for two weeks) or placebo. The primary endpoint was the combined number of syncopal and pre-syncopal episodes. RESULTS: Among 843 patients initially screened, 46 were randomized (N = 23 in each group) and reevaluated at one and three months. Compared to placebo, atomoxetine significantly reduced the primary endpoint after three months (P < 0.001). In the atomoxetine arm, the median time to first pre-syncopal episode was 55 days (95% confidence interval (CI): 41.21-68.79), while this was 27 days (95% CI: 14.48-39.52) for the placebo group (P < 0.001). In a subgroup analysis of patients with systolic blood pressure < 110 mmHg, atomoxetine reduced the primary endpoint, and the number of syncopal and pre-syncopal episodes after one and three months. In this subgroup, the median time to first pre-syncopal attack was 56 days in the atomoxetine group as opposed to 9 days in the placebo group. CONCLUSIONS: In this pilot study, the promising effects of atomoxetine in reducing syncopal/pre-syncopal episodes in recurrent VVS, especially with low blood pressure phenotype, warrant the conduction of future randomized trials.

Safety in Dermatologic Procedures: Anaphylaxis, Vasovagal Reaction, and Hyperventilation. / Seguridad en procedimientos dermatológicos: anafilaxia, reacción vasovagal e hiperventilación.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is the vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.

Nitrates and risk of vasovagal reaction in femoral sheath removal after percutaneous intervention : A retrospective observational study.

BACKGROUND: The aim of this study was to analyze the risk factors for vasovagal reaction (VVR) in manual femoral sheath removal after percutaneous coronary intervention and to discuss methods for the prevention and control of VVR. METHODS: The data of 455 patients who underwent percutaneous intervention in four interventional centers during a period of 30 months were retrospectively analyzed. Patients were divided into a VVR group and a control group according to whether VVR developed. The clinical data of all patients were analyzed using univariate and multivariate logistic regression analysis to examine VVR -related factors. RESULTS: A total of 455 patients underwent 464 manual femoral sheath removal operations, of whom 12 developed VVR (2.59%). Of these 12 VVR patients, one had VVR during and 11 had VVR after the intervention. There were no statistically significant differences between the two groups in age, body mass index, gender, time of sheath removal, proportions of patients with hypertension, diabetes, and hyperlipemia, laboratory values of hemoglobin a1c, and ejection fraction (p > 0.05). Compared with the control group, use of nitrates was the only risk factor with a significant correlation with VVR (p = 0.012). CONCLUSION: In manual femoral sheath removal, the use of nitrates is the most important risk factor for the occurrence of VVR after percutaneous intervention.

Analysis of risk factors for vasovagal syncope in children / 中国学校卫生

Objective@#To analyze the related factors of the onset of vasovagal syncope (VVS) in children, and to provide basis for the early prevention, early diagnosis and early treatment of VVS.@*Methods@#A total of 126 children with syncope admitted to Department of Pediatric Cardiology, Second Hospital of Lanzhou University from October 2018 to September 2019 were invited in the study. Totally 73 cases of children diagnosed with VVS by HUTT were selected as VVS group, and 53 HUTT negative children were selected as control group. Related factors were retrospectively investigated, and risk factors for VVS were analyzed by univariate and multivariate regression.@*Results@#The VVS group showed statistically significant difference in age distribution with the control group ( χ 2=19.22, P <0.05). The VVS group showed statistically significant differences of proportion in family history, syncope history, prolonged standing, electrocardiogram abnormalities, and vitamin D deficiency (43.84%，31.51%，47.95%，34.25%， 30.14 %) compared with the control group (15.09%，13.21%，20.75%，15.09%，9.43%) ( χ 2=11.71,5.67,9.79,5.83,7.82, P < 0.05 ). Multivariate Logistic regression analysis showed that age and family historywere risk factors for VVS( χ 2=3.13, 11.06, P < 0.05 ).@*Conclusion@#Age and family history may be risk factors for the onset of VVS. Active attention should be paid to the high risk factors of child patient, early identification and diagnosis can prevent the occurrence and development of VVS in children.

The Diagnostic Value of Cardiac Deceleration Capacity in Vasovagal Syncope.

