Syncope as a health risk for soldiers - influence of medical history and clinical findings on the sensitivity of head-up tilt table testing

Gilfrich, H. J.; Heidelmann, Lena Marie; Grube, Franziska; Frickmann, Hagen; Jungblut, Sven

doi:10.1186/s40779-015-0062-1

Cited by 3 publications

(4 citation statements)

References 36 publications

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“…Orthostatic responses were recently found by our study group to be influenced by age, gender, body weight status and the level of physical fitness . Regarding the impact of body weight status on OI, cross‐sectional studies investigating the relationship between orthostatic responses and body mass index (BMI) found conflicting results . Moreover, studies evaluating the effects of bariatric surgery have consistently reported increased OI and propensity to NCS after surgically induced weight loss, although these studies were only case reports or they had a small number of participants .…”

Section: Introductionmentioning

confidence: 83%

“…Regarding the first setting, an important consideration is the aggressiveness of the HUT protocol, as determined by the angle of tilt table, the duration of passive phase and whether or not pharmacological provocation was performed. Studies using too aggressive protocols failed to find a significant difference in BMI between individuals with positive and the ones with negative result during HUT, while studies using less aggressive protocols showed that BMI of the positive responders was lower compared with the one of the negative responders (Table 1) (3,4,7,18,19). A possible explanation for these findings is that the more aggressive the HUT protocol is, the higher the incidence of positive responses is in individuals with higher BMI values, diminishing any difference in the positive responses between individuals with different BMI values.…”

Section: Excess Body Weightmentioning

confidence: 99%

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The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope

Christou

Kiortsis

2017

Obesity Reviews

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Orthostatic intolerance (OI) is frequently the mechanism underlying the occurrence of noncardiac syncope (NCS) and is associated with substantial risk for injury. Body weight status appears to be a modifier of orthostatic responses and possibly influences the propensity to NCS. The majority of cross-sectional studies have found that the lower the body mass index (BMI) the greater the predisposition to OI is, accompanied with both down-regulation of sympathetic nervous system activity and up-regulation of parasympathetic nervous system activity. These changes appear to occur across the whole spectrum of BMI values from underweight to obesity, while they may be associated more strongly with central body fat than total body fat. Weight loss following bariatric surgery has been consistently found to increase OI, attributed first to the effects of weight loss per se, second to the specific type of surgical procedure and third to the potential postoperative autonomic neuropathy due to vitamin deficiency. The increased OI following bariatric surgery renders this intervention not easily tolerable for the affected individuals, mandating increased fluid and salt intake, pharmacological measures or surgical adjustments to attenuate OI. All future studies investigating orthostatic responses and NCS should implement a matching of the population arms for BMI and ideally for body fat.

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Section: Introductionmentioning

confidence: 83%

Section: Excess Body Weightmentioning

confidence: 99%

The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope

Christou

Kiortsis

2017

Obesity Reviews

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“…In a study of 178 subjects with recurrent syncope who underwent a head-up tilt test (HUTT), male gender (HR 0.61) and smoking (HR 0.18) were significantly protective for syncope following nitroglycerin provocation 14. Previous studies have shown that height is a predictive factor, in terms of a positive HUTT15 or time to syncope using supine lower body negative pressure (LBNP),16 although height does not appear to explain the gender difference in orthostatic tolerance 17. We found no significant difference in height (Table 3) in the syncope group, even when we specifically compared those with orthostatic-mediated reflex syncope (Table 1), and control group.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for reflex syncope in the British Army

Parsons

Ellwood²,

Stacey

et al. 2022

BMJ Mil Health

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IntroductionReflex syncope in the UK Armed Forces is reportedly higher than comparable militaries and civilian populations and is significantly more common in soldiers who take part in State Ceremonial and Public Duties (SCPD) compared with other British Army service personnel (SP). This study aimed to investigate individual susceptibility factors for syncope in soldiers who regularly take part in SCPD.MethodsA retrospective cohort study was performed in 200 soldiers who perform SCPD. A questionnaire was undertaken reviewing soldiers’ medical history and circumstances of any fainting episodes. A consented review of participants’ electronic primary healthcare medical record was also performed. Participants were divided into two groups (syncope, n=80; control, n=120) based on whether they had previously fainted.ResultsIn the syncope group orthostasis (61%) and heat (35%) were the most common precipitating factors. The most common interventions used by soldiers were to maintain hydration (59%) and purposeful movements (predominantly ‘toe wiggling’; 55%). 30% of participants who had previously fainted did not seek definitive medical attention. A history of migraines/headaches was found to increase the risk of reflex syncope (OR 8.880, 1.214–218.8), while a history of antihistamine prescription (OR 0.07144, 0.003671–0.4236), non-white ethnicity (OR 0.03401, 0.0007419–0.3972) and male sex (OR 0.2640, 0.08891–0.6915) were protective.ConclusionThis is the first study, in the British Army, to describe, categorise and establish potential risk factors for reflex syncope. Orthostatic-mediated reflex syncope is the most common cause in soldiers who regularly perform SCPD and this is further exacerbated by heat exposure. Soldiers do not use evidence-based methods to avoid reflex syncope. These data could be used to target interventions for SP who have previously fainted or to prevent fainting during SCPD.

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“…In Gilfrich et al [10] a study assessed the Syncope as a health risk for soldiers-influence of medical history and clinical findings on the sensitivity of head-up tilt table testing on 100 consecutive patients aiming to identify major and minor criteria that might suggest diagnostic benefit from head-up tilt testing included 55% female and45% male patients with mean age of population study 53 years.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Age Distribution of Syncope in Delta Area Patients

Saleh

Bayomy

Elhefnawy

et al. 2022

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Background: Syncope is a Total Loss of Consciousness (TLOC) due to cerebral hypo-perfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery. It shares many clinical features with other disorders; it therefore presents in many differential diagnoses. This group of disorders is labelled TLOC. The aim of the present study was to determine the etiologies and the age distribution of patients with syncope in Delta area. Methods: This study included thirty patients who had at least one episode of syncope. All patients in this study were subjected to history taking, clinical examination, laboratory investigations, standard 12-lead Electrocardiogram (ECG), Resting Transthoracic Echocardiography (TTE). Some patients were subjected to Prolonged ECG monitoring (Holter, Event, ILR), Brain computed tomography (CT) and Magnetic resonance imaging (MRI), Tilt table test and Electrophysiology study (EP study). Results: Most common ECG rhythm was normal sinus rhythm, complete heart block, left ventricular hypertrophy, Slow Atrial fibrillation (AF), Left bundle branch block (LBBB), ventricular tachycardia. The most common diagnosis of syncope was vasovagal syncope, idiopathic syncope then cardiac syncope. Incidence of idiopathic syncope in populations under 40 years was significantly higher than in populations over 40 years, meanwhile regarding cardiac-related etiology for syncope in patients under age 40 was significantly lower than those patients over age 40. Conclusion: For age distribution, the incidence of idiopathic syncope in populations under 40 years was significantly higher than in populations over 40 years, meanwhile cardiac-related etiology for syncope in patients under age 40 was significantly lower than those patients over age 40.

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Syncope as a health risk for soldiers - influence of medical history and clinical findings on the sensitivity of head-up tilt table testing

Cited by 3 publications

References 36 publications

The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope

The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope

Risk factors for reflex syncope in the British Army

Etiology and Age Distribution of Syncope in Delta Area Patients

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