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Clinical and Electrophysiologic Management of Syncope, An Issue of Cardiac Electrophysiology Clinics, E-Book
Antonio Raviele | Andrea Natale
(2013)
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Book Details
Abstract
This issue of Cardiac Electrophysiology Clinics devoted to syncope a disorder that is associated with increased mortality. Internationally recognized experts discuss the many causes of syncope, helping the clinician to distinguish life-threatening etiologies from benign ones.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Clinical and Electrophysiologic Management of Syncope\r | i | ||
Copyright\r | ii | ||
Contributors | iii | ||
Contents | vii | ||
Cardiac Electrophysiology Clinics\r | xi | ||
Preface\r | xiii | ||
Syncope | 387 | ||
Key points | 387 | ||
Introduction | 387 | ||
Definition | 387 | ||
Transient Loss of Consciousness | 388 | ||
Is TLOC Characterized by Rapid Onset and Short Duration? | 388 | ||
Recovery | 388 | ||
Rule Out Head Trauma and Epilepsy | 388 | ||
Epidemiology | 389 | ||
Classification | 389 | ||
Pathophysiology | 390 | ||
Low CO | 390 | ||
Low Peripheral Resistance | 390 | ||
Summary | 391 | ||
References | 391 | ||
Initial Clinical Evaluation | 393 | ||
Key points | 393 | ||
Was LOC complete? | 393 | ||
Did LOC have rapid onset, short duration, and spontaneous recovery? | 395 | ||
Diagnosis of the cause of transient LOC | 395 | ||
Clinical findings of nonsyncopal LOC | 396 | ||
Epilepsy | 396 | ||
Transient Ischemic Attack | 397 | ||
Hypoglycemia | 397 | ||
Psychogenic Pseudosyncope | 397 | ||
Cataplexy | 398 | ||
Diagnosis of the cause of syncope | 398 | ||
Typical Vasovagal Syncope | 398 | ||
Situational Syncope | 398 | ||
Syncope Caused by Orthostatic Hypotension | 399 | ||
Clinical findings that are only suggestive of a cause of syncope | 399 | ||
Sleep syncope | 400 | ||
References | 400 | ||
The Value of Tilt Testing and Autonomic Nervous System Assessment | 403 | ||
Key points | 403 | ||
History | 403 | ||
Impact of tilt testing | 403 | ||
Negativity toward tilt testing | 404 | ||
The place of tilt testing today | 405 | ||
Autonomic nervous system function tests | 405 | ||
Summary | 405 | ||
References | 405 | ||
Value of Ambulatory Electrocardiographic Monitoring in Syncope | 407 | ||
Key points | 407 | ||
Introduction | 407 | ||
Technical aspects, implanting technique, and follow-up of ILR | 407 | ||
ILRs in the diagnostic evaluation of transient loss of consciousness | 409 | ||
Unexplained Syncope | 409 | ||
Difficult Cases of Epilepsy | 409 | ||
Unexplained Falls | 410 | ||
Limitations of ILRs | 411 | ||
References | 411 | ||
Value of EP Study and Other Cardiac Investigations | 413 | ||
Key points | 413 | ||
Introduction | 413 | ||
Identification of high-risk patients | 413 | ||
Electrophysiology study | 415 | ||
Bradyarrhythmia | 415 | ||
Tachyarrhythmia | 419 | ||
Summary | 420 | ||
References | 421 | ||
How to Differentiate Syncope from Seizure | 423 | ||
Key points | 423 | ||
Introduction | 423 | ||
Epileptic seizures | 423 | ||
Syncope | 424 | ||
Convulsive syncope | 425 | ||
The role of the history | 426 | ||
Tilt tests for questionable epilepsy | 427 | ||
Video recording | 428 | ||
ILR for questionable epilepsy | 428 | ||
Health services delivery | 428 | ||
Summary | 429 | ||
References | 429 | ||
Risk Stratification of Patients Presenting with Transient Loss of Consciousness | 433 | ||
Key points | 433 | ||
Introduction | 433 | ||
Classification of syncope | 434 | ||
Reflex Syncope (Also Termed Neurally Mediated Reflex Syncope) | 434 | ||
Orthostatic Syncope | 434 | ||
Syncope Caused by Cardiac Arrhythmias | 435 | ||
Syncope Caused by Structural Cardiac and Cerebrovascular Disease | 435 | ||
Syncope mimics | 435 | ||
Diagnostic pathway | 435 | ||
Risk stratification of patients with suspected syncope | 436 | ||
Short-term or Immediate Risk | 437 | ||
Short-term high-risk TLOC/syncope markers | 438 | ||
Longer-term risk | 438 | ||
Risk stratification based on cardiac versus noncardiac causes of syncope | 440 | ||
Summary | 441 | ||
References | 441 | ||
Syncope in Children and Adolescents | 443 | ||
Key points | 443 | ||
Introduction | 443 | ||
How is syncope defined? | 443 | ||
How common is syncope in children? | 443 | ||
How is syncope classified in children? | 444 | ||
Autonomic Syncope | 444 | ||
Neurocardiogenic syncope | 444 | ||
Dysautonomic syncope | 445 | ||
Postural orthostatic tachycardia syndrome | 445 | ||
Breath-holding spells | 446 | ||
Blood injury phobia | 446 | ||
Fainting lark | 446 | ||
Cardiac Syncope | 446 | ||
Obstructive causes | 446 | ||
Hypertrophic cardiomyopathy | 446 | ||
Aortic stenosis | 447 | ||
Primary pulmonary hypertension | 447 | ||
Primary myocardial dysfunction | 447 | ||
Arrhythmias as a cause of syncope | 447 | ||
Long QT syndrome | 447 | ||
Brugada syndrome | 448 | ||
Cathocholaminergic polymorphic ventricular tachycardia | 448 | ||
Noncardiac Causes of Syncope | 448 | ||
How is syncope evaluated in children and adolescents? | 449 | ||
Laboratory Studies | 449 | ||
Blood tests | 449 | ||
Electrocardiogram | 449 | ||
Video-assisted recording | 449 | ||
Ambulatory ECG monitoring | 449 | ||
Head-up tilt table testing | 449 | ||
Echocardiogram | 450 | ||
Imaging | 450 | ||
How is syncope managed in children? | 450 | ||
Education and Reassurance | 450 | ||
Physical Countermaneuvers | 450 | ||
Paced Breathing | 451 | ||
Fluid Therapy | 451 | ||
Pharmacologic Treatment | 451 | ||
Pacemaker Therapy | 451 | ||
Cardioneuroablation | 451 | ||
Future perspective | 451 | ||
References | 452 | ||
Syncope in the Older Person | 457 | ||
Key points | 457 | ||
Introduction | 457 | ||
Epidemiology | 457 | ||
Pathophysiology | 458 | ||
Cardiac Causes of Syncope | 458 | ||
Neurally Mediated Syncope | 458 | ||
Managing syncope in the older patient: a case-based approach | 460 | ||
Case Vignette 1: When is a Fall Not a Fall? | 460 | ||
Discussion | 460 | ||
Case Vignette 2: The Swoon | 461 | ||
Discussion | 462 | ||
Case Vignette 3: Don’t Look Now… | 463 | ||
Discussion | 463 | ||
Recapitulation | 464 | ||
Summary | 464 | ||
References | 464 | ||
Syncope as a Warning Symptom of Sudden Cardiac Death in Athletes | 469 | ||
Key points | 469 | ||
Introduction | 469 | ||
Epidemiology and causes of syncope in athletes | 470 | ||
Neurally mediated syncope | 470 | ||
Orthostatic hypotension | 470 | ||
Cardiogenic syncope in the athlete | 470 | ||
Hypertrophic Cardiomyopathy | 470 | ||
Arrhythmogenic Right Ventricular Cardiomyopathy | 472 | ||
Atherosclerotic Coronary Disease | 472 | ||
Congenital Coronary Artery Anomaly | 473 | ||
Ion Channel Diseases | 473 | ||
Clinical work-up of the athlete with syncope | 475 | ||
First Level Exams | 475 | ||
Second- and Third-level Examinations | 475 | ||
Management | 476 | ||
Summary | 476 | ||
References | 477 | ||
Syncope in Hereditary Arrhythmogenic Syndromes | 479 | ||
Key points | 479 | ||
Introduction | 479 | ||
Medical history | 480 | ||
Family History | 480 | ||
Circumstances of Syncope | 480 | ||
Symptoms | 480 | ||
Physical examination | 481 | ||
Electrocardiogram | 482 | ||
Long QT Syndrome | 482 | ||
Brugada Syndrome | 482 | ||
Catecholaminergic Polymorphic Ventricular Tachycardia | 483 | ||
Short QT Syndrome | 483 | ||
Summary | 483 | ||
References | 483 | ||
Syncope and Idiopathic (Paroxysmal) AV Block | 487 | ||
Key points | 487 | ||
Diagnosis of idiopathic AV block | 487 | ||
Differential diagnosis from other types of AV block | 488 | ||
Epidemiology of syncope due idiopathic AV block | 489 | ||
Pathophysiological considerations: the purinergic profile and the role of adenosine | 491 | ||
Clinical perspectives | 492 | ||
References | 492 | ||
Syncope in Patients with Organic Heart Disease | 495 | ||
Key points | 495 | ||
Introduction | 495 | ||
Organic heart disease: what it is and what it is not | 496 | ||
Is organic heart disease common in the syncope patient, and is it reason for concern? | 496 | ||
Syncope and death: a temporal association | 498 | ||
How is syncope related to organic heart disease? Mechanisms of syncope in organic heart disease | 499 | ||
Evaluation and subsequent management of syncope in patients with organic heart disease | 500 | ||
Clinical Assessment: History and Physical | 500 | ||
What evaluation is necessary to rule out a cardiac cause for heart disease? | 502 | ||
Electrophysiology Testing | 503 | ||
Implantable Loop Recorders | 503 | ||
Approach to the syncope patient with organic heart disease in whom the evaluation is negative | 504 | ||
The future of evaluating patients with syncope | 505 | ||
Summary | 505 | ||
References | 505 | ||
Syncope and Driving | 511 | ||
Key points | 511 | ||
Introduction | 511 | ||
Fitness to drive | 511 | ||
Pathophysiologic features of syncope and driving | 512 | ||
Prevalence, recurrence, and prognosis | 513 | ||
Canadian Cardiovascular Society risk of harm formula | 513 | ||
Commercial driving | 513 | ||
Ethics behind regulations and guidelines | 514 | ||
Current guidelines and recommendations | 515 | ||
Canadian Medical Association Driver’s Guide: Determining the Medical Fitness to Operate a Motor Vehicle | 515 | ||
American Heart Association and the Heart Rhythm Society: Personal and Public Safety Issues Related to Arrhythmias that May ... | 516 | ||
Guidelines for the Diagnosis and Management of Syncope (Version 2009): The Task Force for the Diagnosis and Management of S ... | 516 | ||
Summary | 516 | ||
References | 517 | ||
Therapy for Syncope | 519 | ||
Key points | 519 | ||
Introduction | 519 | ||
Reflex syncope | 520 | ||
General Measures | 521 | ||
Water Ingestion | 521 | ||
Physical Counterpressure Maneuvers | 521 | ||
Tilt Training | 521 | ||
Drug Therapy | 521 | ||
Cardiac Pacing | 523 | ||
Syncope secondary to orthostatic hypotension | 524 | ||
Cardiac syncope | 524 | ||
Syncope and bifascicular block | 524 | ||
References | 524 | ||
The Role of the Syncope Management Unit | 529 | ||
Key points | 529 | ||
General features of the syncope care delivery organization | 529 | ||
Rationale for a syncope management unit | 530 | ||
Syncope: the Challenge | 530 | ||
Syncope: a Common Problem | 530 | ||
Syncope is Costly | 532 | ||
Stakeholders | 532 | ||
Settings | 532 | ||
Syncope Management in the ED | 532 | ||
Syncope Management | 533 | ||
Syncope Management: Outpatient | 533 | ||
Professional skill mix for the SMU | 533 | ||
Role of syncope unit | 534 | ||
Initial Evaluation | 534 | ||
Cardiac imaging | 534 | ||
Provocative testing | 537 | ||
Head-up tilt test | 537 | ||
Electrocardiographic monitoring | 537 | ||
Inpatient telemetry | 538 | ||
Holter monitoring | 538 | ||
External loop recorders | 538 | ||
Implantable loop recorders | 538 | ||
Exclusion of other causes for transient loss of consciousness | 538 | ||
Summary | 539 | ||
References | 539 | ||
Index | 543 |