BACKGROUND: Increased parasympathetic activity is thought to play important roles in syncope events of patients with vasovagal syncope (VVS). However, direct measurements of the vagal control are difficult. The novel deceleration capacity (DC) of heart rate measure has been used to characterize the vagal modulation. This study aimed to assess vagal control in patients with VVS and evaluate the diagnostic value of the DC in VVS. METHODS: Altogether, 161 consecutive patients with VVS (43±15 years; 62 males) were enrolled. Tilt table test was positive in 101 and negative in 60 patients. Sixty-five healthy subjects were enrolled as controls. DC and heart rate variability in 24-hour ECG, echocardiogram, and biochemical examinations were compared between the syncope and control groups. RESULTS: DC was significantly higher in the syncope group than in the control group (9.6±3.3 versus 6.5±2.0 ms, P<0.001). DC was similarly increased in patients with VVS with a positive and negative tilt table test (9.7±3.5 and 9.4±2.9 ms, P=0.614). In multivariable logistic regression analyses, DC was independently associated with syncope (odds ratio=1.518 [95% CI, 1.301-1.770]; P=0.0001). For the prediction of syncope, the area under curve analysis showed similar values when comparing single DC and combined DC with other risk factors (P=0.1147). From the receiver operator characteristic curves for syncope discrimination, the optimal cutoff value for the DC was 7.12 ms. CONCLUSIONS: DC>7.5 ms may serve as a good tool to monitor cardiac vagal activity and discriminate VVS, particularly in those with negative tilt table test.

[Syncope]. / Synkope.

Syncope is a frequent disorder, sometimes due to life-threatening causes. The uncertainty in its diagnosis requires a standardized approach. According to the 2018 European Society of Cardiology (ESC) guidelines, new aspects in evaluation and treatment include risk stratification and decision-making strategies during the initial evaluation in the emergency department, a reconsideration of diagnostic tests, algorithms for the treatment of reflex syncope, indications for an implantable cardioverter/defibrillator in high risk patients for sudden cardiac death, and organizational aspects such as interdisciplinary syncope units. The 2018 ESC guideline and the 2019 commentaries of the German Society of Cardiology (DGK) are an excellent and comprehensive instruction for safe, effective and efficient evaluation and therapy. However, some aspects require critical appraisal. The inadequate availability and reimbursement of pivotal diagnostic tests, such as tilt table testing and the implantable loop recorder is emphasized.

2019 American Heart Association and American Red Cross Focused Update for First Aid: Presyncope: An Update to the American Heart Association and American Red Cross Guidelines for First Aid.

This 2019 focused update to the American Heart Association and American Red Cross first aid guidelines follows the completion of a systematic review of treatments for presyncope of vasovagal or orthostatic origin. This review was commissioned by the International Liaison Committee on Resuscitation and resulted in the development of an international summary statement of the International Liaison Committee on Resuscitation First Aid Task Force Consensus on Science With Treatment Recommendations. This focused update highlights the evidence supporting specific interventions for presyncope of orthostatic or vasovagal origin and recommends the use of physical counterpressure maneuvers. These maneuvers include the contraction of muscles of the body such as the legs, arms, abdomen, or neck, with the goal of elevating blood pressure and alleviating symptoms. Although lower-body counterpressure maneuvers are favored over upper-body counterpressure maneuvers, multiple methods can be beneficial, depending on the situation.

Heart rate recovery and diastolic blood pressure ratio on the treadmill test predict an induction and recurrence of vasovagal syncope.

