A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy.
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ABSTRACT:
SUBMITTER: Lilitsis E
PROVIDER: S-EPMC5052875 | biostudies-other | 2016 Oct
REPOSITORIES: biostudies-other
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Project description:IntroductionCarotid sinus hypersensitivity is one of the unexplained causes of syncope in old age. There are variations in presentations of carotid sinus hypersensitivity.Case presentationA 56-year-old male, known case of coronary artery disease, presenting with syncope, was diagnosed as carotid sinus hypersensitivity finally. He was treated with the placement of dual chamber pacemaker.Clinical discussionThe etiology of unexplained syncope is itself a challenging for clinicians. In the presence of a known risk factor, it is uncommon for carotid sinus hypersensitivity to be present as a cause of syncope.ConclusionsHence, the rare disorder like carotid sinus hypersensitivity should also be considered as a cause of syncope despite the presence of co-morbidity like coronary artery disease.
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Project description:Objective Carotid sinus hypersensitivity (CSH) is common in older people. The authors hypothesise that patients with CSH have a higher mortality than a geographically, age-matched older cohort. Design A retrospective cohort study compared to geographical and age-matched data from the Office of National Statistics. Setting Specialist clinic in tertiary centre. Patients 1504 patients with CSH were identified from a single syncope outpatient assessment service between 1990 and 2001. Interventions Vital status was confirmed, and death certificates were sought for all deceased patients up to 2003. Main outcome measures Kaplan-Meier survival curves were analysed within the cohort according to three different subtypes of CSH. Standardised mortality rates (SMRs) were determined using geographical and age-matched data from the Office of National Statistics. Results There was no difference between CSH patients and the general population in SMRs for all causes, or for cerebrovascular or cardiovascular deaths. There was no difference in survival between the three subtypes of CSH (p=0.2) within the study cohort. Conclusion CSH is not associated with a higher mortality than the general population, and there are no differences in mortality between the three subtypes of CSH. This confirms earlier findings and reinforces the neutral effect of CSH on mortality.
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Project description:BackgroundCarotid sinus syndrome accounts for one third of patients who presents with unexplained syncope. Prevalence of carotid sinus hypersensitivity (CSH) in Indians has not been studied till now.ObjectivesTo assess the prevalence and associations of CSH in symptomatic patients above 50 years and to study its prognostic significance pertaining to sudden cardiac death, syncope, recurrent pre syncope and falls on 1 year follow up.MethodsPatients above 50 years who presented with unexplained syncope, recurrent syncope or falls were considered cases and those without these symptoms were considered as controls. All the patients underwent carotid sinus massage and their responses noted. All symptomatic patients were followed up and observed for events like sudden cardiac death, syncope, recurrent pre syncope and falls during 1 year follow up. Patients with recurrent syncope and predominant cardioinhibitory syncope were advised permanent pacemaker implantation.ResultsA total of 252 patients were screened, 130 patients constituted cases and 49 patients constituted controls. CSH was demonstrable in 32% (n = 42) of cases as compared to 8% (n = 4) in controls (p < 0.001). Cardioinhibitory response was the predominant response (88%, n = 38) followed by mixed response (12%, n = 4). CSH was associated with advancing age, male gender (93%, n = 39, p < 0.001) and history of smoking (63%, n = 27, p = 0.009). Composite outcomes of sudden cardiac death, syncope, recurrent pre syncope and falls were significantly higher in patients with symptomatic CSH than in those without it (45%, n = 16 vs. 6.8%, n = 6; p < 0.001).ConclusionsIn conclusion, the prevalence of CSH in patients above 50 yrs with unexplained syncope was high in our population. Patients with CSH and baseline symptoms developed recurrent syncope during follow up. Carotid sinus massage should be a part of routine examination protocol for unexplained syncope.
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Project description:BackgroundAn uncommon cause of reflex syncope is carotid sinus syndrome (CSS). In rare cases, this can be caused by compression of the carotid sinus by a progressive or invasive tumour.Case summaryA 57-year-old female was presented at the emergency department with recurrent syncope in the morning. After initial observation, no heart rhythm abnormalities or syncope were observed. The day after discharge, she was presented again with a syncope. Hypotension and bradycardia were observed this time. Furthermore, a mass in the neck area was found near the carotid artery. She was admitted to the cardiology department with suspected carotid sinus syndrome for telemetric observation. Diagnostics by biopsy and PET-CT showed a metastasized squamous cell carcinoma of the tongue. Initial treatment of dexamethasone was started after which the recurrence of the syncope decreased. However, during admission, an in-hospital cardiac arrest occurred due to persistent vagal stimulation. As a result, the patient was started on neoadjuvant chemotherapy and midodrine, after which she experienced multiple complications and died.DiscussionTo the best of our knowledge, this is the first case report that shows an IHCA due to severe hypotension related to a carotid sinus syndrome.
