Neurally Mediated Syncope Manifesting During Atrial Fibrillation a Case Report
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Stroke Mimics and Chameleons: Quandaries in the Field
Stroke Mimics and Chameleons: Quandaries in the Field Madeleine Geraghty, MD Rockwood Multicare What’s the difference Stroke mimic: Looks like a stroke, is something else Stroke chameleon: Looks like something else, is really a stroke! Scope of the Mimic Recent eval by Briard, et al: ◦ 960 patients transported by EMS during an 18 month period ◦ 42% mimics 55% other neurologic diagnoses 20% seizures, 19% migraines, 11% peripheral neuropathies 45% non-neurologic diagnoses Cardiac 16%, psychiatric 12%, infectious 9% ◦ Neurologic mimics were younger (~64 years) than non-neurologic mimics (~70 years) Entering a new era Large vessel occlusions Now a 24 hour time window for mechanical thrombectomy ◦ Most centers will likely activate the > 6 hour patients from within the ED, still working out those details Volume of stroke mimics/chameleons in the new time window? Effects on resource management? ◦ At the hospital level? ◦ At the regional level with distance transports? Need Emergency Responder Impressions now more than ever in order to learn for the future!! General Principles Positive symptoms Indicate an excess of central nervous system neuron electrical discharges Visual: flashing lights, zig zag shapes, lines, shapes, objects sensory: paresthesia, pain motor: jerking limb movements Migraine, Seizure are characterized with having “positive” symptoms Negative symptoms Indicate a loss or reduction of central nervous system neuron function – loss of vision, hearing, sensation, limb power. TIA/Stroke present with “negative” symptoms. -
About Pain Pharmacology: What Pain Physicians Should Know Kyung-Hoon Kim1, Hyo-Jung Seo1, Salahadin Abdi2, and Billy Huh2
Korean J Pain 2020;33(2):108-120 https://doi.org/10.3344/kjp.2020.33.2.108 pISSN 2005-9159 eISSN 2093-0569 Review Article All about pain pharmacology: what pain physicians should know Kyung-Hoon Kim1, Hyo-Jung Seo1, Salahadin Abdi2, and Billy Huh2 1Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea 2Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Received February 8, 2020 Revised March 12, 2020 From the perspective of the definition of pain, pain can be divided into emotional Accepted March 13, 2020 and sensory components, which originate from potential and actual tissue dam- age, respectively. The pharmacologic treatment of the emotional pain component Correspondence includes antianxiety drugs, antidepressants, and antipsychotics. The anti-anxiety Kyung-Hoon Kim drugs have anti-anxious, sedative, and somnolent effects. The antipsychotics are Department of Anesthesia and Pain effective in patients with positive symptoms of psychosis. On the other hand, the Medicine, Pusan National University sensory pain component can be divided into nociceptive and neuropathic pain. Yangsan Hospital, 20 Geumo-ro, Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are usually applied for Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-1422 somatic and visceral nociceptive pain, respectively; anticonvulsants and antide- Fax: +82-55-360-2149 pressants are administered for the treatment of neuropathic pain with positive and E-mail: [email protected] negative symptoms, respectively. The NSAIDs, which inhibit the cyclo-oxygenase pathway, exhibit anti-inflammatory, antipyretic, and analgesic effects; however, they have a therapeutic ceiling. -
Syncope Fainting, Or Syncope, Is the Sudden Loss of Consciousness and Ability to Stand
