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Radiol Case Rep 2021 Aug 8;16(8):2050. Epub 2021 Jun 8.

Department of Emergency Radiology, Ibn Sina Hospital, 19 Rue Camelia, Secteur 9, Rabat Morocco.

Carotid diaphragm usually can cause artery stenosis essentially affecting the internal carotid artery (ICA) beyond the bulb segment.  Patients are often middle aged and the onset of symptoms typically begins with syncopes leading to ischemic stroke.  More than 50 cases have been reported in which all lesions showed as stenosis located in the ICA, in this article, we report a rare common carotid artery (CCA) diaphragm revealed in a 59 year-old female suffering from transient syncopes. Read More

Diving Hyperb Med 2021 Jun;51(2):210-215

Department of Emergency Medicine, University of California San Diego, San Diego CA, USA.

Many competitive breath-hold divers use dry apnoea routines to improve their tolerance to hypoxia and hypercapnia, varying the amount of prior hyperventilation and lung volume. When hyperventilating and exhaling to residual volume prior to starting a breath-hold, hypoxia is reached quickly and without too much discomfort from respiratory drive. Cerebral hypoxia with loss of consciousness (LOC) can easily result. Read More

Seizure 2021 Jun 13;91:141-145. Epub 2021 Jun 13.

Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom.

Objective: There are three common causes of Transient Loss of Consciousness (TLOC), syncope, epileptic and psychogenic nonepileptic seizures (PNES). Many individuals who have experienced TLOC initially receive an incorrect diagnosis and inappropriate treatment. Whereas syncope can be distinguished relatively easily with a small number of "yes"/"no" questions, the differentiation of the other two causes of TLOC is more challenging. Read More

Clin Neurol Neurosurg 2021 Jun 8;207:106739. Epub 2021 Jun 8.

Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. Electronic address:

Background: Non-Epileptic Paroxysmal Events (NEPE) are common clinical manifestations in pediatric age presenting with dysfunction of motor and behavioral activity mimicking features of epileptic seizures.

Objective: To present and analyze number and clinical characteristic of a group of children/adolescents presenting with various types of NEPE; to compare clinical data of this group of NEPE affected children/adolescents with a group of children/adolescents affected by Epileptic Seizures (ES).

Methods: The retrospective study was conducted at the Pediatric Clinic of University of Catania, Catania, Italy, in a period ranging from January 2005 and January 2018. Read More

Indian Pacing Electrophysiol J 2021 Jun 19. Epub 2021 Jun 19.

Department of Clinical Engineering, Ogaki Municipal Hospital, Ogaki, Japan.

Intrinsic anti-tachycardia pacing (iATP) is a novel automated ATP algorithm that employs post-pacing interval (PPI) to design the next ATP sequence based on an analysis of the prior failed ATP sequence. A patient with hypertrophic cardiomyopathy received an implantable cardioverter-defibrillator (ICD) (Cobalt™ XT DR, Medtronic, Minneapolis, MN, USA) following an episode of syncope due to macro-reentrant ventricular tachycardia (VT) (right bundle branch block configuration, cycle length [CL] 280 ms). The VF zone was set to VTCL <300 ms and iATP therapy was prescribed before and during capacitor charging. Read More

Cerebellum 2021 Jun 22. Epub 2021 Jun 22.

Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.

The mechanism of vestibular syncope, the syncope occurring during the vertigo attacks, remains uncertain. This study aims to clarify the mechanism of vestibular syncope by pursuing the function of vestibular system in cardiovascular autonomic control and by defining neuro-hemodynamic changes in vestibular syncope. By integrating the velocity-storage (VS) circuit in the brainstem and cerebellum, we propose that the vestibular syncope develops as a result of dyssynergia of the vestibulosympathetic and baroreflexes in which centrally estimated downward inertial acceleration during the vertigo attacks acts as a trigger. Read More

BMJ Case Rep 2021 Jun 21;14(6). Epub 2021 Jun 21.

Obstetrics and Gynaecology Department, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.

Gestational trophoblastic disease occurs in 1-3:1000 gestations worldwide. Up to one-fifth of complete hydatidiform moles undergo malignant transformation, with 2%-4% manifesting as metastatic disease. Of these, a third present with vaginal metastases, which can cause bleeding and discharge. Read More

Med Clin (Barc) 2021 Jun 18. Epub 2021 Jun 18.

Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario Virgen de Valme, Sevilla, España.

Actas Dermosifiliogr 2021 Jun 18. Epub 2021 Jun 18.

Servicio de Dermatología, Complejo Asistencial de Zamora, Zamora, Spain.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is fainting due to a vasovagal reaction, which is the most common complication in dermatologic surgery. Read More

Neurol Sci 2021 Jun 21. Epub 2021 Jun 21.

Neurology Stroke Unit, Ospedale del Mare Hospital, Via Enrico Russo, 80147, Naples, Italy.

Differential diagnosis of seizures and convulsive syncope may be challenging in clinical practice. Furthermore, a misleading diagnosis of epilepsy may be detrimental for the patient as it often implies an over-prescription and an over-use of antiepileptic drugs which can cause adverse reactions. Moreover, a wrong diagnosis also causes distress to the patient with the risk of performing plenty of investigations without any benefits on the symptoms. Read More

Intern Med J 2021 Jun 20. Epub 2021 Jun 20.

Division of Cardiology, Alfred Health, Melbourne, Australia.

Congenital long QT syndrome (LQTS) is a familial cardiac ion channelopathy first described over sixty years ago. It is characterised by prolonged ventricular repolarization (long QT on ECG), ventricular arrhythmias and associated syncope or sudden cardiac death. As the most closely studied cardiac channelopathy, over the decades we have gained a deep appreciation of the complex genetic model of LQTS. Read More

J Geriatr Cardiol 2021 May;18(5):346-351

Department of Cardiovascular Disease, University of Florida College of Medicine, Jacksonville, FL, USA.

Papillary fibroelastoma (PFE) is a primary, histologically benign endocardial neoplasm. Though PFE has long been reported as the second most common primary cardiac neoplasm, it has since pulled ahead of cardiac myxomas, largely due to evolving cardiac imaging modalities. While PFEs are benign histologically, they have the potential for devastating clinical consequences, transient ischemic attack, stroke, myocardial infarction, syncope, pulmonary, and peripheral embolism. Read More

Circ J 2021 Jun 18. Epub 2021 Jun 18.

Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences.

Background: myBeat is a novel cutaneous patch device that continuously records electrocardiography and automatically detects atrial fibrillation (AF) by using a new algorithm based on RR intervals. We aimed to test the diagnostic ability of this novel device for screening silent AF in asymptomatic patients.Methods and Results:A multicenter randomized prospective clinical study was performed. Read More

Heart Rhythm 2021 Jun 17. Epub 2021 Jun 17.

Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart). Electronic address:

Background: Brugada syndrome (BrS) is an inheritable disease with an increased risk of sudden cardiac death. Although several score systems have been proposed, the management of children with BrS has been inconsistently described.

Objective: To identify the characteristics, outcome and risk factors associated with cardiovascular and arrhythmic events in children < 12 years with BrS. Read More

Heart Rhythm 2021 Jun 17. Epub 2021 Jun 17.

Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France.

Within the span of a few years, watches have functionally morphed from objects that tell time to wearable mini-computers that allow for real-time recording of electrocardiograms (ECGs). Considerable information can be deduced from these single lead tracings and it is now not uncommon to see patients in whom diagnostic tracings of clinically relevant but elusive arrhythmias are captured using a smartwatch. Empowering individuals to record their own ECG tracings in scenarios such as palpitations, syncope, and for risk stratification of sudden death intuitively has considerable potential but its value remains to be robustly demonstrated. Read More

Am J Cardiol 2021 Jun;149:159-160

Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon. Electronic address:

J Electrocardiol 2021 Jun 12;67:115-118. Epub 2021 Jun 12.

Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361000, Fujian, China. Electronic address:

The implantable loop recorder (ILR) is a small device used to monitor the electrical activity of the heart by recording a single‑lead bipolar electrocardiograph signal over a long period of time. The ILR is a valid diagnostic tool but has been vastly underused. In addition to arrhythmia, the ILR may be a useful tool for the detection of repolarization disorders in patients with myocardial ischemia. Read More

Int J Cardiovasc Imaging 2021 Jun 19. Epub 2021 Jun 19.

University of Oxford, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.

QJM 2021 Jun 17. Epub 2021 Jun 17.

Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan.

Uremia affects all parts of the immune system. Since hemodialysis patients travel to the dialysis center three times per week and are surrounded by many other patients and staffs, these could predispose them to a greater risk of coronavirus disease of 2019 (COVID-19) infection. Mortality associated with COVID-19 infection is high in patients receiving dialysis. Read More

World J Clin Cases 2021 Jun;9(16):4095-4103

Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.

Background: Arrhythmogenic right ventricular (RV) cardiomyopathy is a rare and currently underrecognized cardiomyopathy characterized by the replacement of RV myocardium by fibrofatty tissue. It may be asymptomatic or symptomatic (palpitations or syncope) and may induce sudden cardiac death, especially during exercise. To prevent adverse events such as sudden cardiac death and heart failure, early diagnosis and treatment of arrhythmogenic RV cardiomyopathy (ARVC) are crucial. Read More

Ear Nose Throat J 2021 Jun 16:1455613211022102. Epub 2021 Jun 16.

Valley ENT, Scottsdale, AZ, USA.

Olfactory neuroblastoma (ONB) is a rare malignancy of the sinonasal cavity, originating from neuroepithelial olfactory cells. Olfactory neuroblastoma can be difficult to diagnose due to its anatomic position and variable symptomatic presentation, leading to diagnosis at a more advanced stage. Here, we present the case of a 35-year-old man with no previous medical history who had a bicycle accident secondary to syncope. Read More

Rev Invest Clin 2021 Jun 15. Epub 2021 Jun 15.

Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Background: Cerebral hypoperfusion before syncope has been shown in patients with chronic orthostatic intolerance (OI) without tachycardia, but it is unknown if an initial decrease of cerebral blood flow velocity (CBFv) could be related to the vasovagal response (VVR) to head-up tilt test (HUTT).

Objective: The objective of the study was to compare cardiovascular, cerebrovascular, and autonomic variables during HUTT in OI patients with or without a VVR.

Methods: We included 74 subjects (58% female, mean age 33 ± 12 years) who underwent a 30-min HUTT and were divided into three groups: OI with VVR positive (VVR+), OI without VVR negative (VVR-), and asymptomatic healthy subjects with negative HUTT (control group). Read More

Arch Dis Child 2021 Jun 14. Epub 2021 Jun 14.

Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan

Objective: To retrospectively investigate the clinical spectrum, genetic profiles and outcomes of survivors of paediatric sudden cardiac arrest (SCA).

Design And Patients: All 66 patients (aged 1-20 years), with unexpected SCA or syncope related to ventricular tachycardia (VT)/fibrillation and who survived to discharge from a tertiary centre, were enrolled from 1995 to 2018. Of these, 30 with underlying diseases prior to the events were excluded. Read More

Zhonghua Xin Xue Guan Bing Za Zhi 2021 Jun;49(6):615-620

Cardiac Arrhythmia Center, National Center of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

To investigate the clinical and electrophysiological features of ventricular tachycardia (VT) in tetralogy of Fallot (TOF) patients post surgical repair (rTOF) and to analyze the therapeutic effect and prognosis of radiofrequency ablation of rTOF-VT. This is a retrospective study. Consecutive patients with rTOF-VT, who were treated in Fuwai Hospital from January 2015 to March 2020, were enrolled. Read More

Eur Heart J Case Rep 2021 Apr 19;5(4):ytab100. Epub 2021 Apr 19.

Department of Cardiothoracic Anaesthesia, Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Road 4524, Block 945, Al Riffa, Awali, Kingdom of Bahrain.

Background: Pulmonary embolism with thrombus-in-transit through a patent foramen ovale is rare. It may present with neurological sequalae and rapid diagnosis is needed to prevent mortality and morbidity. The European Society of Cardiology (ESC) published guidelines in 2019 for diagnosis and management of acute pulmonary embolism which were useful in this case. Read More

J Cardiovasc Electrophysiol 2021 Jun 13. Epub 2021 Jun 13.

J Vet Cardiol 2021 May 13;36:89-98. Epub 2021 May 13.

Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA.

Introduction: The objective of this retrospective study was to describe the indications, complications, and long-term outcomes in a group of cats that received an epicardial pacing (EP) system.

Animals: Twenty client-owned cats.

Materials And Methods: Medical records were reviewed for signalment, presenting complaint, primary electrocardiogram (ECG) diagnosis, presence of structural heart disease, presence of congestive heart failure (CHF), presence of major or minor complications, and survival time. Read More

Eur J Neurol 2021 Jun 12. Epub 2021 Jun 12.

Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.

The recent recommendations regarding tilt table testing (TTT) from the European Federation of Autonomic Societies (EFAS) provides a rationale and evidence-base for the use of TTT in conditions that cause transient loss of consciousness (TLOC) and insights into current attitudes regarding TTT. Historically, only few neurologists took an interest in clinical disorders of the autonomic nervous system, and often focused their attention toward debilitating but rare causes of neurogenic orthostatic hypotension. Read More

AJNR Am J Neuroradiol 2021 Jun 11. Epub 2021 Jun 11.

Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina

Background And Purpose: Transient loss of consciousness is commonly evaluated in the emergency department. Although typically caused by epileptic seizure, syncope, or psychogenic nonepileptic seizure, the underlying etiology is frequently misdiagnosed. Lateral tongue bites are reportedly a specific clinical finding of seizure. Read More

BMJ Case Rep 2021 Jun 11;14(6). Epub 2021 Jun 11.

Department of Cardiology, Glenfield Hospital, Leicester, UK.

We report the first leadless pacemaker (L-PM) providing atrioventricular synchronous pacing implanted into a heart transplant patient receiving chronic immunosuppressive therapy. The patient presented with syncope corresponding to sinus rhythm with high-grade atrioventricular block. Previously, L-PMs provided only single-chamber ventricular sensing and pacing. Read More