1/45. bradycardia, reversible panconduction defect and syncope following self-medication with a homeopathic medicine.Alkaloid extracts from the plant aconitum species have been used in various forms of herbal remedies predominantly as anti-inflammatory and analgesic agents. Many of these alkaloids are extremely potent cardiotoxins and documented cases of various arrhythmias with fatal outcomes have been reported. We report a case of self-medication with 'tincture of aconite' resulting in severe bradycardia, reversible panconduction defect evidenced by sinus inactivity, atrioventricular dissociation with idiojunctional rhythm and left bundle branch block pattern resulting in hypotension and syncope. Complete reversal of ECG findings with marked improvement in symptoms was noted within a few hours. Herbal medicines containing aconite alkaloids may result in severe cardiotoxicity, and strict regulatory measures are warranted to curb unsupervised use for therapeutic purposes.- - - - - - - - - - ranking = 1keywords = syncope (Clic here for more details about this article) |
2/45. Symptomatic hypotension during arm cycle ergometry exercise: a report of five cases.We report five cases of vasovagal and vasodepressor syncope or near-syncope that occurred during arm cycle ergometry. In each case, arm exercise in the seated position had been performed immediately after dynamic leg exercise. A likely mechanism involves a decrease in preload from venous pooling of blood in the lower extremities after leg exercise, and excessive stimulation of ventricular mechanoreceptors with resultant sympatho-inhibition and enhanced vagal tone. Four of the cases occurred early in the course of the exercise program, between the 8th and 10th sessions. The single case of true syncope occurred in a patient not receiving a beta-receptor blocking medication. No further events occurred when the exercise regimen was changed such that arm cycle ergometry was performed before leg exercise. We recommend that when arm ergometry is incorporated into an exercise program: (1) a cool-down period of exercise is performed after dynamic leg exercise, or (2) arm exercise is performed before dynamic leg exercise. These maneuvers may preclude the occurrence of symptomatic hypotension.- - - - - - - - - - ranking = 2.9935790927804keywords = vasodepressor, syncope, vasovagal (Clic here for more details about this article) |
3/45. suicide attempt by pure citalopram overdose causing long-lasting severe sinus bradycardia, hypotension and syncopes: successful therapy with a temporary pacemaker.In few cases, pure citalopram overdose at doses above 600 mg showed electro-cardiographic changes with prolonged QT intervals and sinus bradycardia gradually resolving within 12-24 hours after intoxication. We report on a 32-year-old patient with borderline personality disorder (BPD) who ingested a total of 800 mg citalopram to attempt suicide due to an interpersonal disappointment. She developed severe sinus bradycardia with a minimal pulse rate of 41/min within about 4 hours after intoxication lasting up to six days during intensive care unit (ICU) treatment. Further, hypotension and syncopes occurred. No QT interval prolongations were recorded. To our knowledge, this is the first case report of pure citalopram overdose-induced long-lasting sinus bradycardia associated with severe hypotension and intermittent syncopes that required therapy with a temporary pacemaker.- - - - - - - - - - ranking = 1.2keywords = syncope (Clic here for more details about this article) |
4/45. Nitritoid reactions: case reports, review, and recommendations for management.OBJECTIVE: We assessed nitritoid reactions, which are a well recognized side effect of chrysotherapy that occur in roughly 5% of patients taking gold sodium thiomalate (GST). methods: Between January 1996 and January 2000, 8 patients followed in our gold monitoring program at Mary Pack arthritis Centre experienced nitritoid reactions observed by the clinic nurse. We undertook a chart review to determine the risk factors, timing, course, and outcome of nitritoid reactions. RESULTS: patients' ages ranged from 36 to 69 years, and 7 of 8 were women. Duration of gold therapy prior to nitritoid reactions ranged from 13 months to 13 years. Seven had previously had mucocutaneous reactions, and one experienced gold dermatitis following a nitritoid reaction. Two of 8 patients were taking angiotensin converting enzyme inhibitor agents. Seven reactions were classified as mild, and one was a severe reaction with hypotension, syncope, and angina. CONCLUSIONS: Management includes a high index of suspicion in patients experiencing nausea, flushing, or dizziness following gold injections, switching from GST to gold sodium aurothioglucose, injection in the recumbent position, and observation for 20 minutes after injections in individual patients.- - - - - - - - - - ranking = 0.2keywords = syncope (Clic here for more details about this article) |
5/45. Painless acute aortic dissection and rupture presenting as syncope.Acute aortic dissection is an emergency that may not only cause significant morbidity but often results in death. A timely diagnosis can prove difficult in the event of an atypical presentation. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature. This article reports on a case of a completely painless acute dissection and rupture in a middle-aged man who presented with syncope. The diagnosis was made by a combination of clinical suspicion, emergent bedside echocardiography, and computed tomography scan. This patient underwent immediate surgery, and ultimately had a successful outcome.- - - - - - - - - - ranking = 1keywords = syncope (Clic here for more details about this article) |
