Triggering of cardiovascular incidents by micturition and defecation

Čulić, Viktor

doi:10.1016/j.ijcard.2005.04.032

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Complex acute biological effects of smoked marijuana include increased heart rate and carboxyhemoglobin, typically increased blood pressure in supine position with postural hypotension and imbalance between myocardial oxygen supply and demand [72][73][74]. Toilet activities such as defecation and micturition are extremely rare triggers, perhaps more important in severely ill or immobilized patients with multiple comorbidities [6,75].…”

Section: Other External Triggersmentioning

confidence: 99%

Acute risk factors for myocardial infarction

Čulić

2007

International Journal of Cardiology

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Section: Other External Triggersmentioning

confidence: 99%

Acute risk factors for myocardial infarction

Čulić

2007

International Journal of Cardiology

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“…Several authors believe that the occurrence of CA on the toilet is the consequence of severe defecation/micturition syncope [15]. In patients with defecation/micturition syncope, a paradoxical decrease in blood pressure during straining occurs due to imbalance between sympathetic and parasympathetic autonomic function, which may in turn cause decreased cerebral blood flow and loss of consciousness [15][16][17][18]. Both increased extra-cardiac vascular events after suddenly elevated blood pressure and increased cardiac events after imbalance between sympathetic and parasympathetic nerves may be responsible for the disproportionally high frequency of CA while an individual is in the toilet.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles

Inamasu

2012

Environ Health Prev Med

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Objectives The great majority of non-traumatic cardiac arrests (CA) occur at home. The toilet is a closed and private room where CA occurs frequently. However, due to the feelings of privacy that are associated with this room, the circumstances and causes of CA in the toilet have rarely been investigated. Methods A retrospective study was conducted to clarify clinical characteristics and resuscitation profiles of patients sustaining CA in the toilet. Results Among 907 CA patients treated during a 4-year period, 101 (11 %) sustained CA in the toilet. While the collapse was witnessed in only 10 % of these patients, return of spontaneous circulation (ROSC) was achieved in 41 %. However, the long-term survival rate was 1 %. Multivariate regression analysis revealed that a history of cardiac diseases was predictive of CA in the toilet (odds ratio 3.045; 95 % confidence interval 1.756-5.282) but that there was no correlation with advanced age. The frequency of CA in the toilet may be influenced moderately by seasonal/circadian variations. The 101 patients were classified into four subgroups according to mode of discovery of CA. The frequency of ROSC was highest in those who collapsed in the presence of caregivers and lowest in those whose collapse were discovered later by family members being worried that the patient stayed in the toilet ''too long.'' Imaging studies revealed life-threatening extra-cardiac lesions responsible for CA, such as subarachnoid hemorrhage and aortic dissection, in 23 % of the patient cohort. Conclusions The rarity of long-term survival among individuals sustaining CA in the toilet is mainly due to the delay in discovering the individual who collapsed. Although a history of cardiac diseases is a risk factor, predicting who may sustain CA in the toilet remains difficult due to etiological heterogeneity.

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“…Defecation/micturition is unique from the perspective of vascular medicine: autonomic imbalance between the sympathetic and parasympathetic nerves during defecation/micturition can result in hemodynamic instability and adverse vascular events. Syncope and pulmonary embolism occurring in the toilet have been widely studied. In contrast, stroke occurring in the toilet has been reported very rarely .…”

Section: Introductionmentioning

confidence: 99%