scholarly journals Evaluation and Management of Syncope

2008 ◽  
Vol 2 ◽  
pp. CCRPM.S490
Author(s):  
Paveljit S. Bindra ◽  
Francis E. Marchlinski ◽  
David Lin
Keyword(s):  
Heart Disease ◽  
Primary Care Physicians ◽  
English Language ◽  
Evidence Synthesis ◽  
Fatal Outcome ◽  
Heart Association ◽  
Structural Heart Disease ◽  
Diagnostic Tools ◽  
Methodical Approach ◽  
Effective Manner

Context Syncope is a commonly encountered by primary care physicians and cardiologists. Etiology is frequently not apparent, and patients may undergo unnecessary tests. Treatment must be tailored to the likely etiology. Complexities of diagnosis and treatment often warrant referral to a specialist. Objective To highlight the evolving recommendations for managing syncope in a clinically and cost effective manner. Evidence Acquisition An electronic literature search was undertaken of the Medline database from January 1996 to April 2006, using the Medical Subject Heading syncope, defibrillators, pacemakers, echocardiogram, cardiomyopathy, long QT syndrome, Arrhythmogenic right ventricular dysplasia, and Brugada syndrome. Abstracts and titles were reviewed to identify English-language trials. Bibliographies from the references as well as scientific statements from the Heart Rhythm Society, American Heart Association, and American College of Cardiology were reviewed. Evidence Synthesis A methodical approach to syncope can improve diagnosis, limit testing, and identify patients at risk of fatal outcome. A thorough history, physical exam and electrocardiogram are critical to the initial diagnosis. Presence of heart disease determines the extent of work-up and treatment. A trans-thoracic echocardiogram should be performed in patients with an unclear diagnosis and a positive cardiac history or an abnormal ECG. Ventricular arrhythmias are the most common cause of syncope in patients with structural heart disease. Patients with an ejection fraction less than 30 percent should receive an implantable defibrillator with few exceptions. An electrophysiology study may assist risk stratification in syncopal patients with borderline ventricular function. In patients without structural heart disease, the presence of a well defined arrhythmia syndrome consistent with a genetically determined risk of sudden death must be sought. The 12-lead electrocardiogram, family history and clinical presentation will identify most high-risk patients. Patients without structural heart disease can often be managed conservatively with well defined strategies for preventing neurocardiogenic syncope. Conclusions Managing syncope requires a methodical approach. An understanding of the limitations of the diagnostic tools and treatments is important. Lethal causes of syncope make it imperative to recognize the appropriate timing of referring patients to specialists.

Abstract 15345: Prevalence of Abnormal Preparticipation Screening H&Ps in Collegiate Athletes as Compared to Focused Screening Echocardiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Daniel Modaff ◽  
Sheila Hegde ◽  
Dennis Helwig ◽  
Nancy Bell ◽  
Peter Rahko
Keyword(s):  
Heart Disease ◽  
Collegiate Athletes ◽  
Heart Association ◽  
Structural Heart Disease ◽  
Structural Abnormality ◽  
Preparticipation Screening ◽  
Structural Abnormalities ◽  
Cardiac Evaluation ◽  
Heart Abnormalities ◽  
A Minor

Introduction: For all competitive athletes, the American Heart Association preparticipation screening (AHA PPS) guidelines recommend a 12 element focused history and physical. Evaluation of an abnormal PPS finding is left to the clinician’s discretion. The correlation between an abnormal PPS finding and structural heart disease is not well documented. A murmur on physical exam is classically used as a tool to identify a multitude of structural heart abnormalities. We propose that the current AHA PPS and specifically, a murmur detected on exam, correlate poorly with true echocardiographic abnormalities in the collegiate athlete population. Methods: A PPS modeled after the AHA guidelines was conducted on all incoming athletes at a single university from 2007 to 2013. All athletes independently underwent a focused screening echo the same day of the exam. PPS examiners were blinded to results of the screening echoes. Data from both screening exams were compared. We report the prevalence of abnormal H&P findings and its relation to structural abnormalities found on focused echo screening. Results: There were 2472 athletes screened. At least one positive PPS element was noted in 655 (26.5%) athletes. Of this group, 24 (3.7%) had an abnormal focused echo. The PPS was normal in 1817 (73.5%) athletes but an abnormal echo was found in 19 of these athletes, indicating 44.2% of all abnormal echoes (N=43) had a negative PPS. Of the athletes with abnormal echo findings, 23 had structural abnormalities classically associated with a murmur. Only four of these athletes had an actual murmur on exam. In total, a murmur was detected in 36 athletes. By echocardiography, 25 (69.4%) had no structural abnormalities, thereby rendering the murmur benign. A murmur consistent with a minor structural abnormality was found in 7 (19.4%) athletes, and a murmur consistent with a significant structural abnormality was found in 4 (11.1%) athletes. Conclusions: The AHA PPS and specifically, a murmur on exam, do not reliably detect the presence of structural heart disease. An abnormal PPS is rarely associated with structural heart disease and an immediate focused echo can rapidly determine this and eliminate the need for further cardiac evaluation.

