Abstract:
:The noninvasive assessment of patients who present with syncope is based on a thorough, complete history and physical examination. The history requires close attention to precipitating events and the description of the spell. Often, patients are poor historians with regard to symptoms leading up to and following the episode of syncope. Therefore, it is important to interview individuals who observed the spell to improve the accuracy of the history and sort out whether or not the spell was due to cardiogenic syncope, vasodepressor syncope, or a neurologic disorder. Carotid sinus massage is a useful procedure that can be performed during the routine physical examination, identifying patients who are at increased risk for carotid sinus syncope because of hypersensitivity of the carotid sinus. The clinician must be careful to attribute the clinical syncope to carotid sinus hypersensitivity only when the spell induced at the time of carotid massage reproduces the clinical spell. Routine laboratory tests are commonly performed, although the blood tests rarely yield information to confirm the cause of syncope. The routine ECG is often helpful identifying abnormalities of rhythm, conduction, or morphology that give a clue as to the cause for the patient's syncope. The most helpful aspect of ECG recording is to obtain a recording during an episode of syncope when exact correlation can be made between the ECG findings and the patient's symptoms. Recording the ECG during the spell can be achieved using 24-hour ambulatory monitoring, an event recorder, or a memory loop recorder. Twenty-four-hour ambulatory monitoring is useful in patients who have frequent spells that would be expected to be recorded during 1 or 2 days of monitoring. These individuals need to have a non-life-threatening spell and therefore be safe to evaluate as an outpatient. The event recorder and loop memory recorder have proved extremely helpful in evaluating spells that occur too infrequently to be recorded by 24-hour or 48-hour ambulatory monitoring. The nature of these recording devices does require that the patient or a companion be able to activate the monitor at the time of symptoms. If a patient experiences syncope but is unable to activate the device, the important information as to what the rhythm was doing at the time of symptoms is lost. The implantable loop recorder should prove to be uniquely advantageous by allowing extended ECG recording with the device activated by the patient or companion recording 20 minutes before and 4 minutes after device activation. Signal-averaged electrocardiography is most helpful in assessing patients with ischemic heart disease with a substrate capable of supporting a reentrant ventricular arrhythmia. This test should be used in combination with other historical or laboratory predictors of arrhythmic events such as history of myocardial infarction or abnormal ventricular function assessed by echocardiography. In this setting, the signal-averaged ECG helps to identify patients at increased risk for ventricular tachycardia as the cause of syncope who thus may benefit from electrophysiologic testing.
journal_name
Cardiol Clinjournal_title
Cardiology clinicsauthors
Hammill SCdoi
10.1016/s0733-8651(05)70330-1subject
Has Abstractpub_date
1997-05-01 00:00:00pages
195-218issue
2eissn
0733-8651issn
1558-2264pii
S0733-8651(05)70330-1journal_volume
15pub_type
杂志文章,评审abstract::Although it is convenient to think of hypertension in its renal, epidemiologic, and vascular eras, a new perspective is rapidly coming to the forefront. As we become more critical in evaluating the performance of our health care systems, it is obvious that the major problems in hypertension do not lie entirely with un...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-11-01 00:00:00
abstract::The initial evaluation of patients with transient loss of consciousness (LOC) comprises a detailed medical history, physical examination, and 12-lead electrocardiogram. Because there are many causes of syncopal and nonsyncopal LOC, an adequate method of taking the clinical history, which is the cornerstone of diagnosi...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.04.002
更新日期:2015-08-01 00:00:00
abstract::Dilated cardiomyopathy is a heterogeneous disease, both clinically and genetically. Two genes responsible for X-linked DCM have been identified. Five genetic loci responsible for X-linked DCM have been identified. Five genetic loci responsible for autosomal dominant DCM have also been mapped but no genes identified so...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70037-0
更新日期:1998-11-01 00:00:00
abstract::Surgical septal myectomy is the preferred method of septal reduction for most patients with obstructive hypertrophic cardiomyopathy whose symptoms do not respond to medical management. Transaortic extended septal myectomy has low operative mortality and provides durable relief of symptoms. Surgical treatment is possib...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2018.08.006
