1/333. syncope two years after hysterectomy.A 61-year-old woman presented to the emergency department after experiencing palpitations, shortness of breath, and syncope while taking a shower. Her husband revived her with mouth-to-mouth resuscitation. She had had a similar episode three days earlier while making her bed and had lost consciousness for about 10 sec. She did not appear to have had a seizure. Five months earlier, while taking a walk, she had experienced dizziness, dyspnea, and chest pressure lasting about an hour. A workup at that time included cardiac catheterization, lung scanning, and esophagogastroduodenoscopy, but no abnormality was found. lower extremity edema was noted.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
2/333. Neurally mediated syncope in 2 patients with extracardiac disease.We describe the cases of 2 patients with repetitive episodes of syncope with profound bradycardia and hypotension. In both patients, the symptoms were initially thought to be neurally mediated and idiopathic but were ultimately determined to be triggered by serious underlying pathologic processes: a massive and locally invasive tumor of the hypopharynx in 1 patient and a gangrenous gallbladder in the other. Appropriate treatment resulted in a resolution of this syndrome in both patients. These cases emphasize the importance of an appropriate evaluation and broad differential diagnoses for patients with severe bradycardia and hypotension.- - - - - - - - - - ranking = 4keywords = cardiac (Clic here for more details about this article) |
3/333. Cardiac syncope secondary to glossopharyngeal neuralgia--effectively treated with carbamazepine.A 64-year-old male with glossopharyngeal neuralgia, cardiac asystole and grand mal seizures has been relieved of his attacks by intake of 400 mg of carbamazepine per day over a 4-year period. Simultaneous EEG-EKG recordings before and after drinking water document the diagnosis.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
4/333. syncope in the pediatric patient. The cardiologist's perspective.The evaluation of syncopal children or adolescents relies heavily on a thorough, detailed history and physical examination. All syncope associated with exercise or exertion must be considered dangerous. The ECG is mandatory, but other laboratory tests are generally of limited value unless guided by pertinent positives or negatives in the history and physical examination. The ECG allows screening for dysrhythmias, such as wolff-parkinson-white syndrome, heart block, and long qt syndrome, as well as hypertrophic cardiomyopathies and myocarditis. Tilt table testing can be useful in selecting therapy by demonstrating the physiologic response leading to syncope in an individual patient. The most common type of syncope in otherwise healthy children and adolescents is neurocardiogenic or vasodepressor syncope, which is a benign and transient condition. Because syncope can be a predictor of sudden cardiac death, it must be taken seriously, and appropriate screening must be performed.- - - - - - - - - - ranking = 1.9988053942117keywords = cardiac, heart (Clic here for more details about this article) |
5/333. Convulsive syncope following placement of sphenoidal electrodes.Two cases of convulsive syncope following the insertion of sphenoidal electrodes are reported. The episodes occurred shortly after an uneventful insertion of the needle. Both patients exhibited behavioral arrest with loss of muscle tone, followed by flexor posturing, jerking of the extremities, then followed by what appeared to be a panic attack. Episodes were clinically distinct from the patients' typical spells and were initially interpreted as representing psychogenic events. EEGs during the episodes showed diffuse slowing followed by generalized suppression of rhythms. Simultaneous EKG showed bradycardia followed by brief asystole and then resumption of normal heart rhythms in both cases. Vagally mediated cardioinhibitory reactions induced by fear, pain and possibly stimulation of branches of the trigeminal nerve in the face represent an uncommon but potentially serious complication of placement of sphenoidal electrodes.- - - - - - - - - - ranking = 0.99880539421169keywords = heart (Clic here for more details about this article) |
6/333. Metastatic germ cell tumor to the heart presenting with syncope.Malignant nonseminomatous germ cell tumors (NSGCT) rarely metastasize to the heart. The first such case presenting with syncope is described. Eight previously described cases of NSGCT with intracaval metastasis to the heart are reviewed and the literature to date is discussed. Transesophageal echocardiography is the diagnostic study of choice and treatment consists primarily of platinum-based chemotherapy followed by surgical resection of residual deposits.- - - - - - - - - - ranking = 5.9928323652702keywords = heart (Clic here for more details about this article) |
7/333. Continuous haemodynamic monitoring in an unusual case of swallow induced syncope.A 69 year old man is described with a 12 year history of intermittent syncope associated with ingesting solid food, mainly after having fasted. He was taking enalapril, propranolol, bendrofluazide (bendroflumethiazide), omeprazole, finasteride, and aspirin. Detailed investigations, including gastrointestinal evaluation, measurement of various gut hormones, and autonomic testing, indicated no abnormality. A liquid meal, performed before fasting, failed to elicit an episode. However, a solid meal after an overnight fast provoked near-syncope. Continuous non-invasive haemodynamic monitoring (with a Portapres II) indicated a short lived rise in blood pressure and heart rate, followed by severe hypotension, a fall in stroke volume and cardiac output, and then bradycardia. This favoured an initial increase in sympathetic activity, followed by vasodepression due to sympathetic withdrawal or activation of humoral vasodilatatory mechanisms, with bradycardia secondary to impaired cardiac filling. Withdrawal of enalapril abolished the episodes. The unusual nature of this case, in which haemodynamic recordings continuously were made during and after swallow syncope, induced soon after food ingestion, is discussed.- - - - - - - - - - ranking = 2.9988053942117keywords = cardiac, heart (Clic here for more details about this article) |
8/333. Repeat syncopal attacks due to postsurgical right ventricular pseudoaneurysm.Pseudoaneurysm of the right ventricular outflow tract is a rare lesion caused by disruption of the ventricular wall that allows the blood to leak into the surrounding space. It often complicates surgery involving right ventriculotomy and progressively increases in size, therefore causing airway compression, pulmonary perfusion asymmetry, thromboembolism, and rupture. We report on a patient who developed right ventricular pseudoaneurysm early after surgery for atrio-ventricular septal defect with tetralogy of fallot and needed emergency surgical repair due to low cardiac output and repeat syncopal attacks.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
9/333. Lyme carditis: complete AV dissociation with episodic asystole presenting as syncope in the emergency department.We report a case of Lyme carditis in an otherwise-healthy young male who presented to the Emergency Department (ED) with syncope and a possible seizure. This patient, without documented history of lyme disease, acutely developed third-degree atrioventricular (AV) block with episodic asystole, which required placement of a transvenous pacemaker in the ED and resolved only after the patient had been placed on ceftriaxone. We discuss the significance of Lyme carditis and its increasing prevalence, and review the current literature. We also recommend appropriate screening modalities for patients with known lyme disease, or an atypical profile for cardiac abnormalities.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
10/333. A case of sinus arrest and vagal overactivity during REM sleep.A young man presented with tachycardia and faintness after an episode of influenza. He underwent 24-h heart rate recordings, each of which documented episodes of sinus arrest lasting up to 7.2 seconds. All episodes occurred in the second half of the night and were always accompanied by severe bradycardia. Cardiac function tests failed to disclose anything abnormal. Two polysomnographic recordings demonstrated that the sinus arrests occurred during REM sleep. Power spectral analysis of heart rate variability showed that during the second half of the night there was an abnormal prevalence of vagal activity, particularly during REM sleep stages, presumably responsible for the bradycardia and fall in blood pressure. We speculate that the episodes of sinus arrest are linked to a central mechanism that triggers the autonomic imbalance during REM sleep.- - - - - - - - - - ranking = 1.9976107884234keywords = heart (Clic here for more details about this article) |
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