BACKGROUND/AIMS: The induction and recurrence of syncope is a concerning situation that could be unpredicted in the vasovagal syncope (VVS). We investigated a simple predictor for the induced and recurrent VVS during Head-Up table-tilt Test (HUT) and clinically follow-up. METHODS: The 143 consecutive patients with VVS (age 31 ± 19 years, 33 male) who referred by a cardiologist or neurologist and had undergone an echocardiogram, HUT, and a treadmill exercise test (TMT) were recruited and clinically follow-up. Patients were divided into two groups based on the result of HUT and TMT. The data was analyzed and compared between VVS patients and control 141 patients without VVS who were enrolled in the same study period (age 40 ± 5 years, 117 male). RESULTS: The heart rate recovery (HRR), recovery systolic blood pressure (RecSBP), recovery diastolic blood pressure (RecDBP), HRR/RecSBP and HRR/RecDBP were significantly different between controls and VVS during the TMT. Within VVS, even if, baseline characteristics were similar between negative and positive HUT (n = 92 vs. n = 51). HRR (31 ± 10 vs. 35 ± 10), HRR/RecSBP (0.24 ± 0.09 vs. 0.28 ± 0.09) and HRR/RecDBP (0.49 ± 0.18 vs. 0.58 ± 0.19) were significantly different between negative and positive HUT results. Especially, HRR/RecSBP and HRR/RecDBP were significantly correlated with induced syncope with a sensitivity and specificity ([60%, 83%] cut-off, 0.31; [72%, 80%] cut-off, 0.63). In the Cox regression, HRR/ RecDBP were significantly associated with recurrence of VVS with hazard ratio of 3.29 (confidence interval, 0.95 to 11.3; p = 0.049). CONCLUSION: HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.

Effect of Shenfu injection on prognosis and quality of life of patients with vasovagal syncope / 国际中医中药杂志

Objective@#To observe the effect of different doses of Shenfu injection on prognosis and quality of life for patients with vasovagal syncope (VVS).@*Methods@#A total of 126 patients were randomly divided into 3 groups. The control group (n=38) were treated by western medicine comprehensive therapy with tilting training. The low and high dose Shenfu injection groups were treated by Shenfu injection 40 ml/d (n=44) and 120 ml/d (n=44) on the treatment basis of control group. All the groups were treated for 14 days. The patients were followed up for 1 year after discharge. The relapse rate of syncope, quality of life social support rating scale (SSRS), effective rate of treatment, time of stable blood pressure, time of stable heart rate, recovery time of autonomic nervous disorder and adverse reactions were observed in each groups.@*Results@#The total effective rate was 47.4% (18/38) in the control group, 72.7% (32/44) in the low dose group, and 90.9% (40/44) in the high dose group. The difference between the three groups was statistically significant (χ2=18.997, P<0.01), and the total effective rate of Shenfu injection high-dose group was significantly higher than that of low-dose group (P<0.05). After treatment, there were significant differences in the recovery time of blood pressure, heart rate and autonomic nervous disorder among the three groups (F=19.165, 158.428, 33.405, P<0.01). The above indicators in the high dose group of Shenfu injection were significantly higher than the low dose group (t=-4.020, -5.180, -5.307, P<0.05). After 1 year of follow-up, the recurrence rate of the control group was 61.1% (11/18), the low-dose group was 18.8% (6/32), and the high-dose group was 5% (2/40), where there was significant difference among all the groups (χ2=20.886, P<0.01). The quality of life scores were compared for 1 year among the 3 groups, and the difference was statistically significant (F=23.025, P<0.01).@*Conclusions@#The Shenfu injection combined with Western medicine comprehensive therapy can improve the prognosis and quality of life of patients with VVS, and the improvement of each indicator of daily dosage of 120 ml is better than the daily dosage of 40 ml Shenfu injection.

Effect of Shenfu injection on prognosis and quality of life of patients with vasovagal syncope / 国际中医中药杂志

Objective To observe the effect of different doses of Shenfu injection on prognosis and quality of life for patients with vasovagal syncope (VVS). Methods A total of 126 patients were randomly divided into 3 groups. The control group (n=38) were treated by western medicine comprehensive therapy with tilting training. The low and high dose Shenfu injection groups were treated by Shenfu injection 40 ml/d (n=44) and 120 ml/d (n=44) on the treatment basis of control group. All the groups were treated for 14 days. The patients were followed up for 1 year after discharge. The relapse rate of syncope, quality of life social support rating scale (SSRS), effective rate of treatment, time of stable blood pressure, time of stable heart rate, recovery time of autonomic nervous disorder and adverse reactions were observed in each groups. Results The total effective rate was 47.4% (18/38) in the control group, 72.7% (32/44) in the low dose group, and 90.9% (40/44) in the high dose group. The difference between the three groups was statistically significant (χ2=18.997, P<0.01), and the total effective rate of Shenfu injection high-dose group was significantly higher than that of low-dose group (P<0.05). After treatment, there were significant differences in the recovery time of blood pressure, heart rate and autonomic nervous disorder among the three groups (F=19.165, 158.428, 33.405, P<0.01). The above indicators in the high dose group of Shenfu injection were significantly higher than the low dose group (t=-4.020, -5.180, -5.307, P<0.05). After 1 year of follow-up, the recurrence rate of the control group was 61.1% (11/18), the low-dose group was 18.8% (6/32), and the high-dose group was 5% (2/40), where there was significant difference among all the groups (χ2=20.886, P<0.01). The quality of life scores were compared for 1 year among the 3 groups, and the difference was statistically significant (F=23.025, P<0.01). Conclusions The Shenfu injection combined with Western medicine comprehensive therapy can improve the prognosis and quality of life of patients with VVS, and the improvement of each indicator of daily dosage of 120 ml is better than the daily dosage of 40 ml Shenfu injection.

