Deglutition syncope is a relatively rare cause of syncope that belongs to the category of neurally mediated reflex syncopal syndromes. The phenomenon is related to vagal reflex in context to deglutition causing atrioventricular block and acute reduction in cardiac output leading to dizziness or syncope. We present case series of two cases of deglutition syncope, of which first was managed medically and second with pacemaker implantation.
Heart failure with reduced ejection fraction (HFrEF) is defined as the presence of typical
symptoms of heart failure (HF) and a left ventricular ejection fraction ≤ 40%. HFrEF patients constitute
approximately 50% of all patients with clinical HF. Despite breakthrough discoveries and
advances in the pharmacologic management of HF, HFrEF patients continue to pose a significant
economic burden due to a progressive disease characterized by recurrent hospitalizations and need
for advanced therapy. Although there are effective, guideline-directed medical therapies for patients
with HFrEF, a significant proportion of these patients are either not on appropriate medications’
combination or on optimal tolerable medications’ doses. Since the morbidity and mortality benefits
of some of the pharmacologic therapies are dose-dependent, optimal medical therapy is required to
impact the burden of disease, quality of life, prognosis, and to curb health care expenditure. In this
review, we summarize landmark trials that have impacted the management of HF and we review
contemporary pharmacologic management of patients with HFrEF. We also provide insight on general
considerations in the management of HFrEF in specific populations. We searched PubMed,
Scopus, Medline and Cochrane library for relevant articles published until April 2019 using the following
key words “heart failure”, “management”, “treatment”, “device therapy”, “reduced ejection
fraction”, “guidelines”, “guideline directed medical therapy”, “trials” either by itself or in combination.
We also utilized the cardiology trials portal to identify trials related to heart failure. We reviewed
guidelines, full articles, review articles and clinical trials and focused on the pharmacologic
management of HFrEF.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations –citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.