Syncope is a condition often misdiagnosed as epilepsy. Syncope caused by cardiac disturbance is a life-threatening condition and accurate diagnosis is crucial for patient outcome. We present a case study of a 71-year-old woman who was referred to our epilepsy centre with a diagnosis of refractory epilepsy. We diagnosed convulsive syncope caused by malignant cardiac arrhythmia based on the presence of cardiac asystole lasting for 20-30 seconds, which was caused by sick sinus syndrome combined with third-degree atrioventricular block. The most prominent feature of this syncope was atypical trunk (abdominal or thoracoabdominal) convulsions, which were accompanied by other motor signs (head and eye deviation and brief jerks of the extremities). In the periods between attacks, all investigations, including standard 12-lead ECG and 24-hour ECG monitoring, were normal. This case study highlights the challenge in differential diagnosis of sudden loss of consciousness. [Published with video sequences].

• Klíčová slova
• arrhythmia, asystole, central pattern generators, epilepsy, sick sinus syndrome, syncope, trunk convulsion,
• MeSH
• atrioventrikulární blokáda komplikace   diagnóza   MeSH
• diferenciální diagnóza MeSH
• elektroencefalografie MeSH
• elektrokardiografie MeSH
• epilepsie diagnóza   MeSH
• lidé MeSH
• senioři MeSH
• syndrom chorého sinu komplikace   diagnóza   MeSH
• synkopa diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

[Figure: see text]

• Klíčová slova
• Catheter ablation, Methods, Neurally mediated syncope, Reflex syncope, Syncope, Vasovagal syncope,
• MeSH
• bradykardie MeSH
• lidé MeSH
• reflex MeSH
• vazovagální synkopa * diagnóza   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lidé MeSH
• synkopa * diagnóza   etiologie   MeSH
• vazovagální synkopa * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: EGSYS-U, EGSYS-M, and OESIL risk scores for syncope evaluation are introduced, evaluated retrospectively, and their ability to classify cardiac syncopes is compared. The specificity and sensitivity of the scores were analyzed. Guidelines for the practical application of the scoring systems are provided to reduce unnecessary hospital admissions. METHODS: Retrospectively, 153 patients with syncope admitted to the Faculty Hospital in Ostrava in the year 2008 were enrolled for scoring with the EGSYS and OESIL risk scores. The computed scores were assessed with respect to the diagnosed etiology of the syncope. RESULTS: For each score system, the hypothesis that there is no difference in the score between the cardiac and the non-cardiac group was rejected (all p-values below 0.0001). Strong correlation between the three score systems was shown (Spearman correlation coefficient: r = 0.71 p < 0.0001 for EGSYS-U and OESIL, r = 0.88 p < 0.0001 for EGSYS-U and EGSYS-M, r = 0.60 p < 0.0001 for EGSYS-M and OESIL). Sensitivity and specificity of the scores were computed and compared. CONCLUSIONS: All three score systems were found capable of classifying cardiac syncopes, reducing unnecessary hospital admissions and improving syncope risk evaluation. EGSYS-U was recommended for emergency syncope management because it was found to have both high sensitivity and high specificity.

• MeSH
• lidé MeSH
• nemoci srdce komplikace   MeSH
• senzitivita a specificita MeSH
• synkopa klasifikace   diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND AND IMPORTANCE: In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES: To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN: Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS: Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS: Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION: This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.

• MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• synkopa * diagnóza   epidemiologie   terapie   MeSH
• urgentní služby nemocnice * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Kanada MeSH

Nitroglycerin (NTG) administration occasionally leads to syncope due to severe hypotension and bradycardia. This reaction resembles neurocardiogenic syncope but it may occur when the patient is in the supine position. To address the possible role of prevailing autonomic tone and baroreflex control in precipitation of NTG induced syncope, continuous noninvasive blood pressure and an ECG were taken shortly before NTG application in the supine position. Frequency-domain measures of heart rate variability (HRV) and noninvasive indices of baroreflex were compared between subjects who did (n = 6) and did not (n = 41) develop syncope after NTG. Both groups differed only in the phase shift (P(CR)) between oscillations of blood pressure and heart rate during controlled respiration (0.1 Hz). P(CR) was significantly delayed in subjects who developed syncope than in controls (- 99.3+/-14.1 vs -65.5+/-27.0 degrees, P = 0.002). Thus, subjects with prolonged P(CR) are prone to NTG induced syncope because of increased lagging and, consequently, less stable baroreflex control.

• MeSH
• baroreflex účinky léků   MeSH
• bradykardie chemicky indukované   MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• hypotenze chemicky indukované   MeSH
• krevní tlak účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• nitroglycerin aplikace a dávkování   škodlivé účinky   farmakologie   MeSH
• srdeční frekvence účinky léků   MeSH
• supinační poloha fyziologie   MeSH
• synkopa chemicky indukované   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• nitroglycerin MeSH

