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Evaluation and management of syncope and related disorders in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Andrea Ungar, Martina Rafanelli, Michele Brignole
Disappointing results have been obtained by the use of various drugs in the context of neurally mediated syncope (86). Recently, the multicenter POST 2 (Prevention of Syncope Trial 2), a randomized, placebo-controlled, double-blind trial, that assessed the effects of fludrocortisone in vasovagal syncope over a 1-year treatment period, did not meet its primary objective of demonstrating that fludrocortisone reduced the likelihood of VVS (87).
History
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Tilt testing is used to provoke vasovagal syncope. It has a sensitivity of 66% and specificity of 90%, so is useful for excluding neurally mediated syncope. Both false positives and false negatives are common. Patients are tilted head up while their blood pressure and pulse rate are recorded. Patients with neurally mediated syncope have an impaired heart rate and blood pressure response, and may benefit from implantation of a pacemaker.
Antihypertensive treatment and risk factors for syncope in asymptomatic aortic stenosis patients with hypertension
Published in Clinical and Experimental Hypertension, 2022
Meihua Wu, Ping Gu, Qianqiang Cao, Aibin Gong, Wenliang Tan, Dezhi Hong
HTN was defined as a blood pressure >140/90 mmHg on at least two occasions or a history of HTN with normal BP on treatment. Syncope was defined as transient loss of consciousness characterized by rapid onset, short duration, and spontaneous complete recovery (7). In addition, presyncope is described as a state that resembles the prodrome of syncope but which is not followed by loss of consciousness in the guideline (7). In the present study, syncope, including presyncope, was diagnosed by two physicians on the basis of medical records data. Syncopal episodes, diagnosed as neurally mediated syncope and consequential orthostatic hypotension, were included in the definition of syncope in patients with AS because of the possibility that AS triggers or potentiates a reflex mechanism.
Immediate Interventions for Presyncope of Vasovagal or Orthostatic Origin: A Systematic Review
Published in Prehospital Emergency Care, 2020
Jan L. Jensen, Shinichiro Ohshimo, Pascal Cassan, Daniel Meyran, Jennifer Greene, Kee Chong Ng, Eunice Singletary, David Zideman
Two important studies utilizing PCM did not meet our inclusion criteria but support our findings. The Physical Counter Pressure Maneuvers Trial was a large, multicenter RCT evaluating the use of PCM in daily life in 223 participants, aged 16–70 years, with recurrent vasovagal syncope over a 6–18 month time span (13). This study measured syncope burden in terms of episodes per year and found a significant reduction in median (interquartile range) yearly episodes per patient with the use of PCM (0.0 [0.0–0.7]) compared with the conventional treatment group (0.6 [0.0–1.3], p = 0.004), as well as a relative risk reduction (95% CI) for syncope recurrence of 0.36 (0.11–0.53, p = 0.005) and with no adverse events. The authors concluded that PCMs are a low-risk, effective, and low-cost treatment modality in patients with VV and should be used as a first-line treatment in this group. A prospective observational study of 85 enrollees with a mean age of 62 years compared syncope recurrence in participants with a diagnosis of hypotensive neurally-mediated syncope who were trained in the use of PCM and lifestyle changes (4). The syncope recurrence rate at 21 months with the use of PCM was 42% (27–61) and was without PCM 64% (48–80; p = 0.27), with a relative risk reduction of 34%. These studies support the use of PCM for patients with vasovagal syncope and suggest it may be more effective in patients of a younger age and with a sufficient prodromal (presyncope) period.
Insertable cardiac monitors: current indications and devices
Published in Expert Review of Medical Devices, 2019
Rafi Sakhi, Dominic A.M.J. Theuns, Tamas Szili-Torok, Sing-Chien Yap
Syncope is a relatively common clinical symptom in the general population with a lifetime incidence of 30–40% and is responsible for 3–6% of all emergency visits [15]. Despite extensive evaluation, a significant proportion of patients remain without a diagnosis [16–18]. Several studies from the ISSUE-investigators in the early 2000s demonstrated the diagnostic value of an ICM in different syncope populations such as those with neurally mediated syncope, bundle branch block or structural heart disease [19–21]. A meta-analysis of five randomized controlled trials comparing a conventional strategy (external loop recorder, tilt testing, and electrophysiological testing) to ICM implantation showed that an ICM provided a 3.6 increased relative probability of a diagnosis compared with the conventional strategy (46% versus 12%) [1,22–26]. Furthermore, an ICM strategy was more cost-effective than a conventional strategy [23,24]. Currently, an ICM is a well-established diagnostic tool in patients with recurrent unexplained syncope and should be employed in an early phase of evaluation [27].