Risk Factors For Syncope Research Articles

Antihypertensive treatment and risk factors for syncope in asymptomatic aortic stenosis patients with hypertension

ABSTRACT Background Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis(AS) is scarce. Objectives Given the paucity of data on the relationship between syncope and antihypertensive treatment in aortic stenosis. This study sought to investigate this association in patients admitted to our hospital. Methods A total of 158 patients with asymptomatic moderate or severe aortic stenosis were analyzed. Follow-up was conducted by clinic visit, telephone contact, or review of electronic medical records. Outcomes were syncope. Results Hypertension were documented in 90 of the 158 patients with moderate or severe AS, and 77 of them received antihypertensive medications. During an average 28 months follow-up period, the occurrence of syncope was observed in 13 patients. Among them, 8 were in antihypertensive group (n = 77) and 5 in normotensive group (n = 68). There was no significant difference in incidence of syncope between the two groups. Patients with treated hypertension and syncope had a lower stroke volume index (SVi), a higher valve arterial impedance (ZVA), a smaller SAC than those without. Kaplan-Meier analysis showed that there was no significant difference in syncope cumulative incidence between antihypertensive group and normotensive group (log rank P = .478). Multivariate cox regression analysis showed that both ZVA (hazard ratio:19.006, 95% confidence interval: 4.664 to77.448;P = .002) and LVMI (hazard ratio:1.484, 95% confidence interval: 1.427 to 5.157;P = .016) were associated with development of syncope, whereas hypertension were not related independently to syncope (hazard ratio:0.935, 95% confidence interval: 0.786 to3.173; P = .869). Conclusions In patients with moderate or severe AS, concomitant hypertension, and antihypertensive treatment didn’t increase the occurrence of syncope, whereas higher ZVA was independently associated with greater risk of syncope.

Three-Dimensional Reconstruction Algorithm for CT Pulmonary Angiography in Patients with Pulmonary Embolism Combined with Syncope

This paper aimed to study the clinical characteristics of patients with pulmonary embolism (PE) with syncope (PE + S) based on the three-dimensional (3D) reconstruction algorithm in computed tomography (CT) pulmonary angiography (CTPA). In this study, 857 patients with acute PE (APE) who were treated in hospital were selected as the research objects and divided into syncope group (group S) and nonsyncope group (group NS). The 3D reconstruction marching cubes (3DR-MC) algorithm was compared with the traditional MC (T-MC) algorithm and the mesh simplification MC (MMS-MC) algorithm, and the results proved that the running time of the 3DR-MC algorithm on the platform was shorter than that of the other two algorithms. The incidence of syncope in group S in women was higher than that in group NS (51.7% vs. 38.2%). The incidence of syncope classified as high risk in group S was higher than that in group NS, and the mortality rate of pulmonary embolism patients with syncope was higher, and the difference was statistically significant (χ2 = 113.332, P < 0.05 ). The incidence of syncope in group S was higher than that in group NS (χ2 = 4.074, P < 0.05 ). In short, hypertension was an independent risk factor for syncope. PE + S patients could be diagnosed and treated as early as possible based on the clinical characteristics, so as to reduce the adverse consequences of misdiagnosis.

Is donating blood for the faint of heart? a systematic review of predictors of syncope in whole blood donors.

Adverse events during donation negatively impact the likelihood of subsequent donation. Syncope is a possible complication of blood donation in healthy individuals. This systematic review aims to identify risk factors for syncope in healthy blood donors. Medline, Embase, Cochrane, CINAHL, Web of Science, Transfusion Evidence Library, and PubMed libraries up to November 2016 were searched. Inclusion criteria were observational and interventional trials, case series including more than 10 participants, randomized controlled trials, and clinical trials. Papers required data pertaining to syncopal events separate from presyncope for inclusion. Incomplete text or non-English language versions were excluded. Papers were evaluated using the CHARMS 2014 checklist. From 3316 papers, 1297 unique citations were identified, and 11 were selected for data extraction. Sex, estimated blood volume, age, donor status, blood pressure, heart rate, weight, previous reaction, caffeine, sleep, and donation site were identified as risk factors for syncope during blood donation. Possible risk factors for syncope in healthy blood donors have been identified that could allow for improved screening prior to donation and potential reduction in donor attrition due to negative experiences.

