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Syncope: Physiology, Pathophysiology and Aeromedical Implications
Published in Anthony N. Nicholson, The Neurosciences and the Practice of Aviation Medicine, 2017
David A. Low, Christopher J. Mathias
Syncope (or fainting) is defined as a transient loss of postural tone and/or consciousness due to transient global cerebral hypoperfusion (Moya et al., 2009). The regulation of blood pressure and thus maintenance of cerebral blood flow within normal limits are critical in preserving adequate cerebral oxygenation and ensuring consciousness (van Lieshout et al., 2003). Neural and non-neural mechanisms must ensure effective and rapid return of blood to the heart and continued delivery to the brain, particularly in the upright posture, where the anatomical positions of the brain and the heart and the hydrostatic gradient imposed by gravitational stress result in about 70 per cent of the body’s blood volume being located below the heart (Rowell, 1993). A precipitous decrease in blood pressure may lead to inadequate cerebral perfusion, potentially causing reduced physical and/or mental capacity and syncope. Moreover, a syncopal episode may lead to injury through loss of postural tone and to seizures as a result of cerebral hypoxia. Furthermore, if the syncopal attack and the cerebral hypoperfusion continue to be unresolved, irreversible damage can occur. The cardiovascular system has to monitor and regulate blood pressure continuously through the autonomic modulation of the heart and circulation that plays a key role in determining and integrating haemodynamic adjustments.
Effectiveness and safety of implantable loop recorder and clinical utility of remote monitoring in patients with unexplained, recurrent, traumatic syncope
Published in Expert Review of Medical Devices, 2023
Pietro Palmisano, Federico Guerra, Vittorio Aspromonte, Gabriele Dell’Era, Pier Luigi Pellegrino, Mattia Laffi, Carlo Uran, Silvana De Bonis, Michele Accogli, Antonio Dello Russo, Giuseppe Patti, Francesco Santoro, Antonella Torriglia, Gerardo Nigro, Antonio Bisignani, Giovanni Coluccia, Giulia Stronati, Vincenzo Russo, Ernesto Ammendola
Syncope is common in the general population and is perceived as a serious clinical problem, with adverse outcomes including associated physical trauma, impaired quality of life, and potentially fatal events [1]. In patients with unexplained, recurrent syncope of suspected arrhythmic etiology in whom initial clinical evaluation has not yielded a diagnosis, the demonstration of a correlation between symptoms and ECG findings is pivotal in treating the patient correctly [1–4]. In these patients, current guidelines strongly recommend a strategy of long-term continuous ECG monitoring by an implantable loop recorder (ILR), as this is better able to establish a symptom-rhythm correlation than a conventional testing approach [1,5–9].