1/51. Orthostatic hypotension improved after bilateral carotid endarterectomy--case report.A 60-year-old male with recurrent syncopal attacks presented with orthostatic hypotension on the head-up tilt test. angiography also showed severe stenosis of the bilateral extracranial carotid arteries. He underwent two-staged bilateral carotid endarterectomy. After the operations, the orthostatic hypotension resolved and the syncopal attacks have disappeared completely. Orthostatic hypotension in this patient was due to vasodepressor-type carotid sinus syndrome caused by compression of the carotid baroreceptors by atherosclerotic plaques.- - - - - - - - - - ranking = 1keywords = vasodepressor (Clic here for more details about this article) |
2/51. Successful treatment of severe orthostatic hypotension with cardiac tachypacing in dual chamber pacemakers.Orthostatic hypotension is an evolving and disabling disease usually observed in elderly patients with dramatic consequences on morbidity, mortality, and impairing the quality of life. We studied the effects of the pacing rate and AV interval on the blood pressure drop in the upright position in two patients with previously implanted pacemakers for sinus node dysfunction. Although the AV interval did not affect the blood pressure drop in the upright position, tachypacing at 100 paces/min improved it dramatically and prevented syncope. Cardiac tachypacing is a useful therapeutic option in severe refractory orthostatic hypotensive patients, especially those with chronotropic incompetence.- - - - - - - - - - ranking = 0.12823280605526keywords = syncope (Clic here for more details about this article) |
3/51. Downbeating nystagmus and postural hypotension due to basilar invagination.Downbeating nystagmus is an involuntary vertical rhythmic eye movement with the fast component in the downward direction. The sign indicates a craniocervical disorder. The most common cause is the arnold-chiari malformation, followed by cerebellar degeneration. Basilar invagination is a rare cause of downbeating nystagmus. However, with appropriate treatment its prognosis is good. Here, we report a case of basilar invagination which presented with downbeating nystagmus and postural hypotension. A 31 year-old Thai male patient had a 20 year history of postural hypotension. He had recurrent pneumonia and cough-induced syncope a year before admission. He complained of symptoms of an acute febrile illness and a productive cough. The physical examination showed high grade fever, postural hypotension and medium crepitation in the right upper lobe. The neurological examination showed downbeating nystagmus, atrophy and fasciculation of the right side of the tongue, atrophy of the right sternocleidomastoid muscle, mild weakness of the extremities and generalized hyperreflexia. The cervical spine X-ray revealed upward displacement of the vertebral bodies of C1 and C2, with a mild narrowing of the space between C1 and the occiput. The CT-myelogram and MRI showed upward displacement of C1 with overriding of the dens over the anterior lip of the foramen magnum; this also compressed the medulla. syringomyelia was seen at the C1-C5 level. We report a patient who presented with postural hypotension, recurrent pneumonia and downbeating nystagmus due to basilar invagination. The symptoms were aggravated by cough which caused an increase in intracranial pressure. This resulted from medulla compression in the foramen magnum by the first cervical spine. The treatment of choice was surgical decompression.- - - - - - - - - - ranking = 0.12823280605526keywords = syncope (Clic here for more details about this article) |
4/51. Initial orthostatic hypotension as a cause of recurrent syncope: a case report.A 60-year-old male patient with recurrent unexplained syncope on standing was studied. During continuous, noninvasive blood pressure (BP) recording with a Finapres device, an abnormally large and symptomatic initial decrease in systemic BP was documented. After 2 minutes of standing, BP had recovered. The transient decrease in BP was attributed to the use of a combination of antidepressants known to interfere with sympathetic function. This case shows the importance of continuous, noninvasive BP measurement on standing: routine intermittent BP recording would have missed the abnormality. In patients using medications such as antidepressants, initial transient hypotension should be considered as the cause of falls and syncope.- - - - - - - - - - ranking = 0.76939683633154keywords = syncope (Clic here for more details about this article) |
5/51. Successful treatment of severe orthostatic hypotension with erythropoietin.A 71-year-old man, who was diagnosed with familial amyloidosis type I, was admitted for treatment of severe orthostatic hypotension associated with recurrent syncopal attacks. head-up tilt testing demonstrated severe orthostatic hypotension (114/72 mmHg in the supine position and 62/34 mmHg in the upright position) with syncope or presyncope. Oral midodorine and fludrocortisone therapies failed to prevent his symptoms. After administration of subcutaneous erythropoietin, his blood pressure drop in the upright position was decreased and symptoms disappeared unassociated with improvement of anemia. Although previous reports have shown that the mechanism by which erythropoietin improves orthostatic hypotension is related to improvement in anemia, other mechanisms may also play a role.- - - - - - - - - - ranking = 0.25646561211051keywords = syncope (Clic here for more details about this article) |
