2018 ESC Guidelines for the diagnosis and management of syncope

Brignole, Michele; Moya, Àngel; Lange, Frederik J. de; Deharo, Jean‐Claude; Elliott, Perry; Fanciulli, Alessandra; Fedorowski, Artur; Furlan, Raffaello; Kenny, Rose Anne; Martiın, Alfonso; Probst, Vincent; Reed, Matthew J; Rice, Ciara; Sutton, Richard; Ungar, Andrea; Dijk, J. Gert van

doi:10.5603/kp.2018.0161

Cited by 209 publications

(375 citation statements)

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“…In fact, lower bone mineral density, implicating higher susceptibility to fragility fractures, is associated with increased coronary calcification index and risk of coronary disease 27. Although the design of our study does not allow detailed analysis of all fracture scenarios, it is estimated that primary cardiac arrhythmias are responsible for about 10%–15% cases of unexplained syncope, and, probably, a similar proportion of unexplained falls 28. Thus, the assessed biomarkers may herald risk of circulatory collapse due to autonomic dysfunction and primary heart disease, especially in regard to increased MR-proANP 13.…”

Section: Discussionmentioning

confidence: 94%

Cardiovascular biomarkers predict fragility fractures in older adults

Johansson

Ricci

et al. 2018

Heart

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ObjectiveTo assess the role of four biomarkers of neuroendocrine activation and endothelial dysfunction in the longitudinal prediction of fragility fractures.MethodsWe analysed a population-based prospective cohort of 5415 community-dwelling individuals (mean age, 68.9±6.2 years) enrolled in the Malmö Preventive Project followed during 8.1±2.9 years, and investigated the longitudinal association between C-terminal pro-arginine vasopressin (CT-proAVP), C-terminal endothelin-1 precursor fragment (CT-proET-1), the mid-regional fragments of pro-adrenomedullin (MR-proADM) and pro-atrial natriuretic peptide (MR-proANP), and incident vertebral, pelvic and extremity fractures.ResultsOverall, 1030 (19.0%) individuals suffered vertebral, pelvic or extremity fracture. They were older (70.7±5.8 vs 68.4±6.3 years), more likely women (46.9% vs 26.3%), had lower body mass index and diastolic blood pressure, were more often on antihypertensive treatment (44.1% vs 38.4%) and had more frequently history of fracture (16.3% vs 8.1%). Higher levels of MR-proADM (adjusted HR (aHR) per 1 SD: 1.51, 95% CI 1.01 to 2.28, p<0.001) and MR-proANP (aHR: 1.23, 95% CI 1.05 to 1.45, p<0.001) were independently associated with increased risk of any fracture. The fracture risk increased linearly across MR-proANP quartiles. Individuals who were in the top quartile of all four biomarkers had a significant higher risk of fracture at any site (aHR: 2.32, 95% CI 1.86 to 2.91), vertebral fracture (aHR: 3.16, 95% CI 1.97 to 5.07) and femoral fracture (aHR: 2.35, 95% CI 1.64 to 3.36).ConclusionsElevated levels of MR-proADM and MR-proANP independently predict fragility fractures in older adults. In subjects with top quartile levels of all four biomarkers there is a twofold to threefold increase in risk of vertebral and femoral fractures.

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Section: Discussionmentioning

confidence: 94%

Cardiovascular biomarkers predict fragility fractures in older adults

Johansson

Ricci

et al. 2018

Heart

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“…The two most common causes for this are syncope and neurological seizure. Differentiation of the two is not always straightforward; the 2018 European Society of Cardiology (ESC) guidelines for the diagnosis and management of syncope highlight the difficulty of diagnosing TLOC as being of syncopal origin (ie, due to cerebral hypoperfusion) in the ED 2. SYNcope Expert Research Group International3 suggest a pragmatic definition of syncope: ‘a transient loss of consciousness, associated with inability to maintain postural tone and with immediate spontaneous and complete recovery’ 4.…”

Section: Is This Syncope?mentioning

confidence: 99%

Approach to syncope in the emergency department

Reed

2018

Emerg Med J

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Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge.

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“…Subsequent studies have carried out corresponding adjustments to BP limits [3,5]. The majority causes of OH are circulatory system disorders, such as insufficient blood volume, heart failure, and chronic kidney disease [3,6]. A minority of OH causes are due to neurological diseases such as multiple system atrophy, Lewy body disease, and primary autonomic nerve damage [7].…”

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confidence: 99%

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confidence: 99%

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Orthostatic Hypotension and Albuminocytologic Dissociation as Primary Manifestations of the Paraneoplastic Syndrome

Xing

et al. 2018

Eur Neurol

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Background: Orthostatic hypotension (OH) is the key manifestation of autonomic dysfunction with many causes. Systemic neurological causes such as paraneoplastic syndrome are usually ignored. Methods: We retrospectively analyzed clinical and examination data of 2 patients who were hospitalized, with onset symptom of OH and who were diagnosed as paraneoplastic syndrome. Results: The patients were characteristic of an initial symptom of OH, positive anti-Hu antibody and albuminocytologic dissociation in the cerebrospinal fluid. Patient 2 died and Patient 1 worsened during follow-up. Conclusions: The diagnosis of paraneoplastic syndrome is usually neglected when the onset symptoms are autonomic dysfunctions such as OH. Neurologists should improve their knowledge to diagnose accurately.

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2018 ESC Guidelines for the diagnosis and management of syncope

Abstract: ESC Guidelines for the diagnosis and management of syncopeThe Task Force for the diagnosis and management of syncope of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA)

Cited by 209 publications

References 341 publications

Cardiovascular biomarkers predict fragility fractures in older adults

Cardiovascular biomarkers predict fragility fractures in older adults

Approach to syncope in the emergency department

Orthostatic Hypotension and Albuminocytologic Dissociation as Primary Manifestations of the Paraneoplastic Syndrome

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