[Association between C1114G polymorphism in the regulator of G protein signaling 2 and vasovagal syncope in children].

Objective: To analyze the distribution of the regulator of G protein signaling 2 (RGS2) gene C1114G polymorphism in children with vasovagal syncope (VVS) and the associated clinical classification groups, and to explore the association between RGS2 C1114G and VVS. Methods: This was a prospective case-control study. A head-up tilt test (HUT) was performed in 300 children visiting Children's Hospital Affiliated to Shanghai Jiaotong University from August 2010 to December 2015 for unexplained syncope. A total of 150 children with positive HUT and a diagnosis of VVS were enrolled and assigned to the VVS group. The VVS group was further divided into 3 subgroups based on characteristics of the heart rate and blood pressure measured during the HUT. A total of 150 children with negative HUT were enrolled and assigned to the HUT-negative group. A total of 150 healthy children were enrolled as the normal control group for genetic polymorphism detection. The clinical characteristics of patients in the VVS group and the HUT-negative group were recorded. Peripheral blood samples of each case were collected. RGS2 C1114G polymorphism was evaluated using high-resolution melting curve and polymerase chain reaction together with gene sequencing. The genotype and allele frequency were analyzed and compared among different groups (VVS, HUT-negative, and normal control) and VVS subgroups. Comparisons among groups were performed using Chi-square test. Results: Patients in the VVS group (48 males and 102 females, aged (10.1±3.2) years) were more frequently female (68.0% vs. 57.3%;χ(2)=5.090, P=0.024) compared with patients in the HUT-negative group (67 males and 83 females, aged (10.8±2.2) years). No significant difference was found regarding the distribution of the CC genotype, CG genotype and GG genotype among the VVS group (n=98, 65.3%; n=36, 24.0%; n=16, 10.7%), the HUT-negative group (n=112, 74.7%; n=28, 18.7%; n=10, 6.7%) and the normal control group (n=108, 72.0%; n=31, 20.7%; n=11, 7.3%) (χ(2)=3.632, P=0.458). There was no significant difference in the frequencies of C allele and G allele in the VVS group (n=232, 77.3%; n=68, 22.7%), the HUT-negative group (n=252, 84.0%; n=48,16.0%) and the normal control group (n=247, 82.3%; n=53, 17.7%) (χ(2)=4.659, P=0.097). The 150 children in the VVS group were further divided into the mixed-response subgroup (n=83), vasodepressor-response subgroup (n=42) and cardioinhibitory-response subgroup (n=25). The CC genotype, CG genotype and GG genotype in the mixed-response subgroup, the vasodepressor-response subgroup and the cardioinhibitory-response subgroup were (n=65, 78.3%; n=16, 19.3%; n=2, 2.4%), (n=20, 47.6%; n=11, 26.2%; n=11, 26.2%) and (n=13, 52.0%; n=9, 36.0%; n=3, 12.0%), respectively. The frequencies of C allele and G allele in the mixed-response subgroup, the vasodepressor-response subgroup, and the cardioinhibitory-response subgroup were (n=146, 88.0%; n=20, 12.0%), (n=51, 60.7%; n=33, 39.3%) and (n=35, 70.0%; n=15, 30.0%), respectively. The percentages of the GG genotype and G allele were significantly higher in the vasodepressor-response subgroup than the other two subgroups (χ(2)=21.698, 25.345, all P=0.000). Conclusions: No significant association was found between RGS2 C1114G polymorphism and VVS in children. Due to the higher distribution of GG genotype and G allele in the vasopressor-response subgroup, RGS2 C1114G may be associated with the regulation of blood pressure during the onset of VVS in children.

