Cardiogenic syncope in therapeutic practice

Recent publications devoted to the etiology, diagnosis and treatment of cardiogenic syncope were reviewed. The analysis of the current state of views on a pathogenesis, classification and features of a clinical picture of syncope of cardiogenic etiology was performed. Cardiogenic syncope has a 20-30% mortality. The highest risk is characteristic for the age more than 45 years, heart failure, history of ventricular tachycardia, nonspecific changes on ECG. With three and more risk factors the probability of a sudden cardiac death within the next year can reach 80%. The cause of cardiogenic syncope is reduction of cerebral blood flow. Cardiogenic syncope can be caused by a fall in blood pressure, cardiac output and total peripheral vascular resistance. Cardiogenic syncope may be the result of bradycardia and asystole, supraventricular and ventricular tachycardia, pulmonary embolism, dissecting aortic aneurysm, structural defects and cardiac anomalies, presence of myxoma or mobile atrial clot, cardiac tamponade, constrictive pericarditis, acute myocardial ischemia, abnormalities of the coronary arteries, dysfunction of prosthetic valve and cardiac pacemakers. In the diagnosis of cardiogenic syncope anamnesis and data received on physical examination are important. Instrumental examination should include electrocardiography, detection of comorbid conditions, exercise stress tests such as cycle ergometry or treadmill test, Holter ECG monitor, echocardiography, and coronary angiography for suspected acute myocardial ischemia.

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A Homozygous CASQ2 Mutation in a Japanese Patient with Catecholaminergic Polymorphic Ventricular Tachycardia

Case Reports in Genetics ◽

10.1155/2019/9056596 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Taishi Fujisawa ◽

Yoshiyasu Aizawa ◽

Yoshinori Katsumata ◽

Akihiro Udo ◽

Shogo Ito ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Japanese Patient ◽

Stress Testing ◽

Catecholaminergic Polymorphic Ventricular Tachycardia ◽

Exercise Stress ◽

Polymorphic Ventricular Tachycardia ◽

Ventricular Ectopy ◽

Recessive Form ◽

History Of ◽

Structural Disease

A 62-year-old female had suffered from recurrent syncopal episodes triggered by physical and emotional stress since childhood. She had no family history of sudden death. An intensive examination could not detect any structural disease, and exercise stress testing provoked polymorphic ventricular ectopy followed by polymorphic ventricular tachycardia accompanied with syncope leading to a diagnosis of catecholaminergic polymorphic ventricular tachycardia (CPVT). A genetic analysis with a next generation sequencer identified a homozygous W361X mutation in the CASQ2 gene. Careful history taking disclosed that her parents had a consanguineous marriage. Here we present a Japanese patient with a recessive form of CPVT.

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Exercise Stress Tests for Detecting Myocardial Ischemia in Asymptomatic Patients With Diabetes Mellitus

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.02.047 ◽

2013 ◽

Vol 112 (1) ◽

pp. 14-20 ◽

Cited By ~ 14

Author(s):

Fadi G. Hage ◽

Lara Lusa ◽

Maurizio Dondi ◽

Raffaele Giubbini ◽

Ami E. Iskandrian

Keyword(s):

Diabetes Mellitus ◽

Myocardial Ischemia ◽

Exercise Stress ◽

Stress Tests ◽

Asymptomatic Patients ◽

Patients With Diabetes

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Ischemia-modified albumin (IMA) is not useful for detecting myocardial ischemia during symptom-limited exercise stress tests

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2008.23.3.121 ◽

2008 ◽

Vol 23 (3) ◽

pp. 121 ◽

Cited By ~ 5

Author(s):

June Hong Kim ◽

Jae Hoon Choi ◽

Hyun-Kook Lee ◽

Woo Hyung Bae ◽

Kook-Jin Chun ◽

...

Keyword(s):

Myocardial Ischemia ◽

Exercise Stress ◽

Stress Tests ◽

Ischemia Modified Albumin

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Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit

Cardiology in the Young ◽

10.1017/s1047951112000881 ◽

2012 ◽

Vol 23 (3) ◽

pp. 361-367 ◽

Cited By ~ 13

Author(s):

Ahmet Sert ◽

Ebru Aypar ◽

Dursun Odabas ◽

Cem Gokcen

Keyword(s):

