Tag Archives: syncope

Case report Figure 1. The extracorporeal membrane oxygenation (ECMO) system A 20-year-old female student under investigation for syncopal attacks was found to have a normal electrocardiogram (ECG) and cardiac morphology on echocardiography. She then suffered ventricular fibrillation at rest while talking to friends. They performed cardiac massage and a paramedic ambulance arrived within four minutes. Defibrillation was attempted using anterior and lateral electrodes. When this was unsuccessful, she was intubated and a Lucas cardiac compression device applied, even though the Accident and Emergency (A&E) department was less than one mile a

Introduction Heart rhythm changes are common during seizures, even those seizures not associated with convulsive activity. Most studies report tachycardia, a heart rate increase of more than 10 beats per minute above the baseline, as the most common rhythm abnormality occurring in 64–100% of temporal lobe seizures.1,2 By contrast, ictal bradycardia has been reported in less than 6% of patients with complex partial seizures.3,4 The ictal bradycardia syndrome occurs in those with established epilepsy when epileptic discharges disrupt normal cardiac rhythm leading to a decrease in heart rate of more than 10 beats per minute below the baseline.

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Prognostic implications There are profound prognostic implications for those suffering from syncope – Soteriades et al., in their study, evaluated the incidence and prognosis of syncope in participants in the Framingham Heart Study.5 They found the most frequently identified causes were vasovagal syncope, cardiac syncope and orthostatic hypotension: 36% still had no demonstrable cause. There was no increased risk of cardiovascular morbidity or mortality associated with vasovagal syncope, but persons in this study who fell into the diagnostic categories of cardiac syncope or syncope of unknown cause, were at increased risk of death from any

Introduction Case history 1 PL is a 19-year-old female who presented with two episodes of blackout accompanied with convulsions. She was diagnosed with epilepsy and prescribed carbamazepine. Episodes continued, however, and one year later she was further investigated by tilt-testing and discovered to have cardioinhibitory vasovagal syncope. A dual-chamber rate-drop-response pacemaker was implanted and no further episodes occurred during five years of follow-up. Anticonvulsant medication was stopped without ill effect. Case history 2 CM is a 72-year-old male admitted for pain control following an unwitnessed fall, which although initially bel

Case report Figure 1. Electrocardiogram (ECG) features of left ventricular hypertrophy A 67-year-old man was referred to the cardiology clinic with a history of collapse and a family history of hypertrophic cardiomyopathy (HCM). He denied any history of angina or dyspnoea. On physical examination he had a 3/6 grade ejection murmur in the aortic area and a pansystolic murmur at the mitral area accentuated on squatting. There were no signs of volume overload. X-ray angiography demonstrated normal coronaries but a raised end diastolic pressure. His electrocardiogram (ECG) was compatible with left ventricular (LV) hypertrophy (figure 1). A single

Editors: Natale A, Wazni O Publisher: Informa Healthcare, London, 2007 ISBN: 184184620 Price: £110 There are sections on implantation techniques for pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation devices (CRT). The latter is an excellent introduction to the practical aspects of asessing the patient, implanting and extracting devices. A good section of the book details the approach to interventional electrophysiology including basic principles behind diagnostic electrophysiology testing and catheter ablation of the most commonly encountered arrhythmias. The handbook also has comprehensive coverage of

In patients in whom the heart rate drops dramatically before the fainting episode, traditional pacemakers are well established as a good form of therapy. But most patients with recurrent syncope do not experience any clear fall in heart rate ahead of a fainting episode. The new Biotronik Cylos 990 pacemaker, may help these patients by detecting early changes in the body’s control systems ahead of a fainting episode and then working to prevent the fainting episode. The pacemaker also contains a chip enabling remote follow-up of the patient at home.  “This way of supporting pacemaker patients in their everyday lives is the future of cardia

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