Index Note: Page numbers of article titles are in boldface type. A Adenosine in idiopathic AV block, 445 446 Adolescent(s) syncope in, 397 409. See also Syncope, in children and adolescents AECG monitoring. See Ambulatory electrocardiographic (AECG) monitoring Ambulatory electrocardiographic (AECG) monitoring in syncope, 361 366. See also Implantable loop recorders (ILRs) American Heart Association (AHA) recommendations for driving with syncope, 470 ANS assessment. See Autonomic nervous system (ANS) assessment Aortic stenosis syncope in children and adolescents due to, 401 Arrhythmia(s). See also specific types, e.g., Bradyarrhythmia syncope due to, 389 in children and adolescents, 401 402 Arrhythmogenic right ventricular cardiomyopathy (ARVC) as warning symptom of SCD, 426 ARVC. See Arrhythmogenic right ventricular cardiomyopathy (ARVC) Atherosclerotic coronary disease as warning symptom of SCD, 426 427 Athlete(s) SCD in syncope as warning symptom of, 423 432. See also Syncope, syncope in as warning symptom of SCD, 423 432. See also Syncope, Atrioventricular (AV) block idiopathic. See Idiopathic atrioventricular (AV) block Autonomic nervous system (ANS) assessment in syncope evaluation function tests, 359 Autonomic syncope in children and adolescents, 398 400 blood injury phobia, 400 breath-holding spells, 400 dysautonomic syncope, 399 fainting lark, 400 Cardiol Clin 33 (2015) 497 502 http://dx.doi.org/10.1016/s0733-8651(15)00055-7 0733-8651/15/$ see front matter Ó 2015 Elsevier Inc. All rights reserved. neurocardiogenic syncope, 398 399 POTS, 399 400 AV block. See Atrioventricular (AV) block B Bifascicular block Blood injury phobia in children and adolescents, 400 Bradyarrhythmia EP study of, 369 373 Breath-holding spells in children and adolescents, 400 Brugada syndrome in children and adolescents, 402 ECG of, 436 437 C Canadian Cardiovascular Society (CCS) risk of harm formula syncope while driving related, 467 Canadian Medical Association Driver s guide in determining medical fitness for driving with syncope, 469 Cardiac arrhythmias. See also specific types, e.g., Bradyarrhythmia syncope due to, 389 Cardiac output (CO) low, 344 Cardiac pacing in syncope management, 477 478 Cardiac syncope in children and adolescents, 400 402 causes of arrhythmias, 401 402 obstructive, 400 401 primary myocardiac dysfunction, 401 Cardiogenic syncope as warning symptom of SCD, 424 429 Cardioneuroablation cardiology.theclinics.com
498 Index Cataplexy nonsyncopal LOC and, 352 Catecholaminergic polymorphic ventricular tachycardia (CPVT) ECG of, 437 Cathocholaminergic polymorphic ventricular tachycardia syncope in children and adolescents due to, 402 CCS. See Canadian Cardiovascular Society (CCS) Children syncope in, 397 409. See also Syncope, in children and adolescents CO. See Cardiac output (CO) Commercial driving, 467 468 Congenital coronary artery anomaly as warning symptom of SCD, 427 Consciousness loss of. See Loss of consciousness (LOC) transient loss of. See Transient loss of consciousness (TLOC) Convulsive syncope, 379 380 CPVT. See Catecholaminergic polymorphic ventricular tachycardia (CPVT) D Driving, 465 471 CCS risk of harm formula related to, 467 commercial driving, 467 468 fitness for, 465 466 pathophysiologic features of, 466 467 prevalence of, 467 prognosis of, 467 recommendations related to, 469 470 recurrence of, 467 regulations and guidelines related to ethics behind, 468 469 Drug therapy in syncope management, 475 477 Dysautonomic syncope in children and adolescents, 399 E ECG. See Electrocardiogram (ECG) Elderly syncope in, 411 421. See also Syncope, in older adults Electrocardiogram (ECG) of syncope in hereditary arrhythmogenic syndromes, 436 437 Electrocardiogram (ECG) monitoring in SMU, 491 492 Electrophysiology (EP) study in syncope evaluation, 367 375 bradyarrhythmia, 369 373 introduction, 367 in organic heart disease patients, 457 tachyarrhythmia, 373 374 EP study. See Electrophysiology (EP) study Epilepsy difficult cases related to ILRs in, 363 364 nonsyncopal LOC and, 350 351 questionable ILRs for, 382 tilt tests for, 381 382 TLOC and, 342 Epileptic seizures syncope vs., 377 378 European Society of Cardiology (ECS) recommendations for driving with syncope, 470 External loop recorders in SMU, 492 F Fainting lark in children and adolescents, 400 Fall(s) unexplained ILRs in, 364 365 Fluid therapy H HCM. See Hypertrophic cardiomyopathy (HCM) Head trauma TLOC and, 342 Head-up tilt table (HUTT) testing in SMU, 491 in syncope evaluation in children and adolescents, 403 404 Heart Rhythm Society (HRS) recommendations for driving with syncope, 470 Hereditary arrhythmogenic syndromes syncope in, 433 440. See also Syncope, in hereditary arrhythmogenic syndromes Holter monitoring in SMU, 492 HUTT testing. See Head-up tilt table (HUTT) testing Hypertrophic cardiomyopathy (HCM) as warning symptom of SCD, 424 426 syncope in children and adolescents due to, 400 401 Hypoglycemia nonsyncopal LOC and, 351