Chest Pain ◽

Physical Examination ◽

Clinical Characteristics ◽

Complete Blood Count ◽

Exercise Stress ◽

Child Psychiatrist ◽

Stress Tests ◽

Paediatric Cardiology ◽

Premature Cardiovascular Disease ◽

History Of

AbstractBackgroundChest pain is a common presenting complaint to paediatrics, paediatric cardiology, and paediatric emergency departments. In this study, we prospectively evaluated clinical characteristics and causes of chest pain in children referred to our paediatric cardiology unit.MethodsA total of 380 children were included. Associated symptoms and past and family histories were evaluated. All patients underwent physical examination. The following studies were performed: complete blood count in all patients; fasting lipid profiles in overweight and obese children and children with a family history of premature cardiovascular disease; and electrocardiogram, chest X-ray, and echocardiogram in all patients. If necessary, 24-hour electrocardiogram monitoring or exercise stress tests were performed. Patients with a history of positive psychological findings were evaluated by a child psychiatrist.ResultsThe most common causes of chest pain were musculoskeletal disorders (37.1%), idiopathic chest pain (29.2%), and miscellaneous disorders, for example precordial catch syndrome (15%), respectively. Only 1 of 380 (0.3%) patients had chest pain due to a cardiac disorder. Electrocardiograms were abnormal in 4 of 380 (1.1%) patients. A total of 9 of 380 patients (2.3%) had dyslipidaemia.ConclusionsAlthough a paediatric cardiology referral may provide reassurance to the primary care and emergency department physicians, our results show that cardiac aetiologies for paediatric chest pain are very rare. We think that many patients in our study were adequately evaluated only by careful history, and physical examination. Therefore, we suggest that it may not be necessary to use echocardiogram in the routine evaluation of children with chest pain.

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Exercise Stress Tests for Detecting Myocardial Ischemia in Asymptomatic Patients with Diabetes Mellitus

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2013.08.005 ◽

2013 ◽

Vol 45 (4) ◽

pp. 635-636

Author(s):

Jenelle Holst

Keyword(s):

Diabetes Mellitus ◽

Myocardial Ischemia ◽

Exercise Stress ◽

Stress Tests ◽

Asymptomatic Patients ◽

Patients With Diabetes

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Morphology of ectopic ventricular beats and their relationship to ventricular tachycardia in acute myocardial ischemia.

Japanese Heart Journal ◽

10.1536/ihj.26.11 ◽

1985 ◽

Vol 26 (1) ◽

pp. 11-22

Author(s):

Kazuya FUJINO ◽

Yutaka NAKAYA ◽

Hiroyoshi MORI ◽

Yoshikazu HIASA ◽

Takatoshi ISHIDA ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Myocardial Ischemia ◽

Acute Myocardial Ischemia

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Abstract 12598: Stress Testing During Long-term Follow-up After Kawasaki Disease

Circulation ◽

10.1161/circ.142.suppl_3.12598 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Audrey Dionne ◽

Meaghan Beattie ◽

Thomas Giorgio ◽

Annette L Baker ◽

Ming Hui Chen ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Myocardial Ischemia ◽

Cardiac Mri ◽

Stress Testing ◽

Stress Test ◽

Artery Aneurysm ◽

Exercise Stress ◽

Inducible Ischemia ◽

History Of

Introduction: The American Heart Association (AHA) guidelines recommend testing for inducible myocardial ischemia in all patients with a history of coronary artery aneurysm (CAA) after Kawasaki disease (KD). Because the prevalence of clinical coronary complications is exceedingly low in patients whose worst-ever CAA dimension was <large/giant, we examined the yield of stress testing in KD over a 20-year period. Methods: Retrospective study including patients <18 yo with KD who underwent cardiac imaging to evaluate for inducible ischemia between 2000-2019. Patients with a prior coronary artery intervention were excluded. Inducible ischemia was defined as stress-induced reversible wall motion abnormalities on echocardiogram or cardiac MRI, or reversible defect on nuclear myocardial perfusion imaging. Results: A total of 588 stress tests were performed in 208 patients at median age of 12.4 [IQR 8.8, 16.8] years, 8.3 [IQR 5.0, 12.9] years after diagnosis (Table). Tests were performed using either exercise stress (545 [93%] tests) or pharmacologic stress with dobutamine (43 [7%] tests). Echocardiography was the most frequently used modality (n=481, 82%), followed by nuclear imaging (n=133, 23%) and cardiac MRI (n=53, 9%). Inducible ischemia was found on 11 (2%) tests in 6 (3%) patients. All patients with inducible ischemia had a history of giant CAA with persistent CAA at time of testing (moderate CAA in 2 (18%) tests, giant CAA in 9 (82%) tests). After finding inducible ischemia on stress test, coronary artery bypass grafting was performed in 3 cases, cardiac catheterization in 4, stress testing using a different imaging modality in 1, and careful clinical monitoring without intervention in 3. Conclusions: Inducible ischemia was found in 2% of test after KD, and only in patients with a history of giant CAA. Recommendations in the 2017 AHA guidelines for KD for testing for myocardial ischemia in patients with non-giant CAA should be reconsidered in light of these findings.

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