Evaluation of the Tp-e interval and Tp-e/QTc ratio in patients with benign paroxysmal positional vertigo in the emergency department compared with the normal population

Yıldırım, Özge Turgay; Kaya, Şeyhmus; Kaya, Filiz Baloğlu

doi:10.1016/j.jelectrocard.2019.11.002

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…[32][33][34] Interestingly for our study, there has been an observation of changes in the Tp-e/QT ratio, and increased risk of ventricular arrhythmias, in patients with BPPV. 22 More broadly, similar ECG changes have been observed during and between migraine attacks, which was hypothesised as secondary to dysregulation of the autonomic nervous system. 25,26 QTc prolongation and other ECG changes have also been reported in migraine.…”

Section: Discussionmentioning

confidence: 85%

“…The literature review yielded no published articles linking VN to acute AF. Of the 14 articles included, the closest to our research question described electrocardiogram (ECG) changes predisposing to ventricular arrhythmia following benign paroxysmal positional vertigo (BPPV) 22 . Four articles described similar ECG changes secondary to migraine 23–26 .…”

Section: Resultsmentioning

confidence: 99%

“…Of the 14 articles included, the closest to our research question described electrocardiogram (ECG) changes predisposing to ventricular arrhythmia following benign paroxysmal positional vertigo (BPPV). 22 Four articles described similar ECG changes secondary to migraine. [23][24][25][26] Five articles described migraine as a cause of cardiovascular disease, including Takotsubo cardiomyopathy and, in one article, AF.…”

Section: Literature Reviewmentioning

confidence: 99%

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Acute vestibular neuritis may provoke atrial fibrillation

Mirabelli

Dick

Infeld

et al. 2022

Internal Medicine Journal

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BackgroundExclusion of stroke is the focus of guidelines in the emergency department assessment of acute vertigo, especially with new‐onset atrial fibrillation (AF). Early diagnosis of vestibular neuritis (VN) is also important but may be deferred awaiting brain magnetic resonance imaging (MRI) for exclusion of stroke. This may delay potentially beneficial corticosteroid therapy.AimsTo highlight that VN can provoke acute AF.MethodsIn the course of a prospective study of acute vertigo in patients assessable within 24 h of admission, we encountered three patients with acute onset transient AF associated with VN. We performed a detailed neurological examination and quantitated the vestibulo‐ocular reflex (VOR) gain with video‐oculography. Brain MRI was performed in all patients.ResultsThere were two men and one woman, aged 58–66 (mean 61) years. All patients had typical non‐direction‐changing rotatory nystagmus and positive head impulse tests. The horizontal VOR gains ranged 0.38–0.62 (mean 0.47). Diffusion‐weighted MRI within 36 h was normal in all. AF reverted in all three within 24 h.ConclusionsAcute AF can be precipitated by vertigo such as in VN. In VN, the concurrence of acute AF may distract from the correct neurological diagnosis, delaying potentially beneficial corticosteroid therapy, especially if exclusion of stroke is dependent on MRI, which may be delayed.

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Section: Discussionmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Acute vestibular neuritis may provoke atrial fibrillation

Mirabelli

Dick

Infeld

et al. 2022

Internal Medicine Journal

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“…Dizziness is a common complaint for Emergency Department (ED) presentations representing 3 to 4% of ED volumes [ 1 , 2 ]. Dizziness could indicate a wide range of disorders from benign, yet disruptive ear problems such as vertigo, to serious neurological problems such as stroke.…”