6/45. Alcohol-induced sinus bradycardia and hypotension in patients with syncope.We observed 2 cases of repeated episodes of syncope after alcohol ingestion. Both patients were light drinkers and had carotid sinus hypersensitivity. In both cases, alcohol loading tests repeatedly induced sinus bradycardia and hypotension 1.0-1.5 hours after drinking alcohol. atropine was effective in improving symptoms. A loading test using a glucose solution of equivalent osmolarity and volume was negative. Acute alcohol ingestion usually increases heart rate with variable effects on blood pressure. However, our 2 cases exhibited unusual alcohol-induced sinus bradycardia and hypotension, suggesting a paradoxical increase in parasympathetic activity and/or decrease in sympathetic activity.- - - - - - - - - - ranking = 1keywords = syncope (Clic here for more details about this article) |
7/45. Persistent hypotension associated with hypermedullipinemia: a new syndrome.A new syndrome is described in a patient with advanced renal insufficiency. This consists of severe and persistent hypotension causing weakness but associated with a clear mental status. Also present is evidence for decreased vascular reactivity. The hypotension was not orthostatic. The hypotension was associated with a circulating vasodepressor substance having the characteristics of medullipin 1. The medullipin appears to have been derived from the remaining right kidney. hypotension existed despite the presence of major prohypertensive mechanisms, including an endstage kidney, hyperreninemia and hyperaldosteronemia. It is likely that hypotension due to hypermedullipinemia is an entity occurring in the human being.- - - - - - - - - - ranking = 2.2733287470956keywords = vasodepressor (Clic here for more details about this article) |
8/45. A case of vasovagal syncope with convulsions--the effects of midodrine hydrochloride.A 42-year-old female had suffered from repeated syncope. She had vasovagal syncope with convulsions from vasodilatation and cardiac standstill which lasted for 9.8 sec. The 60 degrees head-up tilt test, nitroglycerin injection and isoproterenol infusion provoked vasovagal reaction. Although a beta blocker was not effective in preventing tilt-induced hypotension and bradycardia, midodrine hydrochloride (alpha-1 stimulant) or atropine prevented it. In this patient, insufficient constriction of capacitance vessels might have played an important role in activation of an inhibitory reflex from cardiopulmonary mechanoreceptors which caused hypotension and bradycardia.- - - - - - - - - - ranking = 1.9215020741085keywords = syncope, vasovagal (Clic here for more details about this article) |
9/45. Decreased bispectral index as an indicator of syncope before hypotension and bradycardia in two patients with needle phobia.We report two cases who exhibited a decrease in their bispectral index (BIS) score, associated with syncope during venipuncture in patients with suspected needle phobia. In case 1, the reduction in BIS score occurred during the development of hypotension and bradycardia and may well have been caused by cerebral hypoperfusion. In case 2, the patient lost consciousness with decreasing BIS score before hypotension and bradycardia; this patient's condition could not be completely explained by cerebral hypoperfusion as a result of a vasovagal reflex because the patient's blood pressure and heart rate remained normal during the syncopal episode.- - - - - - - - - - ranking = 1.1202503456847keywords = syncope, vasovagal (Clic here for more details about this article) |
10/45. Near-syncope after exercise.syncope and near-syncope are great diagnostic challenges in medicine. On the one hand, the symptom may result from a benign condition and pose little or no threat to health other than that related to falling. On the other hand, syncope or near-syncope can be the manifestation of a serious underlying condition that poses an imminent threat to life. patients with a cardiac cause of syncope are at far greater risk of dying in the first year after an episode of syncope or near-syncope than individuals with a noncardiac cause. A cardiac cause of syncope should be considered in every patient with syncope or near-syncope, but it is particularly common in older patients or in patients with known structural heart disease, arrhythmia, or certain electrocardiographic abnormalities. Although many diagnostic tests may be helpful in the evaluation of syncope and near-syncope, the history, physical examination, and electrocardiogram pinpoint the cause in many circumstances. syncope after exercise may be due to left ventricular outflow tract obstruction from aortic stenosis or hypertrophic obstructive cardiomyopathy but can also suggest the diagnosis of postexercise hypotension in which an abnormality in autonomic regulation of vascular tone or heart rate results in vasodilation or bradycardia after moderate-intensity aerobic activity. The patient discussed in this case highlights the importance of the clinical history in the evaluation of this condition, since the diagnosis was revealed as the patient's story was described and eventually acted out.- - - - - - - - - - ranking = 3keywords = syncope (Clic here for more details about this article) |
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