Vasovagal syncope(VVS),which is triggered by physical exertion,is typically observed in athletes or patients with structural heart disease.There have been few reported cases among sedentary individuals.This case repor...Vasovagal syncope(VVS),which is triggered by physical exertion,is typically observed in athletes or patients with structural heart disease.There have been few reported cases among sedentary individuals.This case report details the experience of a 42-year-old sedentary woman who fainted during a treadmill stress test.Despite the absence of abnormalities in baseline cardiac and neurological evaluations,the patient exhibited sinus arrest(lasting 5–12 seconds)with significant ST-segment depression during haemodynamic collapse.Comprehensive assessments,incorporating coronary angiography,echocardiography,cranial computed tomography(CT),and biochemical testing,excluded the presence of structural or ischemic heart disease,arrhythmogenic syndromes,and cerebrovascular disorders.A Calgary Syncope Symptom Score of 3 confirmed the diagnosis of VVS,a diagnosis that was further substantiated by the patient’s symptoms resolving spontaneously when she was positioned supine.This case demonstrates that exercise-induced syncope can occur in individuals who are physically unfit and have no cardiac abnormalities.Transient ST-segment changes in such cases reflect autonomic nervous system dysfunction rather than myocardial ischaemia.It is incumbent upon clinicians to consider a neurocardiogenic mechanism in sedentary patients presenting with exertional syncope despite a negative standard cardiac evaluation.展开更多
BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 pati...BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.Syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P<0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DC<8.4 ms had an 8.1(HR=8.1,95%CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.展开更多
Background: The QT interval shortens in response to sympathetic stimulation. Head-up tilt-table (HUT) testing is a straightforward way to achieve brisk sympathetic stimulation. There is not enough information about th...Background: The QT interval shortens in response to sympathetic stimulation. Head-up tilt-table (HUT) testing is a straightforward way to achieve brisk sympathetic stimulation. There is not enough information about the response of the QT interval to HUT, particularly, in patients with orthostatic hypotension (OH). Objective: Analyse the response of the RR, QT and QTc intervals in patients with OH and reflex syncope (NM) during HUT and find differences between groups. Methods: We reviewed the electrocardiograms and compare the RR and QT/QTc intervals during 1) baseline;2) HUT plus hyperventilation;3) positive test. Results: We studied 137 patients, 62 control group (no syncope and negative HUT). On average, the RR HUT interval was shorter than the resting RR by −171 ± 110.4 ms in controls;−228.6 ± 119.4 ms (NM) and −194 ± (OH) (P Conclusion: Significant differences between the reflex group and the OH during a positive test, the QTc decreased in the NM group, but in the OH population increased. This observation has not been described. We hypothesize that QTc prolongation could reflect autonomic nervous system downregulation and could explain to a degree, the increased mortality in this group.展开更多
Background: Vasovagal syncope (VVS) is a neurogenic reflex-mediated fainting episode characterized by sudden, transient, and self-limiting symptoms. While VVS accounts for a significant portion (around 60%) of emergen...Background: Vasovagal syncope (VVS) is a neurogenic reflex-mediated fainting episode characterized by sudden, transient, and self-limiting symptoms. While VVS accounts for a significant portion (around 60%) of emergent medical events in dental practice, it remains an underrecognized condition among dental professionals, often misdiagnosed as hypoglycemia, conversion disorder, or epilepsy. This case report describes a VVS episode induced by tooth extraction, aiming to improve dental clinicians’ awareness and diagnostic approach to VVS. Case Presentation: A 35-year-old female visited the dental department in April 2022 with a two-year history of food impaction in the upper right molar. Examination revealed an elongated, discolored, and tender tooth 18, lacking proper occlusion with the opposing tooth. After confirming no contraindications, the tooth was extracted using a minimally invasive technique. Following the procedure, the patient experienced dizziness upon standing;her blood pressure was 69/47 mmHg, and her heart rate was 65 bpm. The nursing staff assisted her to sit as she showed limb weakness, closed eyes, and briefly lost consciousness. Oxygen was administered, and her blood glucose was 6.5. Blood pressure later improved to 124/78 mmHg, with a pulse of 62 bpm. Oral glucose was given, which she vomited, and emergency services were called. Upon arrival, the patient was alert and cooperative. Neurology consultation and imaging (MRI, MRA, and DWI) ruled out cerebral infarction, initially diagnosing a conversion disorder. A subsequent tilt-table test, including sublingual nitroglycerin, induced a marked blood pressure drop and symptoms confirming a diagnosis of vasovagal syncope (VVS). Conclusions: This case shows that preoperative anxiety, fear, and prolonged waiting can trigger vasovagal reflex during tooth extraction, especially in patients with anxiety or cardiac arrhythmias. For such patients, preoperative precautions and intraoperative cardiac monitoring are advised. In cases of VVS, quick actions like monitoring blood pressure, placing the patient in a supine position, providing oxygen, and administering IV fluids or medications like atropine, if necessary, can help stabilize the patient.展开更多
Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persist...Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persistent, tearing or cutting-like pain in the chest or back. However, there have also been reports of myocardial infarction, heart failure, renal failure, syncope, shock, stroke, paraplegia and other cases. Clinical misdiagnosis is common. Aim: Alert clinicians to aortic dissection with shock and chest tightness as the main clinical presentations. Case Presentation: Report on two cases of aortic dissection with syncope and shock as the main manifestations. Conclusion: Aortic dissection is a highly dangerous cardiovascular emergency with a high mortality rate. In clinical practice, awareness of the clinical manifestations of aortic dissection should be increased. Careful inquiry about medical history, attention to atypical clinical presentations of aortic dissection, thorough physical examination, and comprehensive diagnostic evaluation can improve the success rate of diagnosing aortic dissection.展开更多
Guillain⁃Barré syndrome (GBS) is an immune-mediated peripheral neuropathy with acute or subacute onset of flaccid paralysis of the limbs with symmetrical hypesthesia and autonomic nerve involvement [1]. The clini...Guillain⁃Barré syndrome (GBS) is an immune-mediated peripheral neuropathy with acute or subacute onset of flaccid paralysis of the limbs with symmetrical hypesthesia and autonomic nerve involvement [1]. The clinical manifestations of autonomic nerve damage are complex and varied, which may involve extensive or limited autonomic function damage, including abnormalities of the skin, pupil, urinary tract, gastrointestinal tract, cardiovascular system, body temperature, lacrimal and salivary glands, and sexual function, etc. [2], and some patients may even have autonomic nerve damage as the only symptom, which is a variant of GBS and is prone to misdiagnosis or underdiagnosis. Recurrence of GBS is rare, and the manifestations of recurrence are often similar to those of the first symptoms [3], but the patient admitted to our hospital had syncope as the main clinical manifestation of recurrence, which was completely different from that of the first incidence, and syncope is not a common and typical clinical manifestation of GBS, so misdiagnosis is highly likely.展开更多
The purpose of the present paper is to explore Edgar Lawrence Doctorow’s novel Ragtime(1975)as a masterful adaptation of musical form in fiction.It demonstrates the ways in which the use of musical devices of Ragtime...The purpose of the present paper is to explore Edgar Lawrence Doctorow’s novel Ragtime(1975)as a masterful adaptation of musical form in fiction.It demonstrates the ways in which the use of musical devices of Ragtime shapes the rhythmic/narrative structure of the novel.The article offers the reading of the novel as a musicalized fiction,or,in other words,as a form of musico-literary intermediality.It focuses on the chief characteristics of Doctorow’s novel such as a plurality of independent consciousnesses and a diversity of simultaneous points of view/voices.The novel by its very design is polyphonic.Manipulating polyrhythmic effects,mixed rhythms,repetitive phrases and leitmotifs,Doctorow is experimenting with the rhythm both on micro and macro textual levels.展开更多
Vasovagal syncope(VVS) and postural tachycardia syndrome(POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope.In recent years,increasing attenti...Vasovagal syncope(VVS) and postural tachycardia syndrome(POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope.In recent years,increasing attention has been paid to the management of VVS and POTS in children and adolescents.A number of potential mechanisms are involved in their pathophysiology,but the leading cause of symptoms varies among patients.A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness.This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.展开更多
Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. Vasovagal syncope (VVS) is the most common p...Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. Vasovagal syncope (VVS) is the most common presentation of syncope, and its diagnostic criteria include:(1) absence of any other evident etiology for syncope or presyncope,(2) positive response to head-up tilt test with evident vasovagal reaction (hypotension and/or bradycardia), and (3) no concomitant chronic or acute disease [1, 2]. The onset of VVS peaks initially in childhood and adolescence, and accounts for 60%–70% of all syncopal cases. Clinicians pay great attention to syncope among children and adolescents, due to its high prevalence and its impact on patients’ quality of life. Affected individuals often experience mental stress, economic burdens, and accidental bodily injuries related to syncope [2]. While the pathogenesis of VVS is not fully understood, autonomic nervous dysfunction has been identified as a contributing mechanism. The examination of autonomic nervous function can provide important information about patients with syncope.展开更多
Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive e...Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.展开更多
文摘Vasovagal syncope(VVS),which is triggered by physical exertion,is typically observed in athletes or patients with structural heart disease.There have been few reported cases among sedentary individuals.This case report details the experience of a 42-year-old sedentary woman who fainted during a treadmill stress test.Despite the absence of abnormalities in baseline cardiac and neurological evaluations,the patient exhibited sinus arrest(lasting 5–12 seconds)with significant ST-segment depression during haemodynamic collapse.Comprehensive assessments,incorporating coronary angiography,echocardiography,cranial computed tomography(CT),and biochemical testing,excluded the presence of structural or ischemic heart disease,arrhythmogenic syndromes,and cerebrovascular disorders.A Calgary Syncope Symptom Score of 3 confirmed the diagnosis of VVS,a diagnosis that was further substantiated by the patient’s symptoms resolving spontaneously when she was positioned supine.This case demonstrates that exercise-induced syncope can occur in individuals who are physically unfit and have no cardiac abnormalities.Transient ST-segment changes in such cases reflect autonomic nervous system dysfunction rather than myocardial ischaemia.It is incumbent upon clinicians to consider a neurocardiogenic mechanism in sedentary patients presenting with exertional syncope despite a negative standard cardiac evaluation.
基金supported by the CAMS Central Public Welfare Scientific Research Institute Basal Research Expenses (No.2021-XCGC09-1&No.2022-I2M-C&T-B-045)the Beijing Municipal Science&Technology Commission (Z191100006619019)the High-level Hospital Clinical Scientific Research Business Fees (No.2022-GSP-QZ-4)
文摘BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.Syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P<0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DC<8.4 ms had an 8.1(HR=8.1,95%CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.
文摘Background: The QT interval shortens in response to sympathetic stimulation. Head-up tilt-table (HUT) testing is a straightforward way to achieve brisk sympathetic stimulation. There is not enough information about the response of the QT interval to HUT, particularly, in patients with orthostatic hypotension (OH). Objective: Analyse the response of the RR, QT and QTc intervals in patients with OH and reflex syncope (NM) during HUT and find differences between groups. Methods: We reviewed the electrocardiograms and compare the RR and QT/QTc intervals during 1) baseline;2) HUT plus hyperventilation;3) positive test. Results: We studied 137 patients, 62 control group (no syncope and negative HUT). On average, the RR HUT interval was shorter than the resting RR by −171 ± 110.4 ms in controls;−228.6 ± 119.4 ms (NM) and −194 ± (OH) (P Conclusion: Significant differences between the reflex group and the OH during a positive test, the QTc decreased in the NM group, but in the OH population increased. This observation has not been described. We hypothesize that QTc prolongation could reflect autonomic nervous system downregulation and could explain to a degree, the increased mortality in this group.
文摘Background: Vasovagal syncope (VVS) is a neurogenic reflex-mediated fainting episode characterized by sudden, transient, and self-limiting symptoms. While VVS accounts for a significant portion (around 60%) of emergent medical events in dental practice, it remains an underrecognized condition among dental professionals, often misdiagnosed as hypoglycemia, conversion disorder, or epilepsy. This case report describes a VVS episode induced by tooth extraction, aiming to improve dental clinicians’ awareness and diagnostic approach to VVS. Case Presentation: A 35-year-old female visited the dental department in April 2022 with a two-year history of food impaction in the upper right molar. Examination revealed an elongated, discolored, and tender tooth 18, lacking proper occlusion with the opposing tooth. After confirming no contraindications, the tooth was extracted using a minimally invasive technique. Following the procedure, the patient experienced dizziness upon standing;her blood pressure was 69/47 mmHg, and her heart rate was 65 bpm. The nursing staff assisted her to sit as she showed limb weakness, closed eyes, and briefly lost consciousness. Oxygen was administered, and her blood glucose was 6.5. Blood pressure later improved to 124/78 mmHg, with a pulse of 62 bpm. Oral glucose was given, which she vomited, and emergency services were called. Upon arrival, the patient was alert and cooperative. Neurology consultation and imaging (MRI, MRA, and DWI) ruled out cerebral infarction, initially diagnosing a conversion disorder. A subsequent tilt-table test, including sublingual nitroglycerin, induced a marked blood pressure drop and symptoms confirming a diagnosis of vasovagal syncope (VVS). Conclusions: This case shows that preoperative anxiety, fear, and prolonged waiting can trigger vasovagal reflex during tooth extraction, especially in patients with anxiety or cardiac arrhythmias. For such patients, preoperative precautions and intraoperative cardiac monitoring are advised. In cases of VVS, quick actions like monitoring blood pressure, placing the patient in a supine position, providing oxygen, and administering IV fluids or medications like atropine, if necessary, can help stabilize the patient.