Predictive Tools in the Care of Blood Donors: Prevention of Vasovagal Syndrome.

Prediction in healthcare is essential in order to promote safe and quality care. Taking adequate care of blood donors, who perform an altruistic act towards society, is paramount. Therefore, the use of tools which allow to predict the risk of Vasovagal Syndrome during the act of blood donation is necessary. The objective of this study is to design a predictive engine of an expert system to determine the risk of Vasovagal Syndrome through the use of deductive methodology. Five clusters of predictors of this syndrome were obtained by applying grouping tables of the variables established by logical formulation in such a way that after combinatorial variables, 5 values were obtained for the determination of risk using a Lickert scale. With these results we could design the predictive engine that will allow the development of a computational tool to improve the quality of care of blood donors.

Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects / Respostas Cardíacas e Musculoesqueléticas aos Efeitos do Tilt Test Passivo e Ativo em Indivíduos Saudáveis

Abstract Background: Maintenance of orthostatism requires the interaction of autonomic and muscle responses for an efficient postural control, to minimize body motion and facilitate venous return in a common type of syncope called neurocardiogenic syncope (NCS). Muscle activity in standing position may be registered by surface electromyography, and body sway confirmed by displacement of the center of pressure (COP) on a force platform. These peripheral variables reflect the role of muscles in the maintenance of orthostatism during the active tilt test, which, compared with muscle activity during the passive test (head-up tilt test), enables the analyses of electromyographic activity of these muscles that may anticipate the clinical effects of CNS during these tests. Objective: to evaluate and compare the effects of a standardized protocol of active and passive tests for CNS diagnosis associated with the effects of Valsalva maneuver (VM). Methods: twenty-thee clinically stable female volunteers were recruited to undergo both tests. EMG electrodes were placed on muscles involved in postural maintenance. During the active test, subjects stood on a force platform. In addition to electromyography and the platform, heart rate was recorded during all tests. Three VMs were performed during the tests. Results: progressive peripheral changes were observed along both tests, more evidently during the active test. Conclusion: the active test detected changes in muscle and cardiovascular responses, which were exacerbated by the VM.

Resumo Fundamento: A manutenção do ortostatismo requer interação das respostas autonômicas e musculares para um controle postural eficiente e minimizar oscilações do corpo e facilitar o retorno venoso frente a um tipo comum de síncope chamada neurocardiogênica (SNC). A atividade da musculatura na posição de pé pode ser documentada por meio da eletromiografia de superfície (EMG) e as oscilações do corpo confirmadas pelo deslocamento do centro de pressão (CP) sobre uma plataforma de força. Estas variáveis periféricas mostram o papel muscular na manutenção do ortostatismo durante o tilt test ativo bem como esta atividade muscular ser comparada durante o teste passivo, Head-Up Tilt test, na tentativa de verificar alterações na atividade eletromiográfica destes músculos que podem antecipar os efeitos clínicos da SNC durante estes testes. Objetivo: Avaliar e comparar os efeitos de um protocolo padronizado para testes ativo e passivo de detecção da SNC associado ao efeito da manobra de valsalva (MV). Métodos: 23 voluntárias mulheres clinicamente saudáveis foram recrutadas para realizar ambos os testes. Os eletrodos da EMG foram posicionados em músculos associados com a manutenção postural, além de durante o teste ativo os sujeitos realizarem a postura ortostática sobre uma plataforma de força. Foi registrado além da EMG e da plataforma, a frequência cardíaca durante todo o teste. Três MV foram realizadas durante os testes. Resultados: Alterações periféricas foram verificadas de maneira progressiva ao longo dos testes, sendo mais evidente durante o teste ativo. Conclusão: o teste ativo verificou mudanças mais evidentes nas respostas musculares e cardiovasculares, amplificadas pela MV.