Cases reported "Syncope"

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1/87. 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.
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2/87. andersen syndrome autosomal dominant in three generations.

    andersen syndrome is a rare entity and comprises potassium sensitive periodic paralysis, ventricular arrhythmia, and an unusual facial appearance; syncope and sudden death have also been reported. The recognition of the characteristic face permits an early diagnosis in order to detect the severe systemic manifestations that are associated with this syndrome. The genetic defect is not linked to any other form of potassium sensitive periodic paralysis nor is it related to that of the long qt syndrome; nevertheless, a prolonged QT interval can be detected in a significant proportion of the cases. Sixteen cases of this syndrome have been described. We report on a three-generation family with 10 affected members. To our knowledge, this is the largest number of cases reported in one family. We noted some additional minor anomalies such as broad forehead and malar hypoplasia. Our patients had variable expression in the classical triad and of the severity of the systemic manifestations. Five of 8 affected studied members did not have a long QTc, which has been suggested as a constant finding in this syndrome.
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3/87. 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.
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4/87. Concomitant reentrant tachycardias from concealed accessory atrioventricular bypass tract and atrioventricular nodal reentry in a patient with williams syndrome.

    williams syndrome is characterized by a constellation of features including mental retardation and supravalvular aortic stenosis. Other cardiovascular abnormalities including arrhythmias contributing to sudden death have been described in these patients. In this report we describe a case of a 49-year-old female with williams syndrome who presented with severe symptomatic supraventricular tachycardia. cardiac electrophysiology study identified a left posteroseptal concealed accessory bypass tract responsible for atrioventricular reentrant tachycardia and a concomitant typical atrioventricular nodal tachycardia. Such unusual association of combination of two different types of supraventricular tachycardia and williams syndrome has not been previously reported. Radiofrequency ablation was successfully performed to cure these arrhythmias.
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5/87. 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.
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6/87. Right ventricular cardiomyopathy showing right bundle branch block and right precordial ST segment elevation.

    A 73-year-old man who had a family history of sudden death, experienced syncope. His electrocardiogram (ECG) presented right bundle branch block and right precordial ST segment elevation which are findings identical with those in brugada syndrome. The cardiac MRI showed right ventricular mild dilatation, and endomyocardial biopsy revealed fatty replacement of myocardial fibers. Though no ventricular tachyarrhythmias were induced during an electrophysiologic test, the effects on ECG of antiarrhythmic agents and autonomic modulations were similar to those in brugada syndrome. This case may suggest the relationship between brugada syndrome and right ventricular cardiomyopathy.
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7/87. Aortoduodenal fistula presenting as acute massive gastrointestinal bleeding and recurrent syncope: case report.

    Aortoenteric fistula is a rare condition that may cause death in patients due to gastrointestinal bleeding. The duodenum is the most frequently involved site, at 78.5% of 191 cases by Nagy and Marshall's meta-analysis. It is characterized by the clinical triad of abdominal pain, gastrointestinal bleeding, and an abdominal mass. Abdominal computed tomography is the most useful tool in detecting an aortoenteric fistula. To prevent a high mortality rate, early diagnosis is necessary. Exploratory laparotomy is required for patients who are highly suspected of having an aortoduodenal fistula. Herein, we report a 60-year-old man who suffered from acute gastrointestinal bleeding, recurrent syncope, and impending shock. Abdominal computed tomography revealed a 6 cm longitudinal aneurysm in the infrarenal aorta. Emergency laparotomy was performed and revealed an aortoduodenal fistula in the fourth portion of the duodenum causing acute duodenal bleeding. The patient survived and has undergone 2 years worth of regular follow-up in our outpatient department.
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8/87. arrhythmogenic right ventricular dysplasia. An illustrated review highlighting developments in the diagnosis and management of this potentially fatal condition.

    arrhythmogenic right ventricular dysplasia is an inherited, progressive condition. Characterised by fatty infiltration of the right ventricle, it frequently results in life threatening cardiac arrhythmias, and is one of the important causes of sudden cardiac death in the young. There are characteristic electrocardiographic and echocardiographic features that all physicians need to be aware of if we are to reduce these occurrences of premature death. Diagnosis with magnetic resonance imaging is discussed along with current treatment options.
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9/87. brugada syndrome as the cause of syncope in a 49-year-old man.

    We report the case of a 49-year-old man in whom a diagnosis of brugada syndrome was made after he presented to the emergency department for evaluation of a syncopal episode. The diagnosis was made by ECG changes, after the characteristic findings of peculiar downsloping ST-segment elevation in leads V(1) and V(2) and QRS morphology resembling a right bundle branch block were identified. Emergency physician recognition of this syndrome and its ECG findings is essential, because without treatment the incidence of sudden cardiac death in these patients is high.
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10/87. arrhythmogenic right ventricular dysplasia: an uncommon cause of syncope in a young male.

    arrhythmogenic right ventricular dysplasia (ARVD) is a relatively rare disease first described in 1977. It is characterized by replacement of the right ventricle (RV) by fat or fibrous tissue. patients often present with symptomatic ventricular tachycardia (VT) and the risk of sudden death is approximately 2.5% per year. Physical exam is often unremarkable. To date, the best diagnostic test is the MRI, however, electrocardiographic and echocardiographic data are useful. Treatment can be with beta blockers if a medical approach is desired. Multiple surgical options are available. No long-term studies are available to guide therapy; thus each case should be dealt with on its merits. This article describes the case of a 41-year-old male who had been asymptomatic until he presented with syncope. An extensive work up was undertaken and ARVD was diagnosed by MRI.
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