Cases reported "Syncope"

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11/64. Reversible ventricular dysfunction (takotsubo cardiomyopathy) following polymorphic ventricular tachycardia.

    A 67-year-old female with recurrent syncope and no obvious heart disease developed ventricular dysfunction, known as takotsubo cardiomyopathy, following a 90 s episode of polymorphic ventricular tachycardia originating from a ventricular extrasystole with a short coupling interval. cardiac catheterization performed 30 min after the arrhythmic event revealed angiographically normal coronary arteries, and left ventricular apical akinesis and basal hyperkinesis. An intracoronary injection of acetylcholine revealed no inducible coronary spasm, and an electrophysiological study revealed normal atrioventricular conduction and no inducible ventricular arrhythmia. Thirty hours after the arrhythmic event, electrocardiography revealed deeply inverted T waves in leads V3 to V6, I, and aVL, which continued for more than a week. Although no treatment was given to maintain hemodynamic stability, echocardiography revealed normal left ventricular contraction 14 days after the onset of the ventricular dysfunction. The reversible ventricular dysfunction might have been induced by altered catecholamine dynamics due to the persistent syncope during the occurrence of tachycardia.
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12/64. role of early afterdepolarization in familial long QTU syndrome and torsade de pointes.

    Torsade de pointes (TdP) syncopal episodes were almost invariably precipitated by emotional stress or menstruation in a 17-year-old girl. U wave accentuation occurred during sinus rhythm without pauses in periods of heightened sympathetic tone. To examine the role of early afterdepolarization (EAD), monophasic action potentials were recorded during ventricular extrasystoles and TdP occurring spontaneously and induced by ventricular pacing. The effects of lidocaine, verapamil, propranolol, and epinephrine were assessed. Our data show that: (1) EAD plays a significant role in the genesis of familial long QTU syndrome and TdP; (2) rapid ventricular pacing causes postpause-dependent EADs, U waves, and TdP; and (3) EAD is enhanced by epinephrine infusion in the absence of pause, whereas EAD-triggered firing is inhibited by verapamil and propranolol but not by lidocaine.
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13/64. Moyamoya syndrome after prophylactic cranial irradiation for acute lymphocytic leukemia.

    A 9-year-old boy presented with an episode of syncope, and MR imaging revealed bilateral internal carotid artery stenosis with moyamoya vessel formation. He had had prophylactic cranial irradiation at a total dose of 24 Gy for the treatment of acute lymphocytic leukemia at the age of 4. Following this, he was in a complete state of remission for 6 years. During an observation period of a year after the onset of syncope, MR imaging showed development of multiple ischemic lesions in both hemispheres. He developed a transient ischemic attack of mild motor weakness in his arm and an indirect anastomosis was performed on the severely affected side at the age of 10. Radiation-induced vasculopathies are known to be associated with primary diseases of intracranial tumors, but the frequency is unclear. Ours is the third case in whom prophylactic cranial irradiation for a hematological disorder might have induced cerebral vasculopathies.
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keywords = frequency
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14/64. Electrical alternans in long qt syndrome resembling a brugada syndrome pattern.

    Isolated T wave alternans (repolarization alternans) is frequently associated with long qt syndrome. However, electrical alternans involving the P wave, QRS complex, ST segment (depolarization alternans), and the T wave is a rare finding. This report describes a 62-year-old woman with long qt syndrome and an electrical alternans occurring after previous syncope. Alternating QRS complexes showed a prolonged PR interval, a brugada syndrome resembling pattern of the QRS complexes (elevation and downslope of the ST segments), and a T wave alternans. A genetic basis for the long qt syndrome has been ruled out by sequencing of all coding areas of the LQT genes. Potential mechanisms for the electrical alternans are discussed.
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15/64. Spontaneous ventricular tachycardia and fibrillation in a patient with a positive microvolt T wave alternans test and negative electrophysiological study.

    This report describes a patient with a previous myocardial infarction who presented with syncope. The patient had a positive microvolt T wave alternans test, a negative electrophysiological study, and a normal heart rate variability. In hospital, the patient had episodes of ventricular tachycardia and fibrillation. An implantable cardioverter defibrillator was implanted and during the following week it discharged appropriately.
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16/64. Acute cardiac ischemia in patients with syncope: importance of the initial electrocardiogram.

    OBJECTIVE: To determine the prevalence of acute cardiac ischemia in emergency department (ED) syncope patients without chest pain and to determine which of these patients are at high risk for acute cardiac ischemia. DESIGN: Data were collected prospectively during a study of ED triage of patients who had had possible acute cardiac ischemia. Supplemental retrospective review of records was performed to differentiate syncope from dizziness. SETTING: Six hospital EDs in new england (two primary teaching hospitals in urban locations, two medical-school-affiliated teaching hospitals, and two nonteaching hospitals in rural settings). patients: 5,762 patients had presented to the ED with chief complaints consistent with acute cardiac ischemia, including chest pain, shortness of breath, dizziness, and syncope. The study sample consisted of 251 patients who had had syncope and no chest pain. RESULTS: The prevalence of acute cardiac ischemia among the syncope patients was 7% (18 of the 251 patients). Univariate analysis revealed the following to have significant association with acute cardiac ischemia: ischemic abnormalities on the electrocardiogram (ECG) obtained in the ED (p less than 0.001), arm or shoulder pain on presentation (p less than 0.05), rales (p less than 0.1), and prior history of exercise-induced angina (p less than 0.05) or myocardial infarction (p less than 0.1). All 18 patients with acute cardiac ischemia had ischemic abnormalities (pathologic Q waves, ST-segment elevation or depression, or T-wave abnormalities) on their presenting ECGs. CONCLUSION: For syncope patients who have no chest pain or ischemic abnormality on the presenting ECG in the ED, acute ischemia appears to be unlikely. Admission to the cardiac care unit for these patients for possible myocardial ischemia is probably unnecessary. However, patients who have syncope and ischemic abnormalities on the ECG are at risk for acute cardiac ischemia, even in the absence of chest pain. Hospital admission to rule out myocardial infarction for these patients is prudent.
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17/64. Flutter and fibrillation-like phenomenon of His bundle observed in a patient with persistent atrial standstill.

    A diagnosis of persistent atrial standstill was made in a patient with syncopal attacks, based on: (1) the lack of P waves both in the routine 12-lead electrocardiogram (ECG) and in the right atrial cavity lead; (2) the absence of "a waves in the right atrial pressure curve; and (3) the failure of the atria to respond to electrical stimulation. Compared with previously reported cases of persistent atrial standstill with a slow, regular escape rhythm of supraventricular origin, the present case was characterized by alternate periods of bradycardia and tachycardia, the latter being suggested as AV junctional tachycardia with exit block. Furthermore, the His bundle electrogram (HBE) showed either regular, high frequency deflictions or irregular, deformed potentials, suggesting flutter and fibrillation-like phenomena in the His bundle.
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keywords = wave, frequency
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18/64. Induction of epileptic negative myoclonus by oxcarbazepine in symptomatic epilepsy.

    Provocation of various seizure types including epileptic negative myoclonus and generalised atonic seizures is rarely observed in children treated with carbamazepine (CBZ). Provocation of the latter seizure types by oxcarbazepine (OXC) is not described in the literature. We report a four year-old boy with symptomatic epilepsy caused by left-sided cerebral atrophy of unknown origin who developed numerous daily drop attacks when exposed to OXC. Polygraphic analysis revealed secondary generalised precentral sharp-slow waves frequently associated with a silent period lasting for 100-150 ms in the electromyogram recorded from the deltoid and neck muscles. These seizures stopped promptly within 36 hours after discontinuation of OXC. This case demonstrates that OXC, similar to CBZ, can provoke epileptic negative myoclonus in some children with focal epilepsies. [Published with videosequences].
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19/64. Angina-like chest pain and syncope as the clinical presentation of left ventricular endomyocardial fibrosis: a case report.

    A 47-year-old woman complained of angina-like chest pain, near-syncope, and syncopal episodes of 17 years' duration. physical examination was unremarkable. A 12-lead resting ECG showed symmetrically inverted T waves in the inferior and anterolateral leads. A graded treadmill exercise stress test precipitated angina-like chest pain accompanied by a near-syncopal episode associated with a systemic arterial pressure of 60/40 mm Hg. echocardiography disclosed left ventricular apical obliteration. Left ventriculogram showed a typical "ace of heart'' shadow as well as filling defects and apical obliteration. Endomyocardial biopsy of the left ventricle diagnosed left ventricular endomyocardial fibrosis. Thus, angina-like chest pain and near-syncopal episodes should be added to the list of clinical manifestations of pure left ventricular endomyocardial fibrosis.
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20/64. The head-up tilt test and the differential diagnosis between epileptic attacks and syncope. Case report.

    Often patients who have undergone a false diagnosis of epileptic attack have actually been affected by syncope. One of the most common causes of such misdiagnosis is an abnormal interictal electroencephalographic (EEG) trace. The purpose of this paper is to suggest the usefulness of the head-up tilt test as a differential diagnosis between epileptic attack and syncope. patients underwent the head-up tilt test, which was considered positive only if the syncopal symptomatology was reproduced. The subjects were patients in a neuropsychiatric clinic. Four patients with a positive anamnesis due to brief episodes of unconsciousness and to falls were assessed. All 4 patients showed an abnormal EEG with focal spikes and sharp-waves. The head-up tilt test produced a syncope in all 4 cases. In the symptomatology evoked by the test the patients and their parents recognized the exact same characteristics of those episodes for which they had sought consultation, so a diagnosis of a vasovagal syncope of 3 different types was made. The head-up tilt test proved appropriate to differentiate syncope from epileptic attacks in patients with symptoms of unconsciousness, falls and interictal EEG spikes or sharp-waves.
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