Accidental Falls – ABC CARDIOL

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Case Report

Acute Myocardial Infarction Following Blunt Chest Trauma

Rafael Castro da Silva et al. Ilan Gottlieb Gabriella Andrade de Sá Alex dos Santos Felix … Daniella Bastos Rawet Mariah Rodrigues Paulino Emanuelle Ferreira Adriano Milton Ricardo Poffo André Luiz da Fonseca Feijó

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Original Article

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method

Tan Chen Wu et al. Denise T. Hachul Francisco Carlos da Costa Darrieux Maurício I. Scanavacca

Abstract

Background:

Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of ≤ 85 mmHg to refine the vasodepressor (VD) response diagnosis.

Objective:

To determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria.

Methods:

CSM was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole ≥ 3 seconds, or as VD for SBP decrease ≥ 50 mmHg.

Results:

No differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value 2.5 seconds, regardless of the pattern of response or the presence of previous syncope.

Conclusion:

The response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.

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Original Article

Heart Rate and its Variability Assessed by Spectral Analysis in Elderly Subjects with Orthostatic Hypotension: A Case-Control Study

Rose Mary Ferreira Lisboa da Silva et al. Carlos Eduardo de Souza Miranda Maira Tonidandel Barbosa Maria Aparecida Camargos Bicalho

Abstract

Background:

The prevalence of orthostatic hypotension (OH) increases with age and is associated with changes in autonomic regulation of blood pressure (BP) and heart rate (HR).

Objective:

to assess HR and HR variability (HRV) in elderly subjects with OH and determine OH predictors.

Methods:

a total of 105 patients aged ≥ 60 years, 39 with OH (case group) and 66 without OH (control group) (age-matched) were studied. Patients underwent clinical assessment, electrocardiogram, biochemistry tests and Holter monitoring for spectral analysis of HRV (Fourier transform) in the supine and orthostatism positions to identify low frequency (LF) and high frequency (HF) components, as well as the LF/HF ratio.

Results:

median age was 73.0 years, 64 patients were women. In all participants, there was a reduction in HF (133.0 versus 76.0 ms², p = 0.001) and increase in LF/HF (1.6 vs 2.1; p < 0.001) and no change in LF (233.0 versus 218.0 ms², p = 0.080). Between-group comparisons revealed significant differences in the median values of HR in the supine position (62.0 vs. 69.0 bpm, p = 0.001) and LF in the supine position (157.0 in case group vs. 275.0 ms² in the control group, p = 0.014). Spearman’s correlation coefficient of 0.27 was found between the groups. Multivariate analysis revealed that HR in the supine position was an independent variable for OH (p = 0.001- 95%CI = -0.022 and -0.006). Using the operating characteristic curve, the best cutoff point was 61 bpm, with a sensitivity of 77.3% and specificity of 51.3%, positive predictive value of 61.3%, and negative predictive value 69.3%. Odds ratio was 3.23 for OH in patients with a HR lower than 61 bpm.

Conclusions:

lower LF and HR in the supine position were found in patients with OH, regardless of age and gender. The independent predictor for OH was HR in the supine position, with an odds ratio of 3.23 for values lower than 61 bpm.

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Acute Myocardial Infarction Following Blunt Chest Trauma

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Heart Rate and its Variability Assessed by Spectral Analysis in Elderly Subjects with Orthostatic Hypotension: A Case-Control Study

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

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