Postprandial cardiogenic syncope caused by gastric polyp-induced pyloric obstruction in an elderly woman with a giant hiatal hernia: a case report

BackgroundHiatal hernias are common. In some reports, hiatal hernias have been implicated in causing dyspnea, syncope, and heart failure.Case presentationAn 82-year-old woman with a hiatal hernia was admitted to our hospital because she had experienced postprandial syncope during the last few years. Esophagogastroduodenoscopy revealed a large hiatal hernia and a pedunculated polyp of the stomach antrum that fit into the pylorus. An upper gastrointestinal contrast study showed that the entire stomach had relocated to the thoracic cavity and that the body of the stomach was located above the fundus, resulting in a so-called upside-down stomach. Contrast-enhanced computed tomography revealed that a large portion of the stomach, transverse colon, and part of the pancreas were present in the mediastinum. We then performed transthoracic echocardiography followed by a water pouring test using a nasogastric tube. After instillation of 2000 ml of saline, the left atrium was markedly compressed and the area of the mitral annulus was reduced. We determined that stomach dilation by the hiatal hernia and gastric polyp had caused the syncope. The patient underwent laparoscopic hiatal hernia repair and endoscopic gastric polypectomy, and she experienced no syncopal episodes for 5 months postoperatively.ConclusionsClinicians should recognize that a large hiatal hernia may be a risk factor for syncope.

Does baseline hypotension predict incident depression in a cohort of community-dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA).

hypotension is now recognised as a risk factor for syncope, cardiovascular events and mortality, but it may also represent a risk factor for late life depression (LLD). The aim of this study was to clarify the longitudinal relationship between hypotension and incident LLD. this is a longitudinal study involving community-dwelling participants aged ≥50 years, using data from The Irish Longitudinal Study on Ageing. The Centre for Epidemiological Studies Depression Scale (CES-D) was administered at baseline and at follow-up 2 years later. Blood pressure (BP) was measured at baseline. Participants with a CES-D score ≥16 at baseline and those taking antidepressants were excluded and considered to have a current diagnosis of depression. A score of ≥16 at follow-up was used to define incident depression. about 4,525 participants were included and 200 participants had diagnosis of incident LLD. The incident depression group had lower systolic BP at baseline than the non-depressed group (132.8 ± 1.43 mm Hg vs. 136.0 ± 0.30 mm HG, P = 0.025). Logistic regression showed those with systolic BP <130 mm HG had an unadjusted odds ratio of 1.31 (1.01-1.68) for incident depression. This persisted after adjustment for confounding factors. systolic BP <130 mm Hg increased the likelihood of incident depression in a cohort of community-dwelling older adults. These findings are important because systolic hypotension may represent a potentially modifiable risk factor for LLD. They are also relevant in the context of BP treatment targets for older people.

Syncope in older adults.

Syncope, defined as a self-limited transient loss of consciousness and postural tone due to global cerebral hypoperfusion, is a common reason for emergency room visits, with a third of these visits leading to an inpatient admission.[1] Syncope carries an estimated 2-year mortality rate of over 25% and is strongly associated with falls, a potentially devastating contributor to morbidity and mortality among the elderly. Given this association, it is not surprising that up to 35% of syncopal episodes result in injury.[2] Dizziness is similarly associated with poor outcomes in the elderly,[3] overlapping substantially with syncope and falls through commonly shared pathophysiologic mechanisms.[4] To optimize care of this vulnerable patient population, it is imperative to recognize the etiologies and associated risk factors for syncope in older adults, as well as appreciate their influence on diagnosis and management.

Association between non-coding polymorphisms of HOPX gene and syncope in hypertrophic cardiomyopathy.

