This book presents a unique collection of clinical cases to help combat the difficulty of diagnosis and treatment of Syncope. Medical professionals using this book are provided with a reference to a large array of succinctly described and illustrated clinical scenarios. Each case is presented with the results of appropriate tests and critical comments about the evaluation, diagnosis and treatment according to guidelines.Syncope is considered a difficult diagnostic and treatment problem for all who work in the field. Regardless of your prior knowledge, you will find the case studies easy to digest, enlightening, and immediately pertinent to improving the care patients - giving you confidence in your diagnosis and your advice.The editors have developed a lively and easy-to-read book with a focused expert editorial commentary, offering the reader a broader and easily understood context for each case, as well as key citations from the literature.Syncope Cases is a valuable contribution to your collection; edited by seven prominent authorities on the management of syncope from four countries, with more than 130 contributors, this book provides a unique additional step in the fostering of a better understanding of the many factors that can cause syncope, with the ultimate goal of facilitating the delivery of more precise and cost-effective care for syncope patients. It is a contribution that should be widely read, and one that offers the possibility of distinctly enhancing medical care of the syncope patient.

Roberto García Civera, MD.

Professor of Cardiology. Department of Medicine. University of Valencia. Spain.

Chief Section of Arrhythmology. Clinical University Hospital. Valencia. Spain.

Gonzalo Barón Esquivias, MD

Syncope Unit. University Hospital Virgen del Rocío. Sevilla. Spain.

Jean-Jacques Blanc, MD. FESC.

Professor of Cardiology. Chief Department Cardiology

Brest University. France.

Member of the Task Force on Syncope of the European Society of Cardiology.

Michele Brignole, MD, FESC

Chief of Cardiology Department. Ospedale Riuniti. Lavagna. Italy.

Chairman of the Task Force on Syncope of the European Society of Cardiology.

Angel Moya i Mitjans, MD., FESC.

Chief Section of Arrhythmology. General University Hospital Vall d’Hebron. Barcelona. Spain.

Member of the Task Force on Syncope of the European Society of Cardiology.

Ricardo Ruíz Granell, MD.

Electrophysiology Laboratory. Clinical University Hospital. Valencia. Spain.

Wouter Wieling, MD, PD.

Professor of Medicine. Department of Medicine.

Academic Medical Center. University of Amsterdam. The Netherlands.

