Tag Archives: syncope

While the aetiology of this complex condition remains unclear, PoTS has been associated with other conditions, including the Epstein-Barr virus, autoimmune conditions1 such as Sjögren’s syndrome and antiphospholipid syndrome, joint hypermobility conditions,2 and chronic fatigue.3 PoTS, as is the case for most syndromes, presents uniquely in everyone in terms of its thumbprint of symptomatic expression. Similarly, these post-COVID-19 cases, in addition to the diagnostic presence of abnormal response by the autonomic nervous system to upright posture (diagnosed by a sustained increase in heart rate of over 30 bpm in adults within 10 minutes

Introduction Postural tachycardia syndrome (PoTS) was first described in American Civil War soldiers,1 and subsequently in First World War soldiers.2 These early descriptions were published by some of the most eminent cardiologists of the time. It was defined formally as a syndrome in 1993,3 leading onto guidelines, more recently published by the Heart Rhythm Society 2015,4 and the Canadian Cardiovascular Society 2020.5 While we remain uncertain in detail about its underlying cause, it seems to be an abnormality in the regulation of the cardiovascular system causing excessive tachycardia on standing, with cardiovascular symptoms including ch

Case A 56-year-old man was referred from the emergency department for further evaluation of recurrent dizzy spells. The patient reported that he had intermittent episodes of palpitations associated with pre-syncope, but denied loss of consciousness. Additionally, he was feeling generally unwell and tired. There was no associated history of shortness of breath, chest pain, nausea, vomiting or sweating. Each episode of dizziness lasted for a few minutes and occurred both at rest and on exertion. There was no history of recent viral infection, tinnitus, otalgia, or otorrhoea. There was no associated facial asymmetry, speech disturbance or sensor

Introduction Syncope is defined as a transient loss of consciousness (TLoC) secondary to cerebral hypoperfusion, associated with loss of tone and spontaneous recovery.1 It has a lifetime prevalence of 20%,2 and an incidence of 0.80–0.93 per 1,000 person-years, which occurs in a roughly bimodal pattern, with an initial peak in early adulthood followed by a further more pronounced peak in older age.3 Syncope is merely one form of TLoC. Other causes of TLoC include seizures, sleep disturbance, accidental falls and some psychiatric disorders. Syncope itself can be grouped into four major categories: reflex syncope (vasovagal and situational), o

Introduction Implantable cardiac monitors (ICMs) are becoming more commonly recommended during the investigation of a patient with transient loss of consciousness.1,2 The original first-generation devices were implanted by a surgical procedure, usually by a cardiologist in a cardiac catheterisation theatre on a day-case basis, lasting up to 30–45 minutes per procedure. This process is inherently resource heavy for theatre time, staff (implanting physician, catheter lab nurses, cardiac radiographer and cardiac physiologist), in addition to pre-admission assessment, surgical equipment and patient recovery in a day-case facility. The developme

Introduction The aim of this study was to introduce a syncope pathway to the Ipswich Hospital NHS Trust (IHT), a busy district general hospital (DGH) and to emphasise the need for a syncope unit. We analysed the care of 500 patients treated for a syncopal event, our hypothesis being that the management of syncope within the trust was not up to the standards laid out in current guidelines. We also hypothesised that small changes, as well as larger scale organisational ones, would be hugely beneficial to patient care. If management was in line with guidelines, then we endeavoured to introduce a ‘Syncope Unit’ based on the European Heart Rhy

Introduction Up to half of the UK population will experience syncope in their lifetime,1 although only a minority will seek medical attention.2 Studies report a constant frequency of syncope in European emergency departments (EDs) with an incidence of 1% of all attendances.3 With a lifetime risk of syncope estimated at 42%,4 it accounts for significant morbidity.5,6 Uncovering the precise aetiology behind a syncopal episode remains a diagnostic challenge for clinicians, and only half of those admitted to hospital will be given a diagnosis on discharge.7 Effective management of syncope relies on early clinical evaluation by specialist staff th

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Plenary session – precision medicine for the next decade A distinguished line-up of speakers enlightened the congress on the future of rhythm management in this session. Dr Calum MacCrae (Brigham and Women’s Hospital, Boston, USA) opened our eyes to the ongoing challenges and potential of genetic testing to tailor the treatment of cardiovascular disease. From genetics and genomics we moved on to proteomics, where Professor Manual Mayr (King’s College London) enlightened us on how this emerging and rapidly growing discipline can shape the future of rhythm management. Professor A John Camm (President, Arrhythmia Alliance) brought the conc

Introduction Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion followed by rapid and complete recovery. It is a common complaint, accounting for 3–5% of Accident and Emergency (A&E) attendances, and up to 50% of these patients are admitted to hospital.1 One rare cause of reflex syncope is mechanical stimulation of the carotid sinus by cancers of the head and neck, and this case demonstrates the challenges in its management. Case report A 68-year-old male presented to the A&E department having suffered from nine episodes of collapse on the day of admission. With the aid of collateral history from h