更新日期:2019-02-01 00:00:00
abstract::ACC Stage C heart failure includes those patients with prior or current symptoms of heart failure in the context of an underlying structural heart problem who are primarily managed with medical therapy. Although there is guideline-based medical therapy for those with heart failure with reduced ejection fraction (HFrEF...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2013.09.012
更新日期:2014-02-01 00:00:00
abstract::Athletes with syncope warrant a full evaluation, as it is possible that athletics may unmask heart disease, either structural or electrical, and these athletes may be at risk for sudden cardiac death. The work-up and treatment of syncope in the athlete offers some unique challenges: to diagnose potentially life-threat...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2007.07.005
更新日期:2007-08-01 00:00:00
abstract::Because of constraints on the costs of providing medical care, cardiologists in the future will find themselves challenged to provide care for their patients in the most cost-effective manner possible. Although stress-echocardiography has been shown to compare favorably with other tests in diagnostic accuracy, data on...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70098-9
更新日期:1999-08-01 00:00:00
abstract::Mechanical circulatory support using left ventricular assist devices (LVAD) has become an accepted mode of therapy for both bridging patients with end-stage heart failure to transplant and as a destination therapy. Right ventricular (RV) dysfunction is common after LVAD insertion and is a significant source of morbidi...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:10.1016/j.ccl.2011.08.011
更新日期:2011-11-01 00:00:00
abstract::Initial pharmacologic therapy for hypertension is low-dose thiazide diuretics, beta-blockers, and ACE inhibitors. Increasing data have confirmed that ACE inhibitors have specific benefit in patients with diabetes, atherosclerosis, left ventricular dysfunction, and renal insufficiency. CCBs are alternative agents for I...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70213-7
更新日期:2001-05-01 00:00:00
abstract::One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2016.08.004
更新日期:2017-02-01 00:00:00
abstract::The medical management of patients with CHF and ventricular arrhythmias is one of the most challenging clinical situations frequently encountered by physicians on a daily basis. Reviewed and examined in this article are available data regarding the clinical relevance and prevalence of ventricular arrhythmias, their pr...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1994-02-01 00:00:00
abstract::The most important factor in the interpretation of any heart lesion is the radiographic appearance of the pulmonary vessels (vascularity) and lung parenchyma. The author discusses several abnormalities; he focuses particularly on pulmonary venous hypertension. ...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:
更新日期:1983-11-01 00:00:00
abstract::Coronary artery bypass grafting (CAGB) is superior to percutaneous coronary intervention (PCI) in reducing mortality in certain patients and improving the composite end points of angina, recurrent myocardial infarction, and repeat revascularization procedures. However, CABG is associated with a higher perioperative st...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2014.04.011
更新日期:2014-08-01 00:00:00
abstract::Chest pain is a common complaint in the emergency department, and it is the job of clinicians to rule out life-threatening diagnoses such as acute coronary syndrome. The history, physical examination, cardiac risk factors, electrocardiogram findings, and clinician judgment are often not enough to distinguish between c...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2017.08.001
更新日期:2018-02-01 00:00:00
abstract::The overall management and prognosis of patients with acute myocardial infarction must take into account not only infarct size but also the site and locus of involvement as determined by electrocardiography. Transmural versus nontransmural infarction is discussed in relation to therapy and prognosis. ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1984-02-01 00:00:00
abstract::Under normal baseline conditions the unique anatomy, myocardial ultrastructure, and coronary physiology of the right ventricle (RV) reflect a high-volume low-pressure pump. Early work described the RV as a passive conduit with minimal pumping capability. It is now appreciated that through a mechanism of ventricular in...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2012.03.009
更新日期:2012-05-01 00:00:00
abstract::Coronary computed tomographic angiography (CTA) is a promising noninvasive tool that allows the visualization of plaque morphology. Plaques characterized by positive remodeling, low attenuation, and napkin ring circular enhancement on contrast-enhanced coronary CTA have been regarded as rupture-prone vulnerable plaque...