Northwestern Memorial Hospital Patient Education CONDITIONS AND DISEASES Syncope Fainting, or syncope, is the sudden loss of consciousness and ability to stand. It is also called “passing out.” This common If you have any problem is the cause of many falls and injuries. One third of people faint at least once during their life. Syncope may occur questions, ask without warning or can be signaled by: ■ Feelings of weakness your physician ■ Feeling hot or sweating ■ Dizziness or nurse. ■ Visual changes ■ Nausea ■ Palpitations Causes of syncope Fainting is due to a sudden decrease in blood flow and oxygen to the brain. There are many causes of syncope, but most fall into 1 of 3 major types. Abnormal nerve reflex Nerves that control heart rate, blood pressure and other body functions may respond in an abnormal way and cause syncope. This can be triggered by: ■ Standing ■ Pain ■ Unpleasant sight or smell ■ Stress, anxiety or emotional distress ■ Coughing, sneezing or swallowing ■ Urinating or having a bowel movement Fainting due to an abnormal nerve reflex is more likely to occur under certain conditions, such as dehydration, viral infection, after prolonged bed rest or a lack of sleep or regular food intake. Types of syncope that involve an abnormal nerve reflex include: ■ Vasovagal (neurocardiac) syncope is the most common type and can occur at any age. It often occurs when blood pools in the leg veins. This triggers a reflex where the heart rate, blood pressure or both may suddenly fall. It generally is not a dangerous condition and can be prevented by avoiding situations that can trigger syncope. -
Latest Diagnostic and Treatment Strategies for the Congenital Long QT Syndromes
Latest Diagnostic and Treatment Strategies for the Congenital Long QT Syndromes Michael J. Ackerman, MD, PhD Windland Smith Rice Cardiovascular Genomics Research Professor Professor of Medicine, Pediatrics, and Pharmacology Director, Long QT Syndrome Clinic and the Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory President, Sudden Arrhythmia Death Syndromes (SADS) Foundation Learning Objectives to Disclose: • To RECOGNIZE the “faces” (phenotypes) of the congenital long QT syndromes (LQTS) • To CRITIQUE the various diagnostic modalities used in the evaluation of LQTS and UNDERSTAND their limitations • To ASSESS the currently available treatment options for the various LQT syndromes and EVALUATE their efficacy WINDLAND Smith Rice Sudden Death Genomics Laboratory Conflicts of Interest to Disclose: • Consultant – Boston Scientific, Gilead Sciences, Medtronic, St. Jude Medical, and Transgenomic/FAMILION • Royalties – Transgenomic/FAMILION Congenital Long QT Syndrome Normal QT interval QT QT Prolonged QT 1. Syncope 2. Seizures 3. Sudden death Torsades de pointes Congenital Long QT Syndrome Normal QT interval QT QT ♥ 1957 – first clinical description – JLNS ♥ 1960s – RomanoProlonged-Ward QT syndrome ♥ 1983 – “Schwartz/Moss score”1. Syncope ♥ 1991 – first LQTS chromosome locus 2. Seizures ♥ March 10, 1995 – birth of cardiac 3. Sudden channelopathies death Torsades de pointes Congenital Long QT Syndrome Normal QT interval QT QT Prolonged QT 1. Syncope 2. Seizures 3. Sudden death Torsades de pointes Congenital Long QT Syndrome Normal -
TREATMENT of VASOVAGAL SYNCOPE Where to Go for Help Syncope: HRS Definition
June 8, 2018, London UK TREATMENT OF VASOVAGAL SYNCOPE Where to go for help Syncope: HRS Definition ▪ Syncope is defined as: —a transient loss of consciousness, —associated with an inability to maintain postural tone, —rapid and spontaneous recovery, —and the absence of clinical features specific for another form of transient loss of consciousness such as epileptic seizure. 3 Syncope Cardiac Vasovagal Orthostatic Carotid sinus 4 Vasovagal Syncope: HRS Definition ▪ Vasovagal syncope is defined as a syncope syndrome that usually: 1. occurs with upright posture held for more than 30 seconds or with exposure to emotional stress, pain, or medical settings; 2. features diaphoresis, warmth, nausea, and pallor; 3. is associated with hypotension and relative bradycardia, when known; and 4. is followed by fatigue. 5 Physiology of Symptoms and Signs Decreased cardiac output Hypotension • Weakness • Lightheadness Retinal hypoperfusion • Blurred vision, grey vision, coning down Physiology of Symptoms and Signs Decreased cardiac output Reflex cutaneous vasoconstriction • Maintains core blood volume • Pallor, looks grey or very white Physiology of Symptoms and Signs Vasovagal reflex Worsened hypotension • More weakness • More lightheadness Vagal • Nausea and vomiting • Diarrhea • Abdominal discomfort Physiology of Symptoms and Signs Increase arterial conductance Rapid transit of core blood to skin • Hot flash • Warmth and discomfort • Lasts seconds • Pink skin SYNCOPE 9 Physiology of Symptoms and Signs Collapse • Preload restored • Reflexes end • Skin -