文摘Background: Aortic dissection (AD) is one of the common causes of fatal chest pain in emergency medicine. The main and most common clinical manifestation is pain, with about 90% of patients experiencing sudden persistent, tearing or cutting-like pain in the chest or back. However, there have also been reports of myocardial infarction, heart failure, renal failure, syncope, shock, stroke, paraplegia and other cases. Clinical misdiagnosis is common. Aim: Alert clinicians to aortic dissection with shock and chest tightness as the main clinical presentations. Case Presentation: Report on two cases of aortic dissection with syncope and shock as the main manifestations. Conclusion: Aortic dissection is a highly dangerous cardiovascular emergency with a high mortality rate. In clinical practice, awareness of the clinical manifestations of aortic dissection should be increased. Careful inquiry about medical history, attention to atypical clinical presentations of aortic dissection, thorough physical examination, and comprehensive diagnostic evaluation can improve the success rate of diagnosing aortic dissection.
文摘Guillain⁃Barré syndrome (GBS) is an immune-mediated peripheral neuropathy with acute or subacute onset of flaccid paralysis of the limbs with symmetrical hypesthesia and autonomic nerve involvement [1]. The clinical manifestations of autonomic nerve damage are complex and varied, which may involve extensive or limited autonomic function damage, including abnormalities of the skin, pupil, urinary tract, gastrointestinal tract, cardiovascular system, body temperature, lacrimal and salivary glands, and sexual function, etc. [2], and some patients may even have autonomic nerve damage as the only symptom, which is a variant of GBS and is prone to misdiagnosis or underdiagnosis. Recurrence of GBS is rare, and the manifestations of recurrence are often similar to those of the first symptoms [3], but the patient admitted to our hospital had syncope as the main clinical manifestation of recurrence, which was completely different from that of the first incidence, and syncope is not a common and typical clinical manifestation of GBS, so misdiagnosis is highly likely.
文摘The purpose of the present paper is to explore Edgar Lawrence Doctorow’s novel Ragtime(1975)as a masterful adaptation of musical form in fiction.It demonstrates the ways in which the use of musical devices of Ragtime shapes the rhythmic/narrative structure of the novel.The article offers the reading of the novel as a musicalized fiction,or,in other words,as a form of musico-literary intermediality.It focuses on the chief characteristics of Doctorow’s novel such as a plurality of independent consciousnesses and a diversity of simultaneous points of view/voices.The novel by its very design is polyphonic.Manipulating polyrhythmic effects,mixed rhythms,repetitive phrases and leitmotifs,Doctorow is experimenting with the rhythm both on micro and macro textual levels.
基金supported by Peking University Clinical Scientist Program (BMU2019LCKXJ001,Beijing)Fundamental Research Funds for the Central Universities of China.
文摘Vasovagal syncope(VVS) and postural tachycardia syndrome(POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope.In recent years,increasing attention has been paid to the management of VVS and POTS in children and adolescents.A number of potential mechanisms are involved in their pathophysiology,but the leading cause of symptoms varies among patients.A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness.This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.
基金supported by the Science and Technology Program of Beijing Municipality, China (Z171100001017253)Peking University Clinical Scientist Program, China (BMU2019LCKXJ001)
文摘Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. Vasovagal syncope (VVS) is the most common presentation of syncope, and its diagnostic criteria include:(1) absence of any other evident etiology for syncope or presyncope,(2) positive response to head-up tilt test with evident vasovagal reaction (hypotension and/or bradycardia), and (3) no concomitant chronic or acute disease [1, 2]. The onset of VVS peaks initially in childhood and adolescence, and accounts for 60%–70% of all syncopal cases. Clinicians pay great attention to syncope among children and adolescents, due to its high prevalence and its impact on patients’ quality of life. Affected individuals often experience mental stress, economic burdens, and accidental bodily injuries related to syncope [2]. While the pathogenesis of VVS is not fully understood, autonomic nervous dysfunction has been identified as a contributing mechanism. The examination of autonomic nervous function can provide important information about patients with syncope.
文摘Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
