Cases reported "Syncope"

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11/87. The brugada syndrome: a recently recognised genetic disease causing sudden cardiac death.

    Australian doctors need to be aware of this little-known syndrome, which is a cause of sudden cardiac death. It is more common among Southeast Asian people, who make up a considerable proportion of our population. We report two cases which represent very different clinical presentations of this condition.
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12/87. Sudden unexpected death as a consequence of indinavir-induced nephropathy. A case report.

    A 60-year-old male had tested in 1986, at age 46, positive for human immunodeficiency virus (hiv). In mid-1996 he was started on a protease inhibitor regimen, which included indinavir, lamivudine and stavudine, and remained on this therapy until his death. In April 1999 he was hospitalized after a fainting episode. Although examination focusing on cardiac disease did not disclose any remarkable findings, he died suddenly one week after being discharged from hospital. At autopsy the kidneys were enlarged, with a total weight of 500 g, patchy pale gray and pinkish. microscopy showed leukocytic cell casts in many of the tubules and collecting ducts. In many of these casts there were clefts left by crystals. In the interstitium, both in the cortex and the medulla, there was focal inflammation and fibrosis. death was attributed to sudden cardiac dysfunction, probably ventricular fibrillation as a consequence of severe nephropathy with electrolyte disturbances. It is likely that kidney damage developed secondary to the indinavir treatment as indinavir can cause not only nephrolithiasis but also crystal-induced acute renal failure.
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13/87. Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart.

    syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT) way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and catecholaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.
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14/87. 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.
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15/87. Arrhythmias in neurofibromatosis. A case report and review of the literature.

    patients with neurofibromatosis have a higher incidence of anatomic cardiac abnormalities. However, there is little data regarding incidence of arrhythmias in this population. It is known that these patients have a higher mortality than the normal population, and it is possible that some deaths may be due to preventable causes such as cardiac arrhythmias. We report a patient with neurofibromatosis who was treated for a refractory seizure disorder for 8 years. However, video/EEG monitoring demonstrated that the patient had recurrent syncopal seizures secondary to sinus node dysfunction. Complete resolution of symptoms occurred after a permanent pacemaker implantation. We believe this is the first reported case of sinus node dysfunction associated with neurofibromatosis.
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16/87. Significance of inducible ventricular fibrillation in patients with coronary artery disease and unexplained syncope.

    OBJECTIVES: This study was designed to determine the incidence and prognostic significance of inducible ventricular fibrillation (VF) in patients with coronary artery disease (CAD) and unexplained syncope. BACKGROUND: Current American College of cardiology/american heart association practice guidelines recommend implantation of internal cardioverter-defibrillators (ICDs) in patients with unexplained syncope in whom either ventricular tachycardia (VT) or VF is inducible during electrophysiologic (EP) testing. Although the prognostic significance of inducible monomorphic VT is known, the significance of inducible VF remains undefined. methods: We evaluated 118 consecutive patients with CAD and unexplained syncope who underwent EP testing. Sustained monomorphic VT was inducible in 53 (45%) patients; in 20 (17%) patients, VF was the only inducible arrhythmia; and no sustained ventricular arrhythmia was inducible in the remaining 45 (38%) patients. The latter two groups of 65 (55%) patients make up the study population. RESULTS: There were 16 deaths among the study population during a follow-up period of 25.3 /- 19.6 months. The overall one- and two-year survival in these patients was 89% and 81%, respectively. No significant difference in survival was observed between patients with and without inducible VF (80% power to detect a fourfold survival difference). CONCLUSIONS: In 17% of patients with CAD and unexplained syncope, VF is the only inducible ventricular arrhythmia. Within the limits of this pilot study, long-term follow-up of patients with and without inducible VF demonstrates no difference in survival between the two groups. Therefore, the practice of ICD implantation in patients with CAD, unexplained syncope and inducible VF, especially with triple ventricular extrastimuli, may merit reconsideration.
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17/87. Familial qt prolongation and risk of sudden death.

    Two sisters with the syndrome of familial QT prolongation in the ECG and syncope are presented. A recently suggested mechanism of the syndrome is presented and preventive measures to reduce the risk of sudden death associated with it are proposed.
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18/87. 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.
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19/87. kearns-sayre syndrome: association with long qt syndrome?

    kearns-sayre syndrome has associated cardiac findings, predominantly complete heart block, which has been implicated as a mechanism of sudden death in these individuals. A patient with kearns-sayre syndrome who had syncope and multiple cardiac arrests due to ventricular tachycardia in the setting of QT prolongation is described. long qt syndrome is implicated as another possibility for sudden death in kearns-sayre syndrome. This potential association is unexplained, but now totals two reports in the small numbers of patients reported.
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20/87. Anomalous origin of the left main coronary artery from the right sinus of valsalva: disabling angina and syncope with noninterarterial courses case report of two patients.

    Anomalous origin of the left main coronary artery from the right sinus of valsalva or the right coronary artery is a rare coronary anomaly. This anomaly has been associated with sudden cardiac death in younger patients, depending on its course relative to the pulmonary artery. The authors report this rare anomaly in two patients. It presented as unstable angina in the first patient with a septal course. In the second patient, it presented as syncope with an anterior free wall course and absent left circumflex artery. A septal course causing unstable angina has not been reported previously.
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