journal_title:Cardiology clinics
pub_type: 杂志文章
doi:10.1016/j.ccl.2011.10.002
更新日期:2012-02-01 00:00:00
abstract::Coronary thrombosis is now recognized as the most common proximate cause of acute myocardial infarction, and thrombolysis is evolving as an accepted therapeutic approach to patients presenting in the early stages of myocardial infarction. The ascent of thrombolysis in treatment hierarchies reflects multiple factors, i...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-02-01 00:00:00
abstract::Because 1.1 million myocardial infarctions occur in the United States alone each year, and 450,000 of them are recurrent infarctions, which carry an inherently greater risk of death and disability than first events, the importance of secondary prevention strategies that can be implemented widely is unparalleled in hea...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2007.12.017
更新日期:2008-05-01 00:00:00
abstract::Diseases of the thoracic aorta are serious conditions that require close observations. Impressive advances in imaging modalities such as magnetic resonance imaging, computed tomography sacs, and transesophageal echocardiography have aided diagnosis and provided insights into the pathogenesis and natural history of tho...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70109-0
更新日期:1999-11-01 00:00:00
abstract::With recent technical and clinical advances, adenosine stress perfusion MRI has evolved from a promising research tool to an everyday clinical test. This article reviews the current state of stress perfusion MRI. Specifically, it addresses the following topics: validation of stress perfusion MRI in preclinical studies...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2007.02.002
更新日期:2007-02-01 00:00:00
abstract::Medical management of PAD is a considerable challenge. Although patients typically present with IC, there is a substantial pool of subclinical PAD patients. PAD, whether symptomatic or not, confers a marked cardiovascular risk; with affected patients dying of heart attack or stroke, identification of index patients an...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(02)00089-9
更新日期:2002-11-01 00:00:00
abstract::Hypertensive heart disease (HHD), a result of long-standing hypertension, is characterized by changes in the myocardial structure and function in the absence of other primary cardiovascular abnormalities. Although increased blood pressure is the initiating stimulus, neurohormonal factors, particularly the renin-angiot...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2010.07.005
更新日期:2010-11-01 00:00:00
abstract::An appreciation of the existence of circadian variation in association with the onset of acute coronary disease and of the public health and clinical implications of this temporal nonrandom disease occurrence with possible precipitating factors has been gained only over the past decade. Data providing support for the ...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70271-x
更新日期:1996-05-01 00:00:00
abstract::This article reviews the wide range of implantable device-based therapies (mainly pacemakers) that are being used in the management of atrial fibrillation (AF), atrial flutter, and atrial tachycardia. The role of pacemakers in the management of patients with AF and in the prevention of AF has been extensively studied....
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2008.09.009
更新日期:2009-02-01 00:00:00
abstract::Syncope due to idiopathic AV block is characterized by: 1) ECG documentation (usually by means of prolonged ECG monitoring) of paroxysmal complete AV block with one or multiple consecutive pauses, without P-P cycle lengthening or PR interval prolongation, not triggered by atrial or ventricular premature beats nor by r...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2015.04.012
更新日期:2015-08-01 00:00:00
abstract::Many of the transcatheter devices described in this article remain investigational in the United States. Currently, we consider the applications of these techniques as either (1) procedures of choice (for closures of patent ductus arteriosus, balloon dilation or stent implantation for peripheral pulmonary stenoses, ba...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract::In the 1960s, when LVADs and TAHs were introduced into clinical use, researchers estimated that, with this technology, the problem of heart failure could be solved within 20 years. Unfortunately, the evolution of these devices has taken much longer than anticipated. Nevertheless, significant advances have been achieve...
journal_title:Cardiology clinics
pub_type: 历史文章,杂志文章
doi:10.1016/s0733-8651(02)00133-9
更新日期:2003-02-01 00:00:00
abstract::Occlusion of the left atrial appendage (LAA) may reduce the risk of stroke in patients with atrial fibrillation (AF). Trials comparing LAA occlusion to warfarin anticoagulation in patients with nonvalvular AF showed a reduction in hemorrhagic stroke, although an increase in safety events due to procedural complication...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccl.2013.05.008
更新日期:2013-08-01 00:00:00
abstract::Transesophageal echocardiography has assisted the detection of intracardiac masses and, in certain cases, aided our ability to define the specific type of mass. This technique, when coupled with three-dimensional imaging, may help to define infiltration of the wall. TEE aids in the intraoperative management of cardiac...
journal_title:Cardiology clinics
pub_type: 杂志文章,评审
doi:10.1016/s0733-8651(05)70184-3
更新日期:2000-11-01 00:00:00