The endothelin system may play a role in the pathogenesis of vasovagal syncope (VVS) because it is implicated in blood pressure regulation. We hypothesized that endothelin-related genetic polymorphisms might modulate susceptibility to VVS. This study aimed to evaluate the possible influence of endothelin-1 (EDN1) and endothelin receptor A (EDNRA) gene variants on the occurrence of tilt-induced VVS and autonomic nervous system activity during the head-up tilt test (HUT). Results were expressed as mean +/- SEM. In 254 patients with recurrent syncope (age 45.33+/-1.22 years, 94 males, 160 females), heart rate variability (HRV) was measured during HUT. EDN1 rs5370 G>T and EDNRA rs5333 T>C gene polymorphisms were assessed using high-resolution melting analysis. There was no statistically significant association between polymorphisms EDN1 rs5370 and EDNRA rs5333 and positivity of HUT or hemodynamic types of VVS. Patients with GT or TT genotypes at the rs5370 locus of the EDN1 had significantly higher values of high-frequency (HF) and the standard deviation of the average NN intervals at the time of the syncope, and they tended to have lower low-frequency (LF) and LF/HF ratio when compared to homozygotes (GG). No statistically significant differences were found in HRV parameters concerning the EDNRA rs5333 genotypes. Our findings suggest the potential role of EDN1 rs5370 variants in regulating autonomic nervous activity and pathogenesis of VVS.

• MeSH
• dospělí MeSH
• endotelin-1 * genetika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polymorfismus genetický genetika   MeSH
• receptor endotelinu A genetika   MeSH
• srdeční frekvence genetika   MeSH
• test na nakloněné rovině MeSH
• vazovagální synkopa * diagnóza   genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• EDNRA protein, human MeSH Prohlížeč
• endotelin-1 * MeSH
• receptor endotelinu A MeSH

Syncope is a symptom, defined as transient loss of consciousness and postural tone with spontaneous and mostly prompt recovery. At first it is necessary to differentiate other non-syncopal transient loss of consciousness and simple falls, where thorough history taking is pivotal. EGSYS and OESIL risk scores seem to be contributional in initial risk stratification, however they are neither widely accepted nor a part of national guidelines. They are part of the European society of cardiology guidelines, though. Next it is essential expert ECG evaluation, thorough physical status examination, supine and standing blood pressure measurement and carotid sinus massage, if not contraindicated. Successively one has to decide if hospitalization or outpatient management is more suitable. Recently it has been shown, that so-called syncope management units (aimed for short-term hospitalization or fast outpatient examination, including vital function monitoring, echocardiography and facile cathlab access) are effective in fast syncope evaluation. Echocardiography, ECG monitoring and head-up tilt test should be a part of complex diagnostic evaluation. If syncope is not clarified by upon stated methods moreover syncope is recurrent, electrophysiological study, ILR implantation or both are justified. Despite of entire health practitioner's effort, more than 1/3 of syncopes remain unexplained.

• MeSH
• algoritmy MeSH
• diferenciální diagnóza MeSH
• lidé MeSH
• synkopa diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

In the present study, we studied whether analysis of the FAP (finger arterial pressure) waveform during supine rest discriminates subjects with recurrent VVS (vasovagal syncope) from healthy controls. Signal-averaged FAP waveforms (Finapres) were obtained in 32 head-up tilt-test-positive subjects with recurrent VVS (35 +/- 13 years) and in 32 sex- and age-matched healthy controls. The DT (time delay) between the systolic and diastolic peaks of the FAP waveform was measured and large artery SI (stiffness index) was calculated as a ratio of body height and DT. VVS patients had significantly shorter DT compared with controls (303 +/- 31 compared with 329 +/- 18 ms; P < 0.001) and higher SI (5.79 +/- 0.70 compared with 5.20 +/- 0.36 m/s; P < 0.001). The differences were independent of heart rate and blood pressure. SI > 5.45 m/s identified subjects with syncope with a sensitivity of 72% and a specificity of 84%. Age-corrected DT (cDT = DT + age-350) identified subjects with syncope with a sensitivity of 75% and a specificity of 84%. Combined use of cDT <0 ms and SI > 5.45 m/s increased sensitivity and specificity to 81% and 96% respectively. The discriminative power of FAP descriptors improved further when younger subjects were excluded. In subjects aged >30 years (median age), the combination of cDT and SI identified subjects with syncope with a sensitivity of 93% and a specificity of 100%. These results suggest that FAP descriptors during supine rest might be useful in the diagnosis of VVS in middle-aged subjects.

• MeSH
• ambulantní monitorování krevního tlaku * MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• odpočinek MeSH
• pulz MeSH
• recidiva MeSH
• ROC křivka MeSH
• senzitivita a specificita MeSH
• studie případů a kontrol MeSH
• supinační poloha MeSH
• tělesná výška MeSH
• vazovagální synkopa diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Recurrent vasovagal syncope is a frequent clinical problem. Provisions regarding the regimen, non-pharmacological treatment and pharmacotherapy are the basic principles of management of patients with vasovagal syncope. Regimen provisions involve avoidance of predisposing factors and immediate horizontalization during initial presyncopal manifestations. Endurance training, tilt training, autogenous training and increased intake of salt and fluids are possible ways of non-pharmacological treatment. According to the relatively extensive number of published reports on pharmacological treatment of vasovagal syncope four preparations proved effective in randomized placebo controlled trials--atenolol, midodrin, paroxetin and enalapril. The author gives an account of non-pharmacological and pharmacological treatment of vasovagal syncope, whereby he concentrates on the validity and clinical importance of different trials.

• MeSH
• lidé MeSH
• vazovagální synkopa farmakoterapie   prevence a kontrola   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH