Syncope Cases

Syncope Cases......Page 5
Contents......Page 7
Contributors......Page 10
Foreword......Page 18
Abbreviations......Page 20
Part I Neurally mediated (reflex) syncope......Page 21
Clinical presentation......Page 23
1 Vasovagal fainting in children and teenagers......Page 25
2 Typical vasovagal syncope (blood/injury phobia)......Page 28
3 Reflex syncope in older adults......Page 30
4 Transient loss of consciousness with muscle jerks: syncope or epilepsy?......Page 32
5 Tilt-induced syncope: mixed response......Page 35
6 Tilt-induced syncope: cardioinhibitory response......Page 39
7 Tilt-induced syncope: purely vasodepressor response......Page 41
8 Tilt-induced syncope: dysautonomic response......Page 45
9 Tilt-induced syncope: chronotropic incompetence......Page 47
10 Syncope and postural orthostatic tachycardia syndrome......Page 49
11 Electroencephalography recordings during syncope......Page 54
12 Psychogenic reaction during tilt-table testing......Page 56
13 Neuromediated syncope presenting as a paroxysmal atrioventricular block......Page 58
14 Multiple manifestations of the cardioinhibitory mechanism detected during prolonged electrocardiographic monitoring......Page 61
15 Neuromediated syncope masquerading as unexplained falls......Page 64
16 Post-exercise vasovagal syncope......Page 66
17 Post-exercise neuromediated syncope......Page 69
18 Vasovagal syncope interrupting sleep......Page 72
19 Syncope during pregnancy......Page 75
20 A pilot with vasovagal syncope: fit to fly?......Page 78
21 Recurrent syncope in a patient with no structural heart disease and a negative tilt-table test......Page 80
22 Swallow syncope associated with asystole......Page 82
23 Swallow syncope presenting with atrioventricular block......Page 84
24 Transient glossopharyngeal syncope......Page 86
25 Tussive syncope......Page 89
26 Laughter-induced syncope......Page 91
27 Syncope and the eye......Page 94
Treatment......Page 97
28 Long-term follow-up of vasovagal syncope with a long asystolic pause......Page 99
29 Averting a vasovagal faint with a combination of leg crossing and muscle tensing......Page 102
30 Vasovagal syncope averted using arm-tensing maneuvers......Page 105
31 Training patients in physical countermaneuvers using continuous on-screen blood-pressure monitoring......Page 107
32 Vasovagal syncope treated with tilt training......Page 109
33 Psychological treatment of malignant vasovagal syncope due to blood phobia......Page 111
34 Syncope relapse in a patient with cardioinhibitory neuromediated syncope treated with pacing......Page 114
Carotid sinus syndrome......Page 117
35 Carotid sinus syndrome......Page 119
36 Carotid sinus hypersensitivity only during tilting......Page 121
37 Complex cardioinhibitory neurally mediated syncope......Page 124
38 Carotid hypersensitivity syndrome secondary to neck tumor......Page 126
39 Syncope in a case of carotid body paraganglioma......Page 128
40 Recurrent syncope in a carotid sinus patient treated with a pacemaker......Page 131
41 Unexplained falls in older patients......Page 133
Part II Orthostatic hypotension......Page 135
42 Initial orthostatic hypotension as a cause of syncope in an adolescent......Page 137
43 Initial orthostatic hypotension and syncope due to medications in a 60-year-old man......Page 140
44 Initial orthostatic hypotension induced by standing up from squatting......Page 143
45 Self-induced syncope: the fainting lark......Page 146
46 Self-diagnosis of orthostatic hypotension in a patient with autonomic failure......Page 148
47 Unexplained transient loss of consciousness in a 58-year-old man after Legionella pneumonia......Page 151
48 Physical maneuvers that reduce postural hypotension in autonomic failure......Page 154
49 Disabling orthostatic hypotension caused by sympathectomies for hyperhidrosis......Page 157
50 Orthostatic hypotension due to arterial baroreflex failure......Page 161
51 Hypotension due to straining in a patient with a high spinal-cord lesion......Page 164
52 Orthostatic hypotension and syncope in a patient with pheochromocytoma......Page 167
Part III Arrhythmic syncope......Page 171
53 Syncope and the Brugada syndrome......Page 173
54 Two types of monomorphic ventricular tachycardia as a cause of syncope in Brugada syndrome......Page 176
55 Syncope and Brugada-like electrocardiography pattern appearing during a febrile illness: neurally mediated or arrhythmic syncope?......Page 179
56 Syncope in a case of acquired long QT syndrome......Page 183
57 Syncope due to torsade de pointes in an HIV-infected patient receiving methadone treatment......Page 185
58 Congenital long QT syndrome......Page 188
59 Long QT syndrome revealed by exercise......Page 190
60 Congenital long QT syndrome: torsade de pointes demonstrated by prolonged monitoring......Page 192
61 Short-coupled variant of torsade de pointes......Page 195
62 Syncope in a patient with a short QT interval......Page 197
63 Syncope in a woman with no heart disease, a normal electrocardiogram, and a family history of sudden death......Page 200
64 Palpitations and syncope: an unusual case of bradycardia–tachycardia syndrome......Page 204
65 Arrhythmic syncope in a child: catecholaminergic ventricular tachycardia......Page 207
66 Adenosine triphosphate-sensitive paroxysmal atrioventricular block......Page 210
67 Adenosine-dependent syncope?......Page 212
68 Syncope due to paroxysmal junctional tachycardia......Page 214
69 Syncope in a patient with atrioventricular nodal reentry tachycardia: reflex hypotension?......Page 217
70 Arrhythmic and neuromediated syncope in a young woman......Page 220
71 Syncope and Wolff–Parkinson–White syndrome: atrial fibrillation with rapid ventricular response......Page 224
72 Wolff–Parkinson–White syndrome with inapparent preexcitation in sinus rhythm: atrial flutter with 1 : 1 atrioventricular conduction......Page 228
73 Syncope in a patient with atrial fibrillation: reflex hypotension?......Page 231
74 Neuromediated syncope inducing atrial fibrillation......Page 233
75 Effort presyncope due to idiopathic right ventricular tachycardia......Page 236
76 Syncope due to idiopathic left ventricular tachycardia......Page 239
77 Syncope and arrhythmogenic right ventricular dysplasia......Page 242
78 Unexpected electrophysiology study result in a patient with repeated syncopal episodes......Page 244
79 Syncope in a patient with right bundle-branch block and alternating anterior and posterior left fascicular block......Page 246
80 Vasovagal syncope in a patient with bundle-branch block......Page 249
81 Intermittent atrioventricular block suggested by an electrophysiological study......Page 251
82 Syncope in a patient with bundle-branch block and negative electrophysiological study......Page 254
83 Syncope in a patient with bundle-branch block and previous myocardial infarction......Page 256
84 Syncope in a case of left bundle-branch block treated with an implantable defibrillator and biventricular pacing......Page 258
Part IV Syncope and cardiovascular disease......Page 261
85 Acute coronary syndrome presenting as syncope......Page 263
86 Syncope as an isolated manifestation of left main coronary artery occlusion......Page 266
87 Syncope in a patient with myocardial infarction......Page 268
88 Acute myocardial infarction and complete heart block: early revascularization procedure......Page 270
89 Syncope in chronic ischemic heart disease: ventricular tachycardia induced during an electrophysiological study......Page 272
90 Syncope in a patient with an earlier myocardial infarction: induction of ventricular fibrillation during electrophysiological testing......Page 276
91 Syncope in a patient with dilated cardiomyopathy, a negative electrophysiological study, and poor left ventricular function......Page 280
92 Syncope in a patient with obstructive hypertrophic cardiomyopathy and left bundle-branch block......Page 283
93 Atrial flutter with 1 : 1 atrioventricular conduction in a patient with hypertrophic cardiomyopathy......Page 287
94 Syncope in hypertrophic cardiomyopathy, atrial fibrillation, and rapid ventricular response......Page 290
95 Syncopal ventricular tachycardia in a case of midseptal hypertrophic cardiomyopathy with apical aneurysm......Page 292
96 Carcinoid syndrome......Page 296
97 Syncope and myotonic dystrophy......Page 298
98 Syncope in a patient with Kearns–Sayre syndrome......Page 303
99 Syncope in aortic stenosis......Page 305
100 Syncope after aortic valve replacement......Page 308
101 Syncope in a patient with aortic valve prosthesis and wide QRS tachycardia......Page 311
102 Presyncope due to left atrial myxoma......Page 315
103 Syncope due to left atrial thrombus......Page 318
104 Cardiac tamponade presenting as syncope......Page 320
105 Syncope in acute aortic dissection......Page 324
106 Pulmonary embolism presenting as syncope......Page 327
107 Subclavian steal syndrome as a cause of syncope......Page 330
108 Multiple malignant causes of syncope in a young girl......Page 332
Index......Page 337