Update on the Diagnosis and Management of Familial Long QT Syndrome
Heart, Lung and Circulation (2016) 25, 769–776 POSITION STATEMENT 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2016.01.020 Update on the Diagnosis and Management of Familial Long QT Syndrome Kathryn E Waddell-Smith, FRACP a,b, Jonathan R Skinner, FRACP, FCSANZ, FHRS, MD a,b*, members of the CSANZ Genetics Council Writing Group aGreen Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland New Zealand bDepartment[5_TD$IF] of Paediatrics,[6_TD$IF] Child[7_TD$IF] and[8_TD$IF] Youth[9_TD$IF] Health,[10_TD$IF] University of Auckland, Auckland, New Zealand Received 17 December 2015; accepted 20 January 2016; online published-ahead-of-print 5 March 2016 This update was reviewed by the CSANZ Continuing Education and Recertification Committee and ratified by the CSANZ board in August 2015. Since the CSANZ 2011 guidelines, adjunctive clinical tests have proven useful in the diagnosis of LQTS and are discussed in this update. Understanding of the diagnostic and risk stratifying role of LQTS genetics is also discussed. At least 14 LQTS genes are now thought to be responsible for the disease. High-risk individuals may have multiple mutations, large gene rearrangements, C-loop mutations in KCNQ1, transmembrane mutations in KCNH2, or have certain gene modifiers present, particularly NOS1AP polymorphisms. In regards to treatment, nadolol is preferred, particularly for long QT type 2, and short acting metoprolol should not be used. Thoracoscopic left cardiac sympathectomy is valuable in those who cannot adhere to beta blocker therapy, particularly in long QT type 1. Indications for ICD therapies have been refined; and a primary indication for ICD in post-pubertal females with long QT type 2 and a very long QT interval is emerging. -
Childhood Neurological Conditions and Disorders
Childhood neurological conditions and disorders Please note: We do include rare conditions. If your one is not in the list below we will still consider your survey responses. Epilepsies Autosomal dominant epilepsy with auditory features (ADEAF) Autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE) Benign epilepsy with centrotemporal spikes (BECTS) Benign familial infantile epilepsy Benign familial neonatal epilepsy (BFNE) Benign infantile epilepsy Benign neonatal seizures (BNS) Childhood absence epilepsy (CAE) Cyclin Dependent Kinase-Like 5 (CDKL5) Deficiency Disorder Dravet syndrome Early myoclonic encephalopathy (EME) Epilepsy of infancy with migrating focal seizures Epilepsy with generalized tonic–clonic seizures alone Epilepsy with myoclonic absences Epilepsy with myoclonic atonic (previously astatic) seizures Epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) Familial focal epilepsy with variable foci (childhood to adult) Febrile seizures (FS) Febrile seizures plus (FS+) (can start in infancy) Gelastic seizures with hypothalamic hamartoma Hemiconvulsion–hemiplegia–epilepsy Juvenile absence epilepsy (JAE) Juvenile myoclonic epilepsy (JME) Landau-Kleffner syndrome (LKS) Late onset childhood occipital epilepsy (Gastaut type) Lennox-Gastaut syndrome Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) Myoclonic epilepsy in infancy (MEI) Ohtahara syndrome Panayiotopoulos syndrome Photosensitive absence epilepsies including Jeavons syndrome, Sunflower syndrome Progressive myoclonus epilepsies -
Cardiovascular Risk After Hospitalisation for Unexplained
