RESUMO
We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.
Assuntos
Cardiomiopatias/complicações , Serviços Médicos de Emergência/estatística & dados numéricos , Síncope/etiologia , Idoso , Brasil/epidemiologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Cardiopatias/complicações , Cardiopatias/epidemiologia , Humanos , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco , Análise de Sobrevida , Síncope/mortalidadeRESUMO
This is the report of a case of fetal tachyarrhythmia with 1:1 atrioventricular conduction detected by pre-natal echocardiography in a fetus at 25-weeks gestation. Adenosine infusion via cordocentesis was performed as a diagnostic test to differentiate between atrioventricular nodal reentrant supraventricular tachyarrhythmia and atrial flutter. After infusion, transient 2:1 atrioventricular dissociation was obtained and the diagnosis of atrial flutter was made. Transplacental therapy with digoxin and amiodarone was then successfully used.
Assuntos
Adenosina , Antiarrítmicos , Doenças Fetais/diagnóstico por imagem , Taquicardia Supraventricular/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adenosina/administração & dosagem , Adulto , Antiarrítmicos/administração & dosagem , Digoxina/administração & dosagem , Feminino , Doenças Fetais/tratamento farmacológico , Humanos , Injeções Intravenosas , Gravidez , Taquicardia Supraventricular/tratamento farmacológico , Veias UmbilicaisRESUMO
Holt-Oram syndrome was first described in 1960 as an association of familial heart disease and musculoskeletal abnormalities. The most important findings include atrial septal defects, atrioventricular conduction abnormalities, vascular hypoplasia, and upper limb musculoskeletal deformities. We report two patients with this syndrome in the same family and discuss the variability of the musculoskeletal abnormalities and their association with the cardiac morphologic defects. Both patients in this study had associated eosinophilia, which has not been reported in the literature.