Section: Introductionmentioning

confidence: 99%

“…Dizziness could indicate a wide range of disorders from benign, yet disruptive ear problems such as vertigo, to serious neurological problems such as stroke. Vertigo is characterized by frequent, irritating and curable symptoms that could have central or peripheral causes with peripheral ones accounting for around 60% of all vertigo cases [ 2 , 3 ]. While vestibular migraine is the most common cause of episodic vertigo [ 4 ], benign paroxysmal positional vertigo (BPPV) is the primary cause of peripheral vertigo with a lifetime prevalence of 36%, lifetime incidence of 2.4% and an annual incidence of 0.6% [ 1 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors for hospital admission in emergency department patients with benign paroxysmal positional vertigo: A retrospective review

et al. 2023

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Objective This study aims to assess the incidence of Emergency Department (ED) visits for benign paroxysmal positional vertigo (BPPV), describe patient characteristics, management practices and predictors of inpatient admission of BPPV patients. Methods This was a retrospective chart review of patients presenting with BPPV to a single ED between November 2018 and August 2020. Patients’ characteristics, ED management, discharge medications, disposition and unscheduled return visits were determined. Results In total, 557 patients were included. Average age was 49 years, 54.2% were females and 12.4% required hospital admission. In the ED, 51.1% received intravenous hydration, 33.8% received anti-emetics, 10.1% received benzodiazepines, 31.8% underwent canalith repositioning maneuvers (CRMs) and 56.7% were discharged on acetyl-leucine. Of discharged patients, 2.5% had unscheduled return visits. A higher likelihood of admission was associated with age above 54 years (aOR = 4.86, p<0.001, 95% CI [2.67, 8.86]), home use of proton pump inhibitors (PPIs) (aOR = 2.44, p = 0.03, 95% CI [1.08, 5.53]), use of anti-emetics and benzodiazepines in the ED (aOR = 2.34, p = 0.003, 95% CI [1.34, 4.07]) and (aOR = 2.18, p = 0.04, 95% CI [1.03, 4.64]), respectively. Conclusion While BPPV is a benign diagnosis, a significant number of patients presenting to the ED require admission. Predictors of admission include older age, PPIs use and ED treatment with anti-emetics and benzodiazepines. Although CRMs are the gold standard for management, CRMs usage did not emerge as protective from admission, and our overall usage was low.

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Association between Benign Paroxysmal Positional Vertigo and Thyroid Diseases: Systematic Review and Meta-Analysis

Lima,

Paiva,

Corona

et al. 2023

Int Arch Otorhinolaryngol

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Introduction Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular dysfunction that most affects people worldwide, but its etiopathogenesis is still not fully understood. Considering the etiological diversity, some studies highlight the association between BPPV and thyroid diseases. Objective To investigate the association between thyroid diseases and BPPV. Data Synthesis Systematic review and meta-analysis of epidemiological studies searched in the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases. Studies that were fully available and investigated the association between BPPV and thyroid diseases were selected. The articles that composed the meta-analysis were analyzed using the dichotomous model, the Mantel-Haenszel statistical test, odds ratio (OR), and a 95% confidence interval (CI). Of the 67 articles retrieved from the databases, 7 met the eligibility criteria of the systematic review, and 4 had data necessary to perform the meta-analysis. Qualitative analysis revealed that the studies were conducted in the European and Asian continents. The predominant methodological design was the case-control type, and thyroid dysfunctions, hypothyroidism, and Hashimoto thyroiditis occurred more frequently. The meta-analysis showed no association between hypothyroidism and BPPV; however, there was a statistically significant relationship between Hashimoto thyroiditis and BPPV. Conclusion The meta-analysis results suggest a possible association between BPPV and Hashimoto thyroiditis. Nevertheless, we emphasize the need for further studies to elucidate the evidence obtained.

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Evaluation of the Tp-e interval and Tp-e/QTc ratio in patients with benign paroxysmal positional vertigo in the emergency department compared with the normal population

Cited by 8 publications

References 24 publications

Acute vestibular neuritis may provoke atrial fibrillation

Acute vestibular neuritis may provoke atrial fibrillation

Predictors for hospital admission in emergency department patients with benign paroxysmal positional vertigo: A retrospective review

Association between Benign Paroxysmal Positional Vertigo and Thyroid Diseases: Systematic Review and Meta-Analysis

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