Heart Online First, published on August 3, 2017 as 10.1136/heartjnl-2017-311857 Cardiac risk factors and prevention ORIGINAL RESEARCH ARTICLE Heart: first published as 10.1136/heartjnl-2017-311857 on 3 August 2017. Downloaded from Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension Ekrem Yasa,1,2 Fabrizio Ricci,3,4 Martin Magnusson,1,2 Richard Sutton,5 Sabina Gallina,3 Raffaele De Caterina,3 Olle Melander,1 Artur Fedorowski1,2 1Department of Clinical ABSTRACT The diagnosis of syncope (R55.9, Interna- Sciences, Lund University, Objective To investigate the relationship of hospital tional Classification of Diseases (ICD)-10) is Clinical Research Center, Skåne often referred to as a synonym for reflex syncope, University Hospital, Malmö, admissions due to unexplained syncope and orthostatic Sweden hypotension (OH) with subsequent cardiovascular events the most common cause of T-LOC, accounting 2Department of Cardiology, and mortality. for about 50%–60% of cases. Conversely, OH Skåne University Hospital, Methods We analysed a population-based prospective is believed to coexist with 10%–15% of T-LOC Malmö, Sweden episodes,3 which are then defined as syncope due to 3Institute of Cardiology, cohort of 30 528 middle-aged individuals (age 58±8 University 'G. d’Annunzio', years; males, 40%). Adjusted Cox regression models OH or autonomic failure. It is universally accepted Chieti, Italy were applied to assess the impact of unexplained that recurrent reflex syncope and OH are different 4 Department of Neuroscience syncope/OH hospitalisations on cardiovascular events clinical manifestations of cardiovascular (CV) auto- and Imaging and ITAB – and mortality, excluding subjects with prevalent nomic dysfunction. -
1 July 2008.Pmd
Bangladesh Journal of Neuroscience 2008; Vol. 24 (1) : 9-16 Initial Neurologic Symptoms Among Bangladeshi Multiple Sclerosis Patients MD BAHADUR ALI MIAH1, ABDUL KADER SHEIKH1, AKHLAQUE HOSAIN KHAN2, MD RAFIQUL ISLAM3, AKM ANWAR ULLAH4, QUAZI DEEN MOHAMMAD5, ANISUL HAQUE4 Abstract vision (optic nerve involvement, 64%), motor This study was undertaken in the weakness (92%), sphincteric disturbances Department of Neurology, Bangabandhu (92%) and a lower rate of brainstem and Sheikh Mujib Medical University (BSMMU), cerebellar involvement. Painful tonic Dhaka, from January 2002 to December spasm was a prominent feature among 2003. The objective of this study was to Bangladeshi patients with multiple sclerosis determine the initial neurologic symptoms (8 out of 25, 32%). of multiple sclerosis among Bangladeshi Out of 25 patients, one (4%) expired due patients. to aspiration pneumonia. Twenty four (96%) A total of 25 respondents of multiple survived. Among them 9 (36%) has sclerosis patients as cases selected by restricted activity, 7 (28%) were bedridden, McDonald et al. (2001) diagnostic criteria 5 (20%) were chairbound, 2 (8%) had minor disability and were in work and 1 (4%) was for multiple sclerosis were enlisted during completely normal. the study period. The clinical details, investigations of the respondents were Introduction reviewed. Data were recorded in Multiple sclerosis (MS) is an inflammatory predesigned data collection sheet. Out of demyelinating disease of central nervous 25 cases, male patients were 12 (48%) and system (CNS) causing significant morbidity females were 13 (52%), ratio being 1:1.08. with a variable course, thought to result from Majority of the patients presented at immune response to myelin sheath with second, third and fourth decades of life. -
London Journtal of Medicine
Lond J Med: first published as 10.1136/bmj.s2-1.7.601 on 3 July 1849. Downloaded from LONDON JOURNTAL OF MEDICINE, A MONTHLY 3Ietortof tte lItbfial *(fences. i5i L JULY 1849.-No. VII. ORIGINAL COMMUNICATIONS. THE CLIMACTERIC DISEASE IN WOMEN; A PAROXYSMAL AFFECTION OCCURRING AT THE DECLINE OF THE CATAXENIA. By W. TYLER SMITH, M.D. Lond.; ectturet on Midwifery and the Diseases of Womeu in the Hunterian School of Medicine. THE Climacteric Disease has received much attention, since the appear- ance of the valuable Essay on the subject ly Sir Henry Halford, in the fourth volume of the Transactions of the College of Physicians. The Climacteric Disorder there described, consists of a sudden decline of the vital or biotic powers in advanced life, and is chiefly met with, in http://www.bmj.com/ the male sex, from the age of sixty-five and upwards, the female being comparatively exempt from its attacks. Periodicity is, however, more indelibly marked upon the female than upon the male constitution; and periodic tendencies are as distinctlv seen in the diseases, as in the functions, of the female economy. With reference to the sex, the most important climacteric or-periodic epoch, of the catamenia. This is is that of the decline epoch generally a time on 30 September 2021 by guest. Protected copyright. of anxiety, both to patients and professional men; and much care has been bestowed on the study of the access and exacerbations of organic diseases, especially of the uterine system, at this time. Still, it ap- pears to me, the specual disorder of this period, from which a variety of secondary disorders arise, has never been noticed with sufficient accu- racy, either for the purposes of diagnosis or of practice. -
Premature Ventricular Contractions Ralph Augostini, MD FACC FHRS
Premature Ventricular Contractions Ralph Augostini, MD FACC FHRS Orlando, Florida – October 7-9, 2011 Premature Ventricular Contractions: ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death J Am Coll Cardiol, 2006; 48:247-346. Background PVCs are ectopic impulses originating from an area distal to the His Purkinje system Most common ventricular arrhythmia Significance of PVCs is interpreted in the context of the underlying cardiac condition Ventricular ectopy leading to ventricular tachycardia (VT), which, in turn, can degenerate into ventricular fibrillation, is one of the common mechanisms for sudden cardiac death The treatment paradigm in the 1970s and 1980s was to eliminate PVCs in patients after myocardial infarction (MI). CAST and other studies demonstrated that eliminating PVCs with available anti-arrhythmic drugs increases the risk of death to patients without providing any measurable benefit Pathophysiology Three common mechanisms exist for PVCs, (1) automaticity, (2) reentry, and (3) triggered activity: Automaticity: The development of a new site of depolarization in non-nodal ventricular tissue. Reentry circuit: Reentry typically occurs when slow- conducting tissue (eg, post-infarction myocardium) is present adjacent to normal tissue. Triggered activity: Afterdepolarization can occur either during (early) or after (late) completion of repolarization. Early afterdepolarizations commonly are responsible for bradycardia associated PVCs, but also with ischemia and electrolyte disturbance. Triggered Fogoros: Electrophysiologic Testing. 3rd ed. Blackwell Scientific 1999; 158. Epidemiology Frequency The Framingham heart study (with 1-h ambulatory ECG) 1 or more PVCs per hour was 33% in men without coronary artery disease (CAD) and 32% in women without CAD Among patients with CAD, the prevalence rate of 1 or more PVCs was 58% in men and 49% in women. -
Respiratory Therapy for Speech in Multiple Sclerosis
Institute of Neurology University of London Respiratory Therapy for Speech in Multiple Sclerosis Ph.D. Thesis Kimberley Anne Mathieson Bradley April 1997 ProQuest Number: 10055444 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10055444 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT Respiratory Support for Speech In Multiple Sclerosis The dysarthria of multiple sclerosis is known to worsen as the disease progresses (Darley, Brown and Goldstein 1972). Thus as activities of daily life and opportunities for activity for the person with multiple sclerosis are curtailed by increasing disability, the capacity of their respiratory system is also diminished both by disease and lack of demand on the system (Olgiati, Hofstetter and Bailey 1988). It is a hypothesis of this paper and others that disuse creates a discrepancy between the functional ability that is neurologically available and that which is characteristically used (Olgiati et al., 1988; Olgiati et al. 1986). It is this functional overlay that may be the target of speech therapy (Farmakides and Boone 1960). Five subjects with MS and dysarthria affecting intelligibility were involved in a multiple baseline therapy study to establish the efficacy of respiratory exercises in improving functional speech performance.