Fisiopatología del síncope neuralmente mediado

Malamud-Kessler, Caroline; Bruno, Erik; Chiquete, Erwin; Sentíes-Madrid, Horacio; Campos-Sánchez, Miguel

doi:10.1016/j.nrl.2014.04.001

Cited by 6 publications

(4 citation statements)

References 40 publications

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“…El síndrome de Ehlers-Danlos es una enfermedad infrecuente, hereditaria con patrón autosómico dominante, caracterizada por producción anormal de procolágeno y colágeno, presentando hiperlaxitud articular, fragilidad tisular y afección en tejidos cartilaginosos incluyendo tráquea, laringe y piel. Incidencia de 1 en 5.000-10.000, el subtipo hipermóvil es el más rorreceptores aórticos o acumulación excesiva de sangre en miembros inferiores por incremento de la distensibilidad e incremento en la capacitancia de la vasculatura venosa durante ortostátismo causando fatiga, somnolencia, nausea, palpitaciones y taquicardia [2], [7], [9]. Existe inestabilidad atlantoaxial y craneocervical presentando dolor, alteraciones sensoriales o motoras.…”

Section: Discussionunclassified

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Caso clínico: Manejo anestésico en la embarazada con síndrome de Ehlers Danlos

Maldonado¹,

Rojas²,

Santiago³

2022

Rev. chil. anest.

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Ehlers-Danlos syndrome is a group of hereditary disorders characterized by alterations in the connective tissue manifested by hypermobility in joints, hyperextensible skin, and fragility associated with respiratory, cardiovascular, digestive, and musculoskeletal disorders. It is necessary to perform a differential diagnosis with hereditary connective tissue diseases such as Marfan syndrome, Larsen, cutis laxa and osteogenesis imperfecta[1]. In the syndrome there is a group of connective tissue disorders, characterized by hyperextensible skin, joint hypermobility, skin disorders, fatigue, chronic pain, cardiovascular, bone, neurological, spinal, psychological, gastrointestinal and respiratory disorders. There are 14 subtypes in the international classification of Ehlers-Danlos syndrome, with the hypermobile subtype being the most common [2]. Intubation difficulties can arise secondary to the collapse of fibroelastic tissues in the trachea, as well as affecting the tissues of the larynx and skin, cervical instability presenting a set of anesthetic challenges. It is associated with obstetric complications such as threatened abortion, spontaneous abortions, premature delivery and premature rupture of membranes [3]. We present the case of a 28-year-old patient with Ehlers-Danlos syndrome with a pregnancy of 35.6 weeks associated with preeclampsia with severity criteria and probable abruption of a normoinserted placenta, managed urgently in our hospital unit, resolving without complications.

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Section: Discussionunclassified

“…Los anestésicos locales, anestésicos volátiles, anestesia total intravenosa, son seguros a menos que exista una contraindicación. Los relajantes neuromusculares facilitarán la intubación y disminuirá la incidencia de hematomas y traumatismos [8], [9].…”

Section: Discussionunclassified

Caso clínico: Manejo anestésico en la embarazada con síndrome de Ehlers Danlos

Maldonado¹,

Rojas²,

Santiago³

2022

Rev. chil. anest.

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“…Сохранение нормальных сосудистого тонуса и АД на протяжении всего ортостаза у тилт-негативных лиц и в течение первой половины вертикальной фазы ДПОП у тилт-позитивных лиц в значительной мере обусловлено нейрогуморальным прессорным ответом [22,23]. Поддержание ОПСС на определенном этапе также обеспечивается транзиторным повышением концентрации в кровотоке активности ренина плазмы, альдостерона, вазопрессина [24].…”

Section: Discussionunclassified

Features of changes in volume-impedance hemodynamic indicators during the tilt test in young males with a history of vasovagal syncopes

et al. 2019

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Background. The direction of changes in hemodynamic parameters during the tilt test (TT) nin individuals with history of vasovagal syncope (VVS) is a subject of discussion. Objective: to study changes of volume-impedance hemodynamic indicators in the process of tilt test in somatically healthy young men with history of VVS. Materials and methods. A total of 102 men aged 18–30 years were divided into 4 groups, taking into account the specific features of fainting history and response to TT. Persons of group 1 (n=14) had history of VVS and positive response to TT (syncope). Subjects of group 2 (n=14) had history of VVS and a pattern of postural tachycardia without fainting during TT. Persons of group 3 (n=42) had history of VVS and negative response to TT. Subjects of group 4 (n=32) had no history of VVS and negative response to TT. During TT, we studied dynamics of some indicators, including cardiac output (CO) and total peripheral vascular resistance (TPVR). Results. In individuals of all groups in the initial horizontal phase of TT values of CO and TPVR corresponded to the norm. Subjects of group 1 had significantly lower CO compared with subjects of groups 2, 3, 4 (p<0.05, p<0.01, p<0.05, respectively). Values of TPVR in subjects of group 1 were significantly higher than in subjects of groups 2, 3, 4 (p<0.05; p<0.05; p<0.05, respectively). In response to orthostasis CO values increased in groups 1, 2, 4 (by 18%, 10%, 5%, respectively) and did not change in group 3; TPVR values decreased in groups 1, 2 (by 8%, 0.5%, respectively), and increased in groups 3, 4 (by 8%, 4% respectively). In the final horizontal phase of TT, CO values in group 1 were significantly lower than in groups 3, 4 (p<0.05), while TPVR values did not significantly differ between all groups (p>0.05). Conclusions. In tilt-positive and tilt-negative subjects with history of VVS, standardized postural stress leads to unidirectional changes in cardiac output, but to multidirectional changes in total peripheral vascular resistance.

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“…El síncope es una pérdida de la conciencia consecutiva a hipoperfusión global transitoria caracterizado por un inicio rápido, corta duración y recuperación espontánea completa 1 . Varios mecanismos fisiopatológicos pueden llevar a su aparición; sin embargo, todos comparten como final común el descenso de la presión arterial y como resultado el desarrollo de hipoperfusión tisular 2 .…”

Section: Introductionunclassified

Crisis hipertensiva y bradicardia secundaria a intoxicación por midodrina

Patiño-Arboleda¹,

Negrete-Salcedo²,

Ocampo-Chaparro³

2022

RCCAR

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El síncope, definido como una pérdida transitoria de la conciencia que cursa con recuperación espontánea y completa, es secundario a un amplio grupo etiológico, incluido el de origen vasovagal desencadenado por una descarga adrenérgica u ortostatismo. El tratamiento de esta entidad incluye medidas no farmacológicas y farmacológicas, como la administración de midodrina, un agonista de los receptores α de acción periférica, usada en el control de la hipotensión ortostática y cuyo empleo ha demostrado mejoría en los síntomas de esta alteración. Se presenta el caso de una mujer de 18 años, con antecedente de síncope vasovagal en tratamiento con medidas no farmacológicas y midodrina desde seis meses antes, quien consultó al servicio de urgencias de un centro de atención de nivel IV por cuadro clínico consistente en ingestión intencionada de una sobredosis de midodrina. En el ingreso se documentaron crisis hipertensiva, bradicardia extrema y compromiso hepático y renal. Se indicó tratamiento sintomático con resolución de las alteraciones clínicas y paraclínicas e intervención del equipo de salud mental.

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Fisiopatología del síncope neuralmente mediado

Abstract: Sympathetic hyperactivity is present in patients with NMS at rest and before syncope. During active standing or passive tilting, excessive tachycardia may be followed by bradycardia and profound hypotension. Recovery of systolic BP is delayed or incomplete.

Cited by 6 publications

References 40 publications

Caso clínico: Manejo anestésico en la embarazada con síndrome de Ehlers Danlos

Caso clínico: Manejo anestésico en la embarazada con síndrome de Ehlers Danlos

Features of changes in volume-impedance hemodynamic indicators during the tilt test in young males with a history of vasovagal syncopes

Crisis hipertensiva y bradicardia secundaria a intoxicación por midodrina

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