1/37. 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 = 1keywords = near (Clic here for more details about this article) |
2/37. Ballooning posterior leaflet syndrome: syncope and sudden death.Two of four patients with ballooning posterior leaflet syndrome died suddenly and the remaining two developed a near-fatal arrhythmia. These four patients demonstrate the potentially fatal nature of the ballooning posterior leaflet syndrome.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/37. Case report of an aviator with a single episode of altered consciousness due to hymenoptera hypersensitivity.This case is presented to: a) emphasize the importance of a careful history, including interviewing witnesses and considering a complete differential diagnosis when evaluating aviators with a history of an episode of altered consciousness; and b) demonstrate an appropriate use of literature review, subspecialty consultations, and U.S. air Force Aeromedical Guidelines to arrive at an aeromedical disposition for an unusual case. A military aviator experienced an episode of syncope/near syncope, initially felt to be caused by a primary seizure or an arrhythmia. Subsequent thorough evaluation included careful history taking, extensive interviewing of witnesses, subspecialty consultations, review of appropriate literature and deliberation by a board of experienced military aeromedical physicians. Cardiac and neurologic diagnoses were considered but careful history and witness interviews revealed that the aviator had sustained an insect sting just minutes before the episode. Evaluation by allergy specialists, including skin testing, identified him as being hypersensitive to hymenoptera stings. A diagnosis of hypersensitivity reaction to a hymenoptera sting was determined to be the cause of the altered consciousness episode. review of the literature revealed that immunotherapy for hymenoptera sensitivity reduces the risk of future anaphylaxis to only 1-2% after maintenance dose is achieved. Consideration of the risk of future events and the success of rush immunotherapy resulted in a recommendation for a waiver to return the aviator to unrestricted flying duties. The importance of diligent history taking must never be forgotten. In this aviator it led to the correct diagnosis and definitive therapy. In addition, appropriate consideration of the literature and knowledge of outcome rates allowed a return to unrestricted flying for this aviator. If the original diagnosis of seizure or arrhythmia had been accepted, this aviator would have been disqualified without waiver and a valuable flying asset would have been lost.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/37. cocaine-induced bradyarrhythmia: an unsuspected cause of syncope.cocaine use is associated with adverse events in nearly every organ system. Cardiovascular complications include hemorrhagic and ischemic stroke, aortic dissection, cardiomyopathy, accelerated coronary artery disease, myocardial infarction, and sudden cardiac death. syncope may be the presenting symptom in these conditions. However, cocaine-induced bradyarrhythmias have been scarcely mentioned. As this case exemplifies, clinicians should be aware of this association when they evaluate syncope, especially in young patients.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/37. Metastatic ocular melanoma to the left ventricle inducing near-syncope attacks in an 84-year-old woman.Cardiac tumors may represent mechanical causes for syncope by limiting left ventricular filling and/or by obstructing the left ventricular outflow tract. Malignant melanoma is known to metastasize to the myocardium or pericardium, but there are only a very limited number of reports describing endocardial involvement by the tumor. We describe herein an 84-year-old woman who presented with daily near-syncope episodes, 9 years after treatment for a choroidal melanoma. The echocardiography and the pathologic examination revealed a metastatic melanoma. This is the first reported case of an ocular melanoma metastasizing to the heart and presenting as a left ventricular intracavitary pedunculated mass.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
6/37. Hypoglycemic syncope induced by a combination of cibenzoline and angiotensin converting enzyme inhibitor.A 65-year-old Japanese woman with dilated cardiomyopathy, hypothyroidism and refractory sustained ventricular tachycardia experienced a near-death hypoglycemic syncope. The attack seemed to be induced by a high level of serum insulin, probably due to cibenzoline and by concomitant use of an angiotensin converting enzyme inhibitor (ACEI). Additionally, decreased food intake because of a severe toothache may have contributed to the deterioration of her condition. This case warns cardiologists that a combined cibenzoline and ACEI therapy can provoke serious adverse effects such as hypoglycemic syncope in the elderly. Therefore, the possibility of a hypoglycemic attack associated with these drugs should be explained to patients who are in poor condition.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/37. Use of an implantable loop recorder in the evaluation of children with congenital heart disease.BACKGROUND: A recently developed implantable loop recorder (ILR) has been used in adult patients whose syncope remains unexplained in spite of extensive investigations. syncope in the patient with congenital heart disease presents a diagnostic challenge. We applied this technology to a cohort of pediatric patients. methods: We reviewed our experience with an ILR in patients with congenital heart disease with syncope or palpitations after conventional investigations failed to identify a cause for the symptoms. RESULTS: ILRs were implanted in 4 patients with congenital heart disease at 2 centers for investigation of syncope (n = 2), near-syncope (n = 1), and palpitations (n = 1). Implantations were performed at a mean age of 5.9 /- 0.9 years (4.2 to 7.6 years) and a mean weight of 26.7 /- 6.6 kg (15.7 to 42.5 kg) with patients under general anesthesia, with no complications. All patients experienced typical symptoms and activated the device appropriately at a median of 86 days (46 to 102) after implantation. Each patient had good-quality data that allowed interpretation of the rhythm. In 2 of 4 cases, a likely cause for the symptoms was identified, with exclusion of more malignant arrhythmic diagnoses in all patients. Escalation of therapy was avoidable in all patients on the basis of the data recorded by the ILR. CONCLUSIONS: Recently developed loop recorder technology can be implanted in the young child without difficulty. The ILR proved to be very useful for excluding malignant arrhythmias as a cause of symptoms in these patients at high risk.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/37. Swallow syncope.Swallow syncope is a rare disorder caused by hypersensitive vagotonic reflex in response to deglutition. A 26-year-old man complained of recurrent light-headedness and near syncope on swallowing was hospitalized for monitoring and evaluation. Continuous electrocardiographic and invasive arterial pressure monitoring showed ingestion of a solid meal evoked light-headedness and complete AV block without an escape rhythm that lasted for 5.6 seconds. This patient received a Medtronic Kappa (401B) DDDR pacemaker with the rate drop feature. The patient has remained asymptomatic on follow-up for the past 2 years.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/37. An unusual cause of new-onset atrial flutter: primary cardiac lymphoma.Primary cardiac lymphoma is a rare disease with a high mortality rate due to the advanced stage of myocardial involvement at presentation. The diagnosis is extremely difficult to make because of the rarity of the disease, variability of clinical manifestations, limited noninvasive diagnostic techniques available, and difficulties and/or delays in the use of invasive measures. The incidence of the disease is increasing, especially among immunocompromised patients, with those suffering from acquired immunodeficiency syndrome accounting for the greatest increase. We report the case of an immunocompetent 76-year-old black woman who presented with near-syncopal episodes. Transthoracic echocardiogram revealed a right atrial mass. Surgical resection was performed, and a diagnosis of large B-cell non-Hodgkin's lymphoma was made. Primary cardiac lymphoma should be considered in any patient with a cardiac mass. Prompt diagnosis and treatment of primary cardiac lymphoma is imperative for survival.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/37. Abnormal somatosensory evoked potentials in two patients with conversion disorder.On clinical grounds, somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) are currently used to discriminate between hysterical and neurological conditions. The present paper reports on two patients with severe gait disturbance who had the near-total absence of SEP responses on the scalp during the symptomatic period, which normalized after recovery. These findings, along with others, may shed light on the brain correlates of conversion phenomena.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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