Coronary Artery Disease
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
The majority of patients experience prodromal symptoms days to weeks before an MI. Symptoms include fatigue, shortness of breath, and crescendo or unstable angina. The first symptom of an infarction is usually deep visceral pain below the sternum that is described as pressure or a severe pain. It often radiates to the back, arms, shoulders, jaw, or all of these locations. The pain is nearly the same as that of angina pectoris, but usually lasts longer and is more severe. There is often sweating, dyspnea, nausea, and vomiting. Relief is usually slight or temporary when the patient rests or takes nitroglycerin. In some patients, the discomfort is mild. Approximately 20% of acute MI cases are silent, with these cases more commonly seen in diabetic patients. In silent MI, the patient may not recognize what is happening since the symptoms are so vague. Some patients actually experience no symptoms as the MI occurs. Often, the affected person thinks they are just having indigestion, and relief of the discomfort may be incorrectly believed to be achieved by taking antacids or belching. Syncope is another symptom that may be seen.
Specific causes of automatism
John Rumbold in Automatism as a Defence in Criminal Law, 2018
Where there is a problem with the circulatory system such that the blood supply to the brain is reduced, this may cause medicolegal automatism. This could be due to a sudden drop in blood pressure affecting the whole brain, which leads to syncope. There are a large number of causes of syncope (see below re Beaumont, diagnosed with pneumonia). The classic faint, known as vasovagal syncope, could be a cause of automatism. A coach driver Peter Huggett described an episode that could have been vasovagal syncope. A putative heart rhythm abnormality was accepted as a cause of insane automatism in MacBrayne(unreported (Lazzari, 2011)). Where the cause is internal, it is possible that it could be deemed an insane automatism. Where the cause is an acute illness, this seems a largely theoretical consideration.
Practice Paper 1: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
The term ‘syncope’ describes the sudden loss of consciousness. Presyncope is a feeling of light-headedness. Vasovagal syncope occurs when there is excessive activation of the parasympathetic nervous system in response to certain stimuli, such as heat, fear and stress. The parasympathetic activity causes systemic vasodilatation and bradycardia, which triggers profound hypotension and cerebral hypoperfusion. Collapse is often preceded by a feeling of faintness, nausea, sweating and ringing in the ears. Occasionally, witnesses may describe the patient twitching and a loss of urinary incontinence, which may be confused with seizure activity. Following collapse, cerebral perfusion is restored and recovery is rapid. Situational syncope describes the scenario when vasovagal episodes are triggered by specific actions, such as coughing, urinating or having blood taken.
Tests for the identification of reflex syncope mechanism
Published in Expert Review of Medical Devices, 2023
Michele Brignole, Giulia Rivasi, Artur Fedorowski, Marcus Ståhlberg, Antonella Groppelli, Andrea Ungar
The strongest argument in favor of a comprehensive assessment of the mechanism of syncope is the evidence from clinical trials supporting the benefit of a personalized mechanism-guided treatment approach. In the metanalysis of 4 trials, cardiac pacing was more effective if an associated hypotensive reflex could be ruled-out by TT [56]. Deprescribing vasoactive drugs in patients with hypotensive phenotype determined an 82% reduction of syncopal burden during the subsequent 2 years of follow-up in patients with VD/mixed CSS [58]. In the randomized controlled STOP-VD trial [59], performed in patients with hypotensive phenotype diagnosed by TT or CSM, there was a 63% (05% CI 0.15–0.91) syncope reduction in patients randomized to deprescription compared to the control arm. Based on these results, it is important that the inclusion criteria of future trials investigating any therapy of reflex syncope will include a description of the relative contribution of hypotensive and bradycardic phenotype. The same stratification should be applied in everyday clinical practice when a mechanism-specific therapy is provided.
Symptoms, impairment and treatment needs among youth with orthostatic intolerance in a secondary care setting
Published in Children's Health Care, 2022
Kristen G. Benito, Amrita Ramanathan, Debra Lobato, Barbara Jandasek, Erin Mamaril, Haley McBride, Lloyd R. Feit
Orthostatic intolerance (OI) is characterized by symptoms that occur when standing upright and are relieved by recumbency. Symptoms always include dizziness or syncope/pre-syncope and can also include wide-ranging symptoms such as heart palpitations, blurred vision, or nausea (Sheldon et al., 2015). Some OI is attributed to normal physiology and up to 20% of youth will experience OI symptoms (Stewart et al., 2018). For some, these symptoms cause moderate to severe disability affecting quality of life in multiple domains (Benrud-Larson et al., 2002). Peak age of onset occurs in adolescence (Stewart et al., 2018), and youth with OI can experience significant difficulties in activities of daily living that interfere with age-appropriate milestones and may have cascading effects on development into adulthood (Bagai et al., 2011; Stewart, 2004). Impairment may be the direct result of symptoms (e.g., fatigue interfering with school performance) or occur secondary to avoidance of activities that trigger symptoms (e.g., withdrawal from social activities; Benarroch, 2012; Kritzberger et al., 2011).
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.