Contributors	p. viii
Foreword	p. xvi
Abbreviations	p. xviii
Neurally mediated (reflex) syncope
Clinical presentation
Vasovagal fainting in children and teenagers	p. 5
Typical vasovagal syncope (blood/injury phobia)	p. 8
Reflex syncope in older adults	p. 10
Transient loss of consciousness with muscle jerks: syncope or epilepsy?	p. 12
Tilt-induced syncope: mixed response	p. 15
Tilt-induced syncope: cardioinhibitory response	p. 19
Tilt-induced syncope: purely vasodepressor response	p. 21
Tilt-induced syncope: dysautonomic response	p. 25
Tilt-induced syncope: chronotropic incompetence	p. 27
Syncope and postural orthostatic tachycardia syndrome	p. 29
Electroencephalography recordings during syncope	p. 34
Psychogenic reaction during tilt-table testing	p. 36
Neuromediated syncope presenting as a paroxysmal atrioventricular block	p. 38
Multiple manifestations of the cardioinhibitory mechanism detected during prolonged electrocardiographic monitoring	p. 41
Neuromediated syncope masquerading as unexplained falls	p. 44
Post-exercise vasovagal syncope	p. 46
Post-exercise neuromediated syncope	p. 49
Vasovagal syncope interrupting sleep	p. 52
Syncope during pregnancy	p. 55
A pilot with vasovagal syncope: fit to fly?	p. 58
Recurrent syncope in a patient with no structural heart disease and a negative tilt-table test	p. 60
Swallow syncope associated with asystole	p. 62
Swallow syncope presenting with atrioventricular block	p. 64
Transient glossopharyngeal syncope	p. 66
Tussive syncope	p. 69
Laughter-induced syncope	p. 71
Syncope and the eye	p. 74
Treatment
Long-term follow-up of vasovagal syncope with a long asystolic pause	p. 79
Averting a vasovagal faint with a combination of leg crossing and muscle tensing	p. 82
Vasovagal syncope averted using arm-tensing maneuvers	p. 85
Training patients in physical countermaneuvers using continuous on-screen blood-pressure monitoring	p. 87
Vasovagal syncope treated with tilt training	p. 89
Psychological treatment of malignant vasovagal syncope due to blood phobia	p. 91
Syncope relapse in a patient with cardioinhibitory neuromediated syncope treated with pacing	p. 94
Carotid sinus syndrome
Carotid sinus syndrome	p. 99
Carotid sinus hypersensitivity only during tilting	p. 101
Complex cardioinhibitory neurally mediated syncope	p. 104
Carotid hypersensitivity syndrome secondary to neck tumor	p. 106
Syncope in a case of carotid body paraganglioma	p. 108
Recurrent syncope in a carotid sinus patient treated with a pacemaker	p. 111
Unexplained falls in older patients	p. 113
Orthostatic hypotension
Initial orthostatic hypotension as a cause of syncope in an adolescent	p. 117
Initial orthostatic hypotension and syncope due to medications in a 60-year-old man	p. 120
Initial orthostatic hypotension induced by standing up from squatting	p. 123
Self-induced syncope: the fainting lark	p. 126
Self-diagnosis of orthostatic hypotension in a patient with autonomic failure	p. 128
Unexplained transient loss of consciousness in a 58-year-old man after Legionella pneumonia	p. 131
Physical maneuvers that reduce postural hypotension in autonomic failure	p. 134
Disabling orthostatic hypotension caused by sympathectomies for hyperhidrosis	p. 137
Orthostatic hypotension due to arterial baroreflex failure	p. 141
Hypotension due to straining in a patient with a high spinal-cord lesion	p. 144
Orthostatic hypotension and syncope in a patient with pheochromocytoma	p. 147
Arrhythmic syncope
Syncope and the Brugada syndrome	p. 153
Two types of monomorphic ventricular tachycardia as a cause of syncope in Brugada syndrome	p. 156
Syncope and Brugada-like electrocardiography pattern appearing during a febrile illness: neurally mediated or arrhythmic syncope?	p. 159
Syncope in a case of acquired long QT syndrome	p. 163
Syncope due to torsade de pointes in an HIV-infected patient receiving methadone treatment	p. 165
Congenital long QT syndrome	p. 168
Long QT syndrome revealed by exercise	p. 170
Congenital long QT syndrome: torsade de pointes demonstrated by prolonged monitoring	p. 172
Short-coupled variant of torsade de pointes	p. 175
Syncope in a patient with a short QT interval	p. 177
Syncope in a woman with no heart disease, a normal electrocardiogram, and a family history of sudden death	p. 180
Palpitations and syncope: an unusual case of bradycardia-tachycardia syndrome	p. 184
Arrhythmic syncope in a child: catecholaminergic ventricular tachycardia	p. 187
Adenosine triphosphate-sensitive paroxysmal atrioventricular block	p. 190
Adenosine-dependent syncope?	p. 192
Syncope due to paroxysmal junctional tachycardia	p. 194
Syncope in a patient with atrioventricular nodal reentry tachycardia: reflex hypotension?	p. 197
Arrhythmic and neuromediated syncope in a young woman	p. 200
Syncope and Wolff-Parkinson-White syndrome: atrial fibrillation with rapid ventricular response	p. 204
Wolff-Parkinson-White syndrome with unapparent preexcitation in sinus rhythm: atrial flutter with 1:1 atrioventricular conduction	p. 208
Syncope in a patient with atrial fibrillation: reflex hypotension?	p. 211
Neuromediated syncope inducing atrial fibrillation	p. 213
Effort presyncope due to idiopathic right ventricular tachycardia	p. 216
Syncope due to idiopathic left ventricular tachycardia	p. 219
Syncope and arrhythmogenic right ventricular dysplasia	p. 222
Unexpected electrophysiology study result in a patient with repeated syncopal episodes	p. 224
Syncope in a patient with right bundle-branch block and alternating anterior and posterior left fascicular block	p. 226
Vasovagal syncope in a patient with bundle-branch block	p. 229
Intermittent atrioventricular block suggested by an electrophysiological study	p. 231
Syncope in a patient with bundle-branch block and negative electrophysiological study	p. 234
Syncope in a patient with bundle-branch block and previous myocardial infarction	p. 236
Syncope in a case of left bundle-branch block treated with an implantable defibrillator and biventricular pacing	p. 238
Syncope and cardiovascular disease
Acute coronary syndrome presenting as syncope	p. 243
Syncope as an isolated manifestation of left main coronary artery occlusion	p. 246
Syncope in a patient with myocardial infarction	p. 248
Acute myocardial infarction and complete heart block: early revascularization procedure	p. 250
Syncope in chronic ischemic heart disease: ventricular tachycardia induced during an electrophysiological study	p. 252
Syncope in a patient with an earlier myocardial infarction: induction of ventricular fibrillation during electrophysiological testing	p. 256
Syncope in a patient with dilated cardiomyopathy, a negative electrophysiological study, and poor left ventricular function	p. 260
Syncope in a patient with obstructive hypertrophic cardiomyopathy and left bundle-branch block	p. 263
Atrial flutter with 1:1 atrioventricular conduction in a patient with hypertrophic cardiomyopathy	p. 267
Syncope in hypertrophic cardiomyopathy, atrial fibrillation, and rapid ventricular response	p. 270
Syncopal ventricular tachycardia in a case of midseptal hypertrophic cardiomyopathy with apical aneurysm	p. 272
Carcinoid syndrome	p. 276
Syncope and myotonic dystrophy	p. 278
Syncope in a patient with Kearns-Sayre syndrome	p. 283
Syncope in aortic stenosis	p. 285
Syncope after aortic valve replacement	p. 288
Syncope in a patient with aortic valve prosthesis and wide QRS tachycardia	p. 291
Presyncope due to left atrial myxoma	p. 295
Syncope due to left atrial thrombus	p. 298
Cardiac tamponade presenting as syncope	p. 300
Syncope in acute aortic dissection	p. 304
Pulmonary embolism presenting as syncope	p. 307
Subclavian steal syndrome as a cause of syncope	p. 310
Multiple malignant causes of syncope in a young girl	p. 312
Index	p. 317
Table of Contents provided by Ingram. All Rights Reserved.

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