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Project description:BackgroundCarotid sinus syndrome (CSS) is an exaggerated response to carotid sinus baroreceptor stimulation, which may result in hypotension, prolonged asystole, and subsequently transient loss of consciousness due to cerebral hypoperfusion. However, this commonly benign syndrome may have lethal consequences under certain circumstances such as scuba diving.Case summaryWe report the case of a trained 73-year-old male diver, who survived an almost fatal diving accident without any neurological deficits due to cardiac arrest under water. After recovery and intensive diagnostics in the local hospital, the origin of cardiac arrest remained unclear. However, after referral to our tertiary care centre CSS could be diagnosed by provoking syncope and asystole with carotid sinus massage (CSM). Consequently, a leadless pacing system was implanted and his medical diving fitness could then be recertified.DiscussionIn conclusion, CSS may be an underdiagnosed cause of loss of consciousness. Thus, screening for CSS by CSM should be included in medical exams in senior athletes and specifically in senior divers.
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Project description:Herein, we describe the rare anatomy of an abnormal shunt from the left atrium to the coronary sinus, which ruptured during a percutaneous ablation for atrial fibrillation. The iatrogenic lesion was successfully repaired after emergent extracorporeal membrane oxygenation set up followed by surgical exploration. The patient's postoperative course was uneventful, and she was regularly followed up without any complications.
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Project description:Recently, several biologics have been approved for the treatment of severe asthma. Dupilumab, a biologic used to treat severe asthma, is a monoclonal antibody targeting interleukin-4 and interleukin-13. In the present case, inhaled corticosteroid-induced glucocorticoid hypersensitivity was suspected, and the administration of omalizumab and mepolizumab had no beneficial effects. Subsequently, we switched to dupilumab therapy, which produced better effectiveness. Therefore, when a biologic agent proves ineffective, changing to another suitable biologic agent should be considered.
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Project description:Lung ultrasound is increasingly utilized as a diagnostic tool for the detection of a pneumothorax. The effect of small changes in patient positioning on the accuracy of lung ultrasound to detect a pneumothorax is not well studied. We present the first known case of lung ultrasound missing a pneumothorax because of suboptimal patient positioning, and discuss the implications of our findings for clinicians that utilize lung ultrasound and for future research.
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Project description:Importance:It is important that clinicians understand consequences of thyoridectomy on swallowing from the patient perspective to better care for this population. Objective:Using rigorous qualitative methodology, this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes. Design, Setting, and Participants:Prospective, grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy (2 weeks, 6 weeks, and 6 months). Data were collected from an ongoing clinical trial (NCT02138214), and outpatient interviews were conducted at the University of Wisconsin Hospital and Clinics. All participants were age 21 to 73 years with a diagnosis of papillary thyroid cancer without cervical or distant metastases and had undergone total thyroidectomy. Exclusion criteria were preexisting vocal fold abnormalities (eg, polyps, nodules), neurological conditions affecting the voice or swallowing ability, and/or development of new-onset vocal fold paresis or paralysis (lasting longer than 6 months) after total thyroidectomy. Interventions:Total thyroidectomy. Main Outcomes and Measures:Symptoms of dysphagia and related effects on quality of life elicited through grounded theory analysis of semistructured interviews with patients after thyroidectomy designed to foster an open-ended, patient-driven discussion. Results:Of the 26 patients included, 69% were women (n?=?18); mean (SD) age, 46.4 (14.1) years; mean (SD) tumor diameter 2.2 (1.4) cm. Two weeks after thyroidectomy, 80% of participants (n?=?20) reported at least 1 swallowing-related symptom when prompted by the interview cards; during the open interview, 53% of participants (n?=?14) volunteered discussion of swallowing-related symptoms unprompted. However, only 8% of participants in this study (n?=?2) qualified for a follow-up dysphagia evaluation, indicating that the majority of reported symptoms were subjective in nature. Six weeks and 6 months after thyroidectomy, 42% (n?=?11) and 17% (n?=?4) of participants, respectively, reported continued swallowing symptoms using the prompts; 12% (n?=?3) discussed symptoms without prompting cards at both time points. Conclusions and Relevance:Swallowing symptoms after thyroidectomy are underreported in the literature. This study revealed that as many as 80% of patients who have thyroidectomy may experience swallowing-related symptoms after surgery, and many develop compensatory strategies to manage or reduce the burden of these symptoms. Considering the large number of individuals who may experience subjective dysphagia, preoperative counseling should include education and management of such symptoms.
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Project description:In this study, we highlight patients’ experiences with metal hypersensitivity (MH) after receiving implantable medical devices (IMDs). We aim to identify gaps in clinical care and improve outcomes for individuals who have or may be sensitive to metals. Secondary data analysis from a previous interpretative phenomenological qualitative study was utilized. Using patient journey maps, we explored the experiences of 8 individuals from outpatient settings who received IMD and have first-hand experience with MH. We documented their journey from MH symptom recognition to diagnosis and subsequent IMD management. The results reveal that the time frames from device implantation to the treatment of MH varied from 17 to 228 months. The longest phase on the patient journey maps was the symptom recognition phase, which refers to the time between symptom emergence and MH diagnosis. Participants also required extensive healthcare utilization following their initial surgery. These findings emphasize that MH should be considered in differential diagnoses for patients with IMD. Early screening and detection of MH can enhance patient safety, alleviate distress, and reduce unnecessary healthcare utilization.
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