6/51. Clinical effects of elastic bandage on neurogenic orthostatic hypotension.Neurogenic orthostatic hypotension (OH) often causes troublesome symptoms such as dizziness, syncope and falling, interfering active daily life or various therapies in rehabilitation. Nonpharmacologic measures for treating patients with OH include wearing elastic leotard, head-up tilting at night, etc. Elastic garment or antigravity suits is certainly effective, but it may be uncomfortable and not practical. Although elastic bandage (EB) bound on the lower limbs has been thought to be useful, there is few clinical report about its beneficial evidence. We investigated short-term clinical effects of commercially available EB on OH, and estimated the mechanism of its effectiveness by measuring some blood pressure-related humoral variables in neurodegenerative patients with OH.- - - - - - - - - - ranking = 0.12823280605526keywords = syncope (Clic here for more details about this article) |
7/51. Sympathoinhibition and hypotension in carotid sinus hypersensitivity.carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.- - - - - - - - - - ranking = 0.12823280605526keywords = syncope (Clic here for more details about this article) |
8/51. Provoking vasodepressor syncope with head-up tilt-table testing.head-up tilt testing has proven effective in identifying individuals prone to vasodepressor syncope (VDS). VDS refers to the transient loss of consciousness/cerebral anoxia seen with hypotension produced by autonomic imbalance. In this case, the hypotension is the result of parasympathetic domination. Most episodes appear to be triggered by reduced venous return which stimulates the cardiac mechanoreceptors in the inferior-posterior left ventricle. Once activated, these receptors send out afferent signals along the unmyelinated C of the vagus nerve and cause vasodilation. Once venous return is restored, the usual sympathetic compensations (increased heart rate/force of contraction and vasoconstriction) overcome the parasympathetic domination. A tilt-study allows one to passively tilt the patient up to 40-80 degrees and abruptly reduce venous return in a controlled environment. One can then determine which mechanism will dominate--the usual sympathetic vasoconstriction or the parasympathetic reflex (Bezold-Jarisch)--by frequent observations of blood pressure and ECG. bradycardia/ventricular standstill may also occur during parasympathetic domination. Once susceptibility to vasodepressor syncope is identified by a tilt study, medications to expand the blood volume and/or minimize venous pooling are often needed. Other drugs to block the parasympathetic pathway and/or the effects of excessive catecholamine levels may also be ordered. Dual chamber pacing may be required for malignant episodes of bradycardia or ventricular standstill.- - - - - - - - - - ranking = 6.7693968363315keywords = vasodepressor, syncope (Clic here for more details about this article) |
9/51. Prolonged asystole during head-up tilt table testing after beta blockade.Neurally mediated vasodepressor syncope is a common clinical problem. The diagnosis is generally associated with a benign prognosis, however, a less common "malignant" form has been identified. head-up tilt table testing is helpful in the confirmation of the diagnosis of neurally mediated vasodepressor syncope and may be useful in the selection of therapy. One form of therapy commonly used is beta blockade. In this case report we describe a patient with neurally mediated vasodepressor syncope who developed asystole during head-up tilt table testing after treatment with a beta blocker.- - - - - - - - - - ranking = 3.3846984181658keywords = vasodepressor, syncope (Clic here for more details about this article) |
10/51. case reports and review of postural orthostatic tachycardia syndrome (POTS).postural orthostatic tachycardia syndrome (POTS) is a type of orthostatic intolerance that is characterized by excessive tachycardia and decreased cerebral blood flow in the upright position. This can result in significant symptoms of dizziness and light-headedness that can eventually lead to syncope. In this review, we describe two patients with POTS that varied in their degree of symptoms and treatment. One patient was able to be treated as an outpatient, while the other required hospitalization and extensive medical therapy. We would like to emphasize with this review that POTS is probably more common than it is diagnosed and is often confused with other conditions, such as chronic fatigue syndrome or functional syncope. It is important to make the correct diagnosis in order to allow appropriate treatment and to improve the quality of life for these patients.- - - - - - - - - - ranking = 0.25646561211051keywords = syncope (Clic here for more details about this article) |
| | Next -> |