Syncope

The study did not meet its primary objective of demonstrating that fludrocortisone reduced the likelihood of vasovagal syncope by the specified risk reduction of 40%. The study demonstrated a significant effect after dose stabilization, and there were significant findings in post hoc multivariable and on-treatment analyses. (A randomised clinical trial of fludrocortisone for the prevention of vasovagal syncope; ISRCTN51802652; Prevention of Syncope Trial 2 [POST 2]; NCT00118482).

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“…V asovagal syncope is a common problem that reduces quality of life (1) and can be difficult to treat (2).…”

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confidence: 99%

“…No therapies have been proven effective by randomized controlled trials (2), with the exception of pacemakers for older patients with documented asystole during syncope (3).…”

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confidence: 99%

Fludrocortisone for the Prevention of Vasovagal Syncope

Sheldon

Raj

Rose

et al. 2016

Journal of the American College of Cardiology

123

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“…1 The aetiology is often elusive, with important prognostic implications; thus, extensive diagnostic testing to distinguish syncope of benign (i.e. vaso-vagal) vs. high-risk (i.e.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic utility of carotid artery duplex ultrasonography in the evaluation of syncope: a good test ordered for the wrong reason

Kadian-Dodov

Papolos

Olin

2015

European Heart Journal - Cardiovascular Imaging

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AimsSyncope refers to a transient loss of consciousness and postural tone secondary to cerebral hypoperfusion. Guidelines recommend against neurovascular testing in cases of syncope without neurologic symptoms; however, many pursue carotid artery duplex ultrasonography (CUS) due to the prognostic implications of identified cerebrovascular disease. Our objective was to determine the diagnostic utility of CUS in the evaluation of syncope and the identification of new or severe atherosclerosis with the potential to change patient management. Methods and resultsWe reviewed records of 569 patients with CUS ordered for the primary indication of syncope through an accredited vascular laboratory at an academic, urban medical centre. Findings on CUS, patient demographic, clinical and laboratory information, and medications within 6 months of the CUS exam were reviewed. Bivariate relationships between key medical history characteristics and atherosclerosis status (known vs. new disease) were examined. Among 495 patients with complete information, cerebrovascular findings could potentially explain syncope in 2% (10 patients). Optimization of cardiovascular risk factors would benefit patients with known (56.6%) and new atherosclerosis (33.5%) with suboptimal lipid control, (LDL . 70 in 42.2 and 34.9% respectively; LDL . 100 in 15.7 and 20.4%), and those not on high-intensity statin therapy (80 and 87.5%) or antiplatelet medications (13.2 and 50.6%). ConclusionCUS is a low-yield diagnostic test in the evaluation of syncope, but it is useful in the diagnosis of atherosclerosis and identification of subjects who would benefit from optimal medical therapy.--

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“…Recurrence of VVS affects physical, psychological and psychosocial aspects of life quality leading to an impaired quality of life [QoL ; 3]. The first-line recommended treatment for a VVS is nonpharmacological measures; no medication has shown any substantial effect in large clinical trials, but sometimes pacemaker implantation can be discussed [4]. Physiotherapeutic measures and psychological approaches, have been evaluated in studies, but with no definitive conclusion [5,6].…”

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confidence: 99%