Homeodomain Only Protein X (HOPX) is an unusual homeodomain protein which regulates Serum Response Factor (SRF) dependent gene expression. Due to the regulatory role of HOPX on SRF activity and the regulatory role of SRF on cardiac hypertrophy, we aimed to investigate the relationship between HOPX gene variations and hypertrophic cardiomyopathy (HCM). In this study, designed as a case-control study, we analyzed coding and flanking non-coding regions of the HOPX gene through 67 patients with HCM and 31 healty subjects. Certain regions of the gene were investigated by Single Stranded Conformation Polymorphism (SSCP) and Restriction Fragment Length Polymorphism (RFLP). Statistical analyses of genotypes and their relationship with clinical parameters were performed by chi-square, Kruskal-Wallis and the Fisher's exact test. In 5' Untranslated Region (UTR) and intronic region of the HOPX gene, we found a C>T substitution and an 8-bp insertion/deletion (In/Del) polymorphism, respectively. These two polymorphisms seemed to constitute an haplotype. While the frequency of homozygous genotypes of In/Del and C/T polymorphisms were found significantly lower in the patients with syncope (p=0.014 and p=0.017, respectively), frequency of their heterozygous genotypes were found significantly higher in the patients with syncope (p=0.048 and p=0.030, respectively). CONCLUSİON: Though there was not found any mutation in coding sequence of HOPX gene, two non-coding polymorphisms were found related to syncope in HCM patients. While homozygous status of these polymorphisms was found to be protective against the syncope, their heterozygous status seemed to be a risk factor for syncope in HCM patients. Our results suggest that HOPX may contribute to pathogenesis or manifestation of HCM as a modifier gene.

Gender differences in cardiac development: are hormones at the heart of the matter?

See article by Valverde et al. [10] (pgaes 625–631) in this issue. Male/female differences in cardiac electrophysiology have long been noted, but only in recent years has there been an increased awareness and appreciation of the influence of a patient's sex on presentation of various cardiac arrhythmias [1]. One of the most dramatic and important differences between men and women regarding sex and arrhythmia is the greater risk in women of torsades de pointes induced by drugs that prolong repolarization [2]. Additionally, female gender is an independent risk factor for syncope and sudden death in the congenital long QT syndrome [3]. Although the molecular mechanisms for these sex-related differences are largely unknown, fundamental differences in the electrophysiology of the male and female hearts are postulated to be responsible. Women have faster resting heart rates and longer rate-corrected QTc intervals than men [4]. However, young boys and girls have similar heart rates and QT intervals [5,6]. From puberty through adult years, the duration of the QTc in men abbreviates and then gradually increases until the age of 50 when QTc approaches that of women [5]. These gender- and age-dependent changes in ventricular repolarization are also present in congenital LTQS patients [7,8]. Further, there is an age-dependent distribution of initial arrhythmic events [9]. The probability of a first ventricular tachyarrhythmia is higher in boys than … * Tel.: +1-305-243-5922; fax: +1-305-243-4555. tpham{at}med.miami.edu

U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor.

The study investigated the clinical significance and mechanism of orthostatic blood pressure (BP) dysregulation in elderly hypertensive patients. Although orthostatic hypotension (OHYPO), often found in elderly hypertensive patients, has been recognized as a risk factor for syncope and cardiovascular disease, both the clinical significance and the mechanism of orthostatic hypertension (OHT) remain unclear. We performed a head-up tilting test and brain magnetic resonance imaging (MRI) in 241 elderly subjects with sustained hypertension as indicated by ambulatory BP monitoring. We classified the patients into an OHT group with orthostatic increase of systolic blood pressure (SBP) of >or=20 mm Hg (n = 26), an OHYPO group with orthostatic SBP decrease of >or=20 mm Hg (n = 23), and a normal group with neither of these two patterns (n = 192). Silent cerebral infarcts were more common in the OHT (3.4/person, p < 0.0001) and OHYPO groups (2.7/person, p = 0.04) than in the normal group (1.4/person). Morning SBP was higher in the OHT group than in the normal group (159 vs. 149 mm Hg, p = 0.007), while there were no significant differences of these ambulatory BPs between the two groups during other periods. The OHT (21 mm Hg, p < 0.0001) and OHYPO (20 mm Hg, p = 0.01) groups had higher BP variability (standard deviation of awake SBP) than the normal group (17 mm Hg). The associations between orthostatic BP change and silent cerebrovascular disease remained significant after controlling for confounders, including ambulatory BP. The orthostatic BP increase was selectively abolished by alpha-adrenergic blocking, indicating that alpha-adrenergic activity is the predominant pathophysiologic mechanism of OHT. Silent cerebrovascular disease is advanced in elderly hypertensives having OHT. Elderly hypertensives with OHT or OHYPO may have an elevated risk of developing hypertensive cerebrovascular disease.