BOOK
Clinical and Electrophysiologic Management of Syncope, An Issue of Cardiac Electrophysiology Clinics, E-Book
Antonio Raviele | Andrea Natale
(2013)
Additional Information
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 |