scholarly journals Stroke Prevention in Atrial Fibrillation and Valvular Heart Disease

2016 ◽  
Vol 10 (1) ◽  
pp. 110-116 ◽  
Author(s):  
Saad Ahmad ◽  
Heath Wilt
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Heart Association ◽  
Heart Rhythm ◽  
Structural Heart Disease ◽  
Pivotal Phase ◽  
European Society Of Cardiology

There is a clinically staggering burden of disease stemming from cerebrovascular events, of which a majority are ischemic in nature and many are precipitated by atrial fibrillation (AF). AF can occur in isolation or in association with myocardial or structural heart disease. In the latter case, and when considering health at an international level, congenital and acquired valve-related diseases are frequent contributors to the current pandemic of AF and its clinical impact. Guidelines crafted by the American Heart Association, American College of Cardiology, European Society of Cardiology and Heart Rhythm Society underscore the use of vitamin K antagonists (VKAs) among patients with valvular heart disease, particularly in the presence of concomitant AF, to reduce the risk of ischemic stroke of cardioembolic origin; however, the non-VKAs, also referred to as direct, target-specific or new oral anticoagulants (NOACs), have not been actively studied in this particular population. In fact, each of the new agents is approved in patients with AFnotcaused by a valve problem. The aim of our review is to carefully examine the available evidence from pivotal phase 3 clinical trials of NOACs and determine how they might perform in patients with AF and concomitant valvular heart disease.

scholarly journals Supine Frequent Ventricular Extrasystoles in a Pregnant Woman without Structural Heart Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Natália Stela Sandes Ferreira ◽  
Tatiana La Croix Barros ◽  
Ronaldo Altenburg Gismondi
Keyword(s):  
Heart Disease ◽  
Pregnant Woman ◽  
Pregnant Women ◽  
Primary Care Physicians ◽  
Venous Return ◽  
Vena Cava ◽  
Structural Heart Disease ◽  
Ventricular Extrasystoles ◽  
Ventricular Premature Complexes ◽  
The Right

Arrhythmias are the most common cardiac complication during gestational period and may occur in women with or without known structural heart disease. Premature extra beats and sustained tachyarrhythmias are the most common arrhythmias in pregnancy. Symptomatic episodes occur in 20–44% of pregnant women, usually as palpitations, dizziness, or syncope. We searched on Pubmed for ventricular premature complexes (VPC) in pregnant women and found no case reporting increased incidence of this arrhythmia while supine. The aim of this study is to report a case of a pregnant woman without previous structural heart disease that presented a great number of VPC when supine. The arrhythmogenesis increase during pregnancy is multifactorial. In the reported case, we believe that augmented venous return was the most important pathophysiologic process. When the patient changes to left lateral decubitus, there could be a sudden release of the inferior vena cava, causing an abrupt augmentation of venous return to the right heart chambers and increasing the risk of arrhythmias. Obstetricians and primary care physicians should be aware of palpitations and related patient complains while they are asleep or supine.

Identification of High-risk Patients for Implantable Cardioverter–Defibrillator Therapy in Asia

2011 ◽  
Vol 3 (1) ◽  
pp. 77
Author(s):  
Cyril YK Ko ◽  
Jeffrey WH Fung ◽  
◽  
Keyword(s):  
Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Asian Population ◽  
Structural Heart Disease ◽  
Medical Problem ◽  
Western World ◽  
Asian Countries ◽  
Cardioverter Defibrillator ◽  
Asian Patients ◽  
Risk Patients

Sudden cardiac death (SCD) is a serious medical problem worldwide. Multiple landmark studies have demonstrated the benefit of implantable cardioverter–defibrillator (ICD) therapy in preventing SCD in at-risk patients. Although the data available in Asia are limited, the disease pattern seems to be different from that in the western world. The Asian population seems to have a lower incidence of SCD. Coronary heart disease, which is the major underlying cause of SCD in the west, may play a less important role in Asian countries. In addition, non-structural heart disease seems to be a more prevalent cause of SCD in Asia. It is thus questionable whether the results of ICD trials can be applied directly to Asian countries, as most of these trials seldom recruited Asian patients. This article will review SCD in Asia, focusing on the epidemiology and risk factors for SCD in Asia and highlighting some unique features that may be different from those seen in the western world.

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