Index 499 Hypotension orthostatic as warning symptom of SCD, 424 syncope secondary to I Idiopathic atrioventricular (AV) block, 441 447 adenosine in, 445 446 clinical perspectives on, 446 diagnosis of, 441 442 differential diagnosis of, 442 443 epidemiology of, 443 445 pathophysiology of, 445 446 purinergic profile, 445 446 ILRs. See Implantable loop recorders (ILRs) Implantable loop recorders (ILRs) limitations of, 365 for questionable epilepsy, 382 in SMU, 492 in syncope, 361 366 in organic heart disease patients, 457 458 technical aspects, implanting technique, and follow-up, 361 363 in TLOC diagnostic evaluation, 363 365 difficult epilepsy cases, 363 364 unexplained falls, 364 365 unexplained syncope, 363 Ion channel diseases as warning symptom of SCD, 427 429 N Neurally mediated reflex syncope, 388 in older adults pathophysiology of, 412 414 Neurally mediated syncope as warning symptom of SCD, 424 Neurocardiogenic syncope in children and adolescents, 398 399 O Older adults syncope in, 411 421. See also Syncope, in older adults Organic heart disease described, 450 syncope in patients with, 449 463 evaluation of, 454 458 clinical assessment in, 454 456 EP studies in, 457 future of, 458 459 ILRs in, 457 458 introduction, 449 450 management of, 458 459 mechanisms of, 453 454 mortality data, 452 453 prevalence of, 450 452 Orthostatic hypotension as warning symptom of SCD, 424 syncope secondary to Orthostatic syncope, 388 L LOC. See Loss of consciousness (LOC) Long QT syndrome (LQTS) in children and adolescents, 401 402 ECG of, 437 Loss of consciousness (LOC) nonsyncopal clinical findings of, 350 352 cataplexy, 352 epilepsy, 350 351 hypoglycemia, 351 psychogenic pseudosyncope, 351 352 TIA, 351 in syncope evaluation of, 347 349 transient. See Transient loss of consciousness (TLOC) LQTS. See Long QT syndrome (LQTS) P Paced breathing Pacemaker therapy Peripheral resistance low, 344 Physical maneuvers in syncope management in children and adolescents, 404 405 counterpressure maneuvers, 475 Postural orthostatic tachycardia syndrome (POTS) in children and adolescents, 399 400 POTS. See Postural orthostatic tachycardia syndrome (POTS) Primary myocardiac dysfunction syncope in children and adolescents due to, 401
500 Index Primary pulmonary hypertension syncope in children and adolescents due to, 401 Pseudosyncope psychogenic nonsyncopal LOC and, 351 352 Psychogenic pseudosyncope nonsyncopal LOC and, 351 352 R Reflex syncope, 388 management of, 474 478 general measures in, 475 water ingestion in, 475 S SCD. See Sudden cardiac death (SCD) Seizure(s) epileptic syncope vs., 377 378 syncope vs., 377 385 history in, 380 381 Seizure disorder in children and adolescents, 398 Short QT syndrome (SQTS) ECG of, 437 Situational syncope diagnosis of, 352 353 Sleep syncope, 354 SMU. See Syncope management unit (SMU) SQTS. See Short QT syndrome (SQTS) Stakeholders in SMU, 486 Sudden cardiac death (SCD) syncope as warning symptom of, 423 432. See also Syncope, Syncope, 341 345. See also Transient loss of consciousness (TLOC) AECG monitoring in, 361 366 causes of, 424 clinical work-up of, 429 430 epidemiology of, 424 management of, 430 as warning symptom of SCD cardiogenic syncope, 424 429 ARVC, 426 atherosclerotic coronary disease, 426 427 congenital coronary artery anomaly, 427 HCM, 424 426 ion channel diseases, 427 429 introduction, 423 424 neurally mediated syncope, 424 orthostatic hypertension, 424 autonomic in children and adolescents, 398 400. See also Autonomic syncope, in children and adolescents cardiac in children and adolescents, 400 402. See also Cardiac syncope, in children and adolescents causes of, 367 368, 423, 449 450 cardiac arrhythmias, 389 diagnosis of, 352 353 structural cardiac and cerebrovascular disease, 389 challenges related to, 484 in children and adolescents, 397 409 causes of noncardiac, 402 403 classification of, 398 403 autonomic syncope, 398 400 cardiac syncope, 400 402 evaluation of, 403 404 imaging studies in, 404 laboratory studies in, 403 404 future perspective on, 405 406 incidence of, 397 398 introduction, 397 management of, 404 405 prevalence of, 397 398 classification of, 343 344, 388 389 as common problem, 484, 486 convulsive, 379 380 costliness of, 486 death related to, 452 453 defined, 341 342, 378, 397, 465 described, 378, 387 388, 423 424 diagnosis of, 485 diagnostic pathway for, 389 390 driving and, 465 471. See also Driving, dysautonomic in children and adolescents, 399 epidemiology of, 343 evaluation of ANS assessment in, 359 EP study in, 367 375. See also Electrophysiology (EP) study, in syncope evaluation initial clinical, 347 355. See also Syncope, initial clinical evaluation of tilt testing in, 357 359. See also Tilt testing, in syncope evaluation in hereditary arrhythmogenic syndromes, 433 440 circumstances of, 434 ECG of, 436 437 Brugada syndrome, 436 437
Index 501 CPVT, 437 LQTS, 437 SQTS, 437 family history in, 434 introduction, 433 434 medical history in, 434 435 physical examination in, 435 436 symptoms of, 434 435 high-risk patients for identification of, 367 369 historical background of, 357 hospital admissions related to, 423, 465 idiopathic AV block and, 441 447. See also Idiopathic atrioventricular (AV) block, syncope and ILRs in, 361 366. See also Implantable loop recorders (ILRs) incidence of, 367, 449 initial clinical evaluation of, 347 355 clinical findings of nonsyncopal LOC, 350 352 diagnosis of cause in, 352 353 findings suggestive of cause only in, 353 354 TLOC cause and diagnosis in, 349 350 was LOC complete in, 347 349 was LOC rapid onset, short duration, and spontaneous recovery in, 349 introduction, 341 low CO with, 344 low peripheral resistance with, 344 management of, 473 481 bifascicular block and, 478 cardiac pacing in, 477 478 cardiac syncope, 478 drug therapy in, 475 477 in emergency department, 486 487 guidelines for, 470 inpatient, 487 introduction, 473 474 outpatient, 487 physical counterpressure maneuvers in, 475 reflex syncope, 474 478. See also Reflex syncope syncope secondary to orthostatic hypotension, 478 tilt training in, 475 mimics of, 389 neurally mediated reflex, 388 in older adults pathophysiology of, 412 414 neurocardiogenic in children and adolescents, 398 399 in older adults, 411 421 epidemiology of, 411 412 introduction, 411 management of, 414 418 case examples, 414 418 pathophysiology of, 412 414 in organic heart disease patients, 449 463. See also Organic heart disease, syncope in patients with orthostatic, 388 orthostatic hypotension and diagnosis of, 353 pathophysiology of, 344 prevalence of, 449 recurrence of, 367 reflex, 388 management of, 474 478 seizure vs., 377 385 epileptic seizures, 377 378 history in, 380 381 situational diagnosis of, 352 353 sleep, 354 unexplained ILRs in, 363 vasovagal in children and adolescents, 398 typical diagnosis of, 352 as warning symptom of SCD, 423 432 Syncope care delivery organization general features of, 483 484 Syncope management unit (SMU), 483 496 cardiac imaging in, 488 491 ECG monitoring in, 491 492 exclusion of other causes of TLOC in, 492 493 external loop recorders in, 492 holter monitoring in, 492 HUTT in, 491 ILRs in, 492 initial evaluation in, 488 inpatient telemetry in, 492 professional skill mix for, 487 488 provocative testing in, 491 rationale for, 484 486 role of, 488 settings of, 486 487 stakeholders in, 486 T Tachyarrhythmia EP study of, 373 374 TIA. See Transient ischemic attack (TIA) Tilt testing for questionable epilepsy, 381 382 in syncope evaluation, 357 359 in children and adolescents, 403 404 current role of, 359 impact of, 357 358 negativity toward, 358 359 Tilt training in syncope management, 475
502 Index TLOC. See Transient loss of consciousness (TLOC) Transient ischemic attack (TIA) psychogenic, 351 Transient loss of consciousness (TLOC). See also Syncope causes of, 387 388 defined, 341 342 described, 342 diagnosis of, 377 ILRs in, 363 365 health services delivery for, 382 383 rapid onset and short duration of, 342 recovery from, 342 risk stratification of patients presenting with, 387 396 cardiac vs. noncardiac causes, 394 395 described, 390 391 longer-term risk, 392 394 short-term high-risk TLOC/syncope markers, 392 short-term or immediate risk, 391 392 rule out head trauma and epilepsy in, 342 in SMU, 492 493 in syncope cause and diagnosis of, 349 350 video recordings of, 382 Trauma head TLOC and, 342 Typical vasovagal syncope diagnosis of, 352 V Vasovagal syncope in children and adolescents, 398 W Water ingestion in syncope management, 475