As appeared in the December 2010 issue of Emergency Medicine Practice Guidelines Update.
by reuben in .syncope
Nynke van Dijk, MD, et al Journal of the American College of Cardiology Effectiveness of Physical Counterpressure Maneuvers in Preventing Vasovagal Syncope Vol. 48, No. 8, 2006 In this study, we assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life. There is presently no evidence-based therapy for vasovagal syncope. Current treatment consists of explanation and life-style advice. Physical counterpressure maneuvers have been shown to raise blood pressure and to control or abort vasovagal episodes in laboratory conditions. We performed a multicenter, prospective, randomized clinical trial, which included 223 patients age 38.6 (????15.4) years with recurrent vasovagal syncope and recognizable prodromal symptoms. One hundred and seventeen patients were randomized to standardized conven- tional therapy alone, and 106 patients received conventional therapy plus training in PCM. The median yearly syncope burden during follow-up was significantly lower in the group trained in PCM than in the control group (p ???? 0.004). During a mean follow-up period of 14 months, overall 50.9% of the patients with conventional treatment and 31.6% of the patients trained in PCM experienced a syncopal recurrence (p ???? 0.005). Actuarial recurrence- free survival was better in the treatment group (log-rank p ???? 0.018), resulting in a relative risk reduction of 39% (95% confidence interval, 11% to 53%). No adverse events were reported. Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope and recognizable prodromal symptoms, and should be advised as first-line treatment in patients presenting with vasovagal syncope with prodromal symptoms. (The PC-Trial; http://www.controlled-trials.com/isrctn/trial/45146526/0/ 45146526.html; ISRCTN45146526)…
1. ACS 2. Wolff-Parkinson-White syndrome (WPW): the most common form of preexcitation, WPW is associated with the classic triad of short PR interval, QRS complex widening greater than 100 milli- seconds, and the delta wave (slurred upstroke of the QRS com- plex). It is important to remember that delta waves, although the most well known of the triad, are often absent in many leads. The short PR interval is actually the most consistent finding in all of the leads. 3. Brugada syndrome: Brugada syndrome is a purely electrical phenomenon (meaning that patients have structurally normal hearts) that is associated with unpredictable episodes of ventricular tachycardia. Patients may have sudden death, but if the arrhythmia terminates spontaneously, the patient presents instead with syncope. The resting ECG demonstrates a right bundle branch block morphology with STE in leads V1 to V2. 4. Hypertrophic cardiomyopathy (HCM): hypertrophic cardiomyopa- thy may be associated with episodes of ventricular tachyarrhyth- mias, usually associated with exertion, in relatively young patients. The ECG manifestations of HCM are often nonspecific (high voltage in the precordial leads, left atrial enlargement, tall R waves in right precordial leads, and abnormal Q waves in the inferior and/ or lateral leads) . However, the combination of high voltage with deep, narrow Q waves in the inferior and/or lateral leads is highly specific for this entity. 5. Prolongation of the QT interval: patients with a prolonged QTc interval are at risk for torsades de pointes. Patients are at highest risk when the QTc interval is greater than 500 milliseconds….
1121. Elements of San Francisco syncope rule // Pediatric anatomy features that affect trauma managementSeptember 20th, 2009
by reuben in .syncope, .trauma-general, kids
206. Monikers & pathophysiology of hypertrophic cardiomyopathy / When to suspect HCM / Investigations to perform if suspiciousJanuary 20th, 2008
by reuben in .syncope, cardiomyopathy
IHSS HOCM OCM
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by reuben in .dizzy, .syncope, .vertigo