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AIMS: Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. METHODS AND RESULTS: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. CONCLUSION: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

• The prevalence of VD response to HUTT was 7 % with an increased prevalence during NTG phases. • Distribution of VD syncope was age-related, characterized by a peak after 69 years, mainly driven by male patients. • Advanced age was the only independent predictor of VD syncope. • Smoking and non-classical presentation of syncope reduced the probability of VD response to HUTT. The aim of our study was to evaluate the prevalence and clinical predictors of vasodepressor (VD) response during head-up tilt test (HUTT) in patients with history of syncope admitted to a tertiary referral syncope unit. We retrospectively evaluated all consecutive patients who underwent HUTT for suspected or established reflex syncope at our institution from March 1st, 2017, to June 1st, 2023. VD response was defined when syncope occurred during hypotension along with no or slight (< 10% bpm) decrease of heart rate. Univariate and multivariate analyses were performed to test the association of VD response to HUTT with a set of clinical covariates. 1780 patients (40 ± 19.9 years; 49.3% male) were included; among them, 1132 (63 %) showed a positive response to HUTT and 124 (7.0%) had a VD response. The prevalence of VD response showed a peak after 69 years (11.52% vs 6.18%; P = 0.0016), mainly driven by male patients (13.7% vs 4.9%; P < 0.0001). At multivariate analysis, age (OR: 1.15; P = 0.0026) was independently associated to HUTT-induced VD syncope; in contrast, smoking (OR: 0.33: P = 0.0009) and non-classical presentation of syncope (OR: 0.55; P = 0.0029) inversely correlated with VD syncope. VD response represents the less frequent responses among those induced by HUTT, accounting up to 7% of overall responses. A gender and age-related distribution has been shown. Advanced age was the only independent predictor of VD syncope; conversely, smoking and non-classical presentation of syncope reduced the probability of VD response to HUTT. [Display omitted] [ABSTRACT FROM AUTHOR]

Buddhist meditation practices, including Samadhi meditation, which forms the basis for mindfulness practice, are broadly promoted as pathways to wellbeing, but evidence of their adverse effects is emerging. In a single-group observational study with assessments of autonomic system before, during, and after Samadhi meditation, we explore the relationship between post-meditation nausea symptoms and the degree of change in autonomic system activity during meditation as compared to before and after in 57 university students (42 women; mean age = 22.6) without any previous experience in meditation or yoga practices. We hypothesize that nauseous feelings in meditation are connected to a rapid increase of activity in the sympathetic nervous system, as indicated by decreased heart-rate variability (HRV). We additionally explore links between meditation-induced nausea and two markers of parasympathetic activity: increased HRV and vasovagal syncope. Engaging in meditation and increased nausea during meditation were both associated with increased markers of HRV parasympathetic activity, but 12 individuals with markedly higher nausea demonstrated increased HRV markers of sympathetic activity during meditation. Vasovagal syncope was observed but found to be unrelated to nausea levels. Drivers of adverse effects of meditation in some individuals require further investigation. [ABSTRACT FROM AUTHOR]

Objectives: Tumors involving the vagus nerve are often clinically silent. We offer a case series with different clinical presentations and distinctive post-surgical sequelae that highlight some of the challenges associated with managing cervical vagal nerve tumors. Methods: Single-institution, retrospective review of patients with tumors involving the vagus nerve. We describe clinical presentations and postoperative sequelae of five patients who underwent surgical management of vagal nerve pathology with atypical presentation or subsequent clinical course. Results: Here, we present five patients treated at our institution for vagal tumors. In four of the five patients, the presenting symptoms resolved after surgery. Two patients presented with intractable neurogenic cough, and another two presented with autonomic symptoms, one with syncope/palpitations and the other with intractable sweating. The final patient presented with a rapidly enlarging vagal paraganglioma and developed intractable cough after resection. We present two patients with novel approach to vagal paragangliomas that underwent ligation of feeding blood supply without removing the tumor, resulting in resolution of an intractable cough in one patient and resolution of severe nighttime sweating in the other. Conclusion: Management of tumors associated with the cervical vagus nerve that present with symptoms or rapid growth poses a clinical dilemma. Consideration of the tumor origin with either enucleation of schwannomas or ligation of feeding vessels may preserve function while addressing the presenting symptoms. [ABSTRACT FROM AUTHOR]

The document explores the physiological challenges associated with artistic swimming, an Olympic sport that combines swimming, dance, weightlifting, cheerleading, and gymnastics. Athletes in artistic swimming perform routines involving vigorous exercise with prolonged breath-holds, leading to complex physiological responses and potential episodes of syncope (loss of consciousness). The text highlights the need for further research into the unique physiological demands of artistic swimming and the safety risks associated with prolonged breath-holding and autonomic conflict. [Extracted from the article]

Purpose: We previously reported that single doses of the norepinephrine transporter inhibitor, atomoxetine, increased standing blood pressure (BP) and ameliorated symptoms in patients with neurogenic orthostatic hypotension (nOH). We aimed to evaluate the effect of atomoxetine over four weeks in patients with nOH. Methods: A randomized, double-blind, placebo-controlled crossover clinical trial between July 2016 and May 2021 was carried out with an initial open-label, single-dose phase (10 or 18 mg atomoxetine), followed by a 1-week wash-out, and a subsequent double-blind 4-week treatment sequence (period 1: atomoxetine followed by placebo) or vice versa (period 2). The trial included a 2-week wash-out period. The primary endpoint was symptoms of nOH as measured by the orthostatic hypotension questionnaire (OHQ) assessed at 2 weeks. Results: A total of 68 patients were screened, 40 were randomized, and 37 completed the study. We found no differences in the OHQ composite score between atomoxetine and placebo at 2 weeks (−0.3 ± 1.7 versus −0.4 ± 1.5; P = 0.806) and 4 weeks (−0.6 ± 2.4 versus −0.5 ± 1.6; P = 0.251). There were no differences either in the OHSA scores at 2 weeks (3 ± 1.9 versus 4 ± 2.1; P = 0.062) and at 4 weeks (3 ± 2.2 versus 3 ± 2.0; P = 1.000) or in the OH daily activity scores (OHDAS) at 2 weeks (4 ± 3.0 versus 5 ± 3.1, P = 0.102) and 4 weeks (4 ± 3.0 versus 4 ± 2.7, P = 0.095). Atomoxetine was well-tolerated. Conclusions: While previous evidence suggested that acute doses of atomoxetine might be efficacious in treating nOH; results of this clinical trial indicated that it was not superior to placebo to ameliorate symptoms of nOH. Trial registration: ClinicalTrials.gov; NCT02316821. [ABSTRACT FROM AUTHOR]

Risk stratification in Brugada syndrome (BrS) is based on the occurrence of dynamic factors, such as unexplained syncope and documentation of spontaneous type 1 pattern. At odds with other channelopathies, the role of nonmodifiable risk factors such as sex or genetics remains uncertain. This study aims to identify nonmodifiable risk factors for the occurrence of life-threatening arrhythmic events (LAEs) and define their clinical utility. Clinical and genetic data from consecutive, unrelated Italian patients with Brugada syndrome screened on the sodium voltage-gated channel alpha subunit 5 (SCN5A) gene and 3 pivotal single-nucleotide variations (formerly single-nucleotide polymorphisms) associated with BrS (rs11708996, rs10428132, and rs9388451) were analyzed using multivariable Cox proportional hazards model. In 2,182 unrelated patients with BrS (81% males; median age at diagnosis: 41.6 years [Q1-Q3: 33.4-50.3 years]), male sex (HR: 3.6; 95% CI: 1.9-6.9; P = 0.0001), missense SCN5A mutations in BrS-enriched domains (HR: 2.3; 95% CI: 1.2-4.3; P = 0.008), nonmissense SCN5A mutations (HR: 3.2; 95% CI: 1.8-5.7; P < 0.001), and polygenic risk score for BrS (HR: 1.3; 95% CI: 1.0-1.6; P = 0.041) were all independently associated with a significantly higher risk of a first LAE since birth. Based on these results, we derived the nonmodifiable risk of each patient with BrS, and the division of nonmodifiable risk into tertiles identified 3 distinct risk profiles. In an analysis at follow-up, nonmodifiable risk was independently associated with LAE at follow-up (HR: 1.8; 95% CI: 1.1-2.7; P = 0.014), alongside classical predictors including: history of LAE before diagnosis (HR: 13.8; 95% CI: 8.1-23.7; P < 0.0001), history of unexplained syncope before diagnosis (HR: 4.1; 95% CI: 2.4-6.8; P < 0.0001), and spontaneous type 1 pattern at diagnosis (HR: 2.1; 95% CI: 1.2-3.8; P = 0.010). The model was internally validated, and we derived the equation permitting to calculate the granular 5-year risk of experiencing an LAE at follow-up for each patient with BrS, which may be used to facilitate clinical decision-making. Our data show that male sex, type of SCN5A mutation, and polygenic risk score for BrS define the nonmodifiable risk of each patient with BrS. Nonmodifiable risk is independently associated with LAE, regardless of symptoms or pattern type. [ABSTRACT FROM AUTHOR]

Background: A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation. Case: A 30-year-old male presented with sudden onset syncope and the passage of 200–300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy's lesion. Conclusions: Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient's postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study aimed to analyze the symptom profile of Meniere's disease (MD) patients, particularly focusing on the cessation of episodic vertigo and the disease's longitudinal course and the impact of major symptoms on quality of life (QoL). Methods: The study employed a cross-sectional design and was conducted on 365 out of 560 individuals with definite MD from the Finnish Vestibular and Meniere Federation, utilizing an internet-based questionnaire. Participants were surveyed on vertigo attacks, vestibular drop attacks (VDA), balance issues, selective cognitive complaints, hearing loss, and their effects on overall quality of life (QoL). The study population comprised 79.5% females and 20.5% males, with a mean age of 63 years and an average disease duration of 15.2 years. Results: The onset of MD was characterized by simultaneous hearing loss, vertigo, and tinnitus in 38% of participants. There was a significant delay in diagnosis for many, with 20% experiencing a delay of over 5 years. The frequency and duration of vertigo attacks generally decreased over time, with attacks becoming shorter and less severe as the disease progressed. Spontaneous remission from episodic vertigo occurred in 34% of participants variably throughout the course of MD. Of the participants 65.5% reported balance issues, and 34% experienced mild VDAs, with severe falls occurring in 10%. VDAs were more common with longer disease duration. Bilateral hearing loss developed in 34.5% of participants over the long term, with a higher risk associated with younger onset age, migraines, and family history of MD. Fatigue, anxiety, and depression were prevalent, particularly among younger participants. Cognitive impairments were linked to the severity of these symptoms and the presence of constant dizziness. QoL was significantly lower among participants with constant dizziness, with factors like fatigue, depression, VDA, and hearing loss contributing to this reduction. Conclusions: The study highlights the complexity of MD. While vertigo may spontaneously remit, other symptoms such as VDAs, balance issues, cognitive complaints, and hearing loss often persist and worsen over time. Assessing MD solely on primary symptoms like vertigo and hearing loss is insufficient; a comprehensive evaluation is necessary for effective management. [ABSTRACT FROM AUTHOR]

Background: Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs. Methods: This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program "Arzneimittelsicherheit in der Psychiatrie" (AMSP) from 1993–2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns. Results: The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92–1.05). However, older patients had a higher risk for delirium (2.35, 1.85–2.99), hyponatremia (3.74, 2.85–4.90), and orthostatