| 1. |
- Furtan, Stanisław, et al.
(författare)
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Prognosis of Syncope With Head Injury : a Tertiary Center Perspective
- 2020
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Ingår i: Frontiers in Cardiovascular Medicine. - : Frontiers Media SA. - 2297-055X. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Head injury is the most common trauma occurring in syncope. We aimed to assess whether syncope as cause of head-trauma affects short-and long-term prognosis. Methods: From a database retrospective analysis of 97,014 individuals attending Emergency Department (ED), we selected data of patients with traumatic head injury including age, gender, injury mechanism, brain imaging, multiple traumas, bone fracture, intracranial bleeding, and mortality. Mean follow-up was 6.4 ± 1.8 years. Outcome data were obtained from a digital national population register. The study population included 3,470 ED head injury patients: 117 of them (50.0 ± 23.6 years, 42.7% men) reported syncope as cause of head trauma and 3,315 (32.2 ± 21.1 years, 68.5% men) without syncope preceding head trauma. Results: Thirty-day mortality was low and similar in traumatic head injury with or without syncope. One year and long-term all-cause mortality were both significantly higher in syncopal vs. non-syncopal traumatic head injury (11.1 vs. 2.8% and 32 vs. 10.2%, respectively; both p < 0.001). In adjusted logistic regression analysis, death between 121st-day and 1 year in patients with head-trauma was associated with male gender [odds ratio (OR): 6.48; 95% CI: 2.59-16.25], advancing age (per year) (OR 1.09; 95% CI 1.07-1.11), Glasgow Coma Scale < 13 (OR: 6.18; 95% CI:1.68-22.8), bone fracture (OR 4.72; 95% CI 2.13-10.5), and syncope (OR 3.70; 95% CI: 1;48-9.31). In multivariable Cox regression analysis, syncope was one of the strongest independent predictors of long-term all-cause death (hazard ratio: 1.95; 95% CI 1.37-2.78). Conclusion: In patients with head trauma, history of syncope preceding injury does not increase 30-day all-cause mortality but portends increased 1 year and long-term mortality.
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| 2. |
- Kozluk, Edward, et al.
(författare)
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Members of the emergency medical team may have difficulty diagnosing rapid atrial fibrillation in Wolff-Parkinson-White syndrome
- 2015
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Ingår i: Cardiology Journal. - 1898-018X. ; 22:3, s. 247-252
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) in patients with Wolff-Parkinson-White (WPW) syndrome is potentially life-threatening as it may deteriorate into ventricular fibrillation. The aim of this study was to assess whether the emergency medical team members are able to diagnose AF with a rapid ventricular response due to the presence of atrioventricular bypass tract in WPW syndrome. Methods: The study group consisted of 316 participants attending a national congress of emergency medicine. A total of 196 questionnaires regarding recognition and management of cardiac arrhythmias were distributed. The assessed part presented a clinical scenario with a young hemodynamically stable man who had a 12-lead electrocardiogram performed in the past with signs of pre-excitation, and who presented to the emergency team with an irregular broad QRS-complex tachycardia. Results: A total of 71 questionnaires were filled in. Only one responder recognized AF due to WPW syndrome, while 5 other responders recognized WPW syndrome and paroxysmal supraventricular tachycardia or broad QRS-complex tachycardia. About 20% of participants did not select any diagnosis, pointing out a method of treatment only. The most common diagnosis found in the survey was ventricular tachycardia/broad QRS-complex tachycardia marked by approximately a half of the participants. Nearly 18% of participants recognized WPW syndrome, whereas AF was recognized by less than 10% of participants. Conclusions: Members of emergency medical teams have limited skills for recognizing WPW syndrome with rapid AF, and ventricular tachycardia is the most frequent incorrect diagnosis.
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| 3. |
- Zyśko, Dorota, et al.
(författare)
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Cardiac arrest during recovery after tilt-induced vasodepressor syncope in a 76-year old man
- 2016
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Ingår i: Journal of Acute Medicine. - : Elsevier BV. - 2211-5587. ; 6:3, s. 67-69
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Tidskriftsartikel (refereegranskat)abstract
- A 76-year-old man with a history of frequent syncope in youth and in the last 5 years was referred for a head-up tilt test. During the head-up tilt test, he developed a classical vasovagal reflex syncope. On immediate return to the supine position, the patient regained consciousness. Shortly afterward, the heart rate slowed distinctly and the patient became unresponsive with undetectable blood pressure. Chest compressions were initiated with return of spontaneous circulation 2 minutes later. Thereafter, the patient regained consciousness without neurological sequelae. This case illustrates cardiac arrest due to prolonged vasovagal reflex.
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| 4. |
- Zysko, Dorota, et al.
(författare)
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History of syncope predicts loss of consciousness after head trauma: Retrospective study
- 2014
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Ingår i: Cardiology Journal. - 1898-018X. ; 21:6, s. 674-678
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Tidskriftsartikel (refereegranskat)abstract
- Background: Head trauma may present as transient loss of consciousness (TLOC) currently classified as traumatic in origin, in contrast to non-traumatic forms, such as syncope. Whether past history of syncope predisposes to loss of consciousness after head injury has been poorly studied. Methods: A retrospective analysis of data obtained from 818 consecutive patients admitted to Emergency Departments was conducted. Face-to-face semi-structured interviews were performed, where patients' past history of syncope and head injury were explored. Head injury events were stratified as high-or low-energy trauma. Data regarding past syncopal events were explored in regard to number, age at the first occurrence, and syncope circumstances. Multivariate logistic regression model was applied to assess the relationship between loss of consciousness during head injury and past history of syncope. Results: Both past history of non-traumatic TLOC (odds ratio [OR] 3.78; 95% confidence interval [CI] 2.13-6.68, p < 0.001) and high-energy mechanism (OR 3.84; 95% CI 2.35-6.28, p < 0.001) predicted TLOC after head trauma. This relationship was even stronger when past episodes of TLOC were limited to those typical for reflex syncope (OR 4.34; 95% CI 2.34-7.89, p < 0.001). Further, the number of non-traumatic TLOC episodes in the patient's history was also predictive of TLOC after head injury (OR per 1 episode: 1.24; 95% CI 1.04-1.48, p = 0.015). Conclusions: Syncope in a patient's history predicts loss of consciousness after head injury. The clinical importance of this finding merits further investigation.
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| 5. |
- Zyśko, Dorota, et al.
(författare)
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The importance of the longest R-R interval on 24-hour electrocardiography in mortality prediction in patients with atrial fibrillation
- 2021
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Ingår i: Kardiologia Polska. - 1897-4279.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Heart rate control in atrial fibrillation (AF) is typically assessed by 24-hour electrocardiography (ECG). There are scarce data on the use of 24-hour ECG parameters to predict mortality in AF.AIMS: We aimed to identify 24-hour ECG parameters that predict mortality in AF.METHODS: We enrolled 280 ambulatory patients (mean [SD] age, 72.0 [8.7] years; 57.9% men) with permanent or persistent AF. Data on mortality and pacemaker or defibrillator implantation during follow-up were collected. Predictors of mortality were assessed using the Cox proportional hazards model and C-statistic.RESULTS: Compared with survivors, 78 (28%) patients who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, a higher number of ventricular extrasystoles, and the longest R-R interval below 2 seconds. Univariate analysis revealed higher mortality in patients with the longest R-R intervals below 2 seconds compared with those with the R-R intervals of 2 seconds or longer (P <0.001). Independent mortality predictors in the regression model included older age, renal failure, history of coronary intervention, chronic obstructive pulmonary disease, LBBB, and a high number (≥770) or absence of R-R intervals of at least 2 seconds. The area under curve (AUC) for mortality prediction increased after inclusion of ECG parameters 0.748 [95% CI, 0.686-0.810] vs 0.688 [95% CI, 0.618-0.758]; P = 0.02).CONCLUSIONS: A high number of R-R intervals longer than 2 seconds or their absence on 24-hour ECG may predict mortality in AF.
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| 6. |
- Zyśko, Dorota, et al.
(författare)
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Tilt testing results are influenced by tilt protocol.
- 2016
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Ingår i: Europace. - : Oxford University Press (OUP). - 1532-2092 .- 1099-5129. ; 18:7, s. 1108-1112
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Tidskriftsartikel (refereegranskat)abstract
- It is unknown how the return to supine position influences duration of loss of consciousness (LOC) and cardioinhibition during tilt test.
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| 7. |
- Zysko, Dorota, et al.
(författare)
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Vasovagal Syncope Related to Emotional Stress Predicts Coronary Events in Later Life
- 2013
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 36:8, s. 1000-1006
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of the study was to assess whether history of vasovagal syncope (VVS) mediated by emotional (emotional VVS) or orthostatic stress (orthostatic VVS) is associated with an increased risk of cardiovascular (CV) events in later life. Methods: Retrospective analysis based on medical records of the consecutive 3,288 cardiologic outpatients (mean age, 61 +/- 12 years; 43% men). Results: A total of 254 patients (7.7%) reported emotional VVS, whereas 294 (9.0%) had history of orthostatic VVS. First-ever syncopal episode was reported at a median age of 16 years (interquartile range [IQR], 12 years to 28 years), and the median total number of episodes was two (IQR, 1 to 5). There were 779 patients (23.7%) with at least one CV event, and the median age for the first CV event was 59 years (IQR, 52 years to 67 years). In the fully adjusted model, history of emotional VVS was predictive of CV event (hazard ratio [95% confidence interval]: 1.63, [1.27-2.09]; P < 0.001), myocardial infarction (1.99, [1.49-2.66]; P < 0.001), and percutaneous coronary intervention (1.84, [1.31-2.60]; P = 0.001). There was one significant interaction (P = 0.07) between history of emotional VVS and gender. Emotional VVS was predictive of CV event in men (1.89 [1.41-2.53]; P < 0.001) but not in women (1.24 [0.79-1.94]; P = 0.35). Conclusions: History of emotional but not orthostatic VVS is independently associated with increased risk of coronary events in later life. The relationship between predisposition to emotional VVS in adolescence and development of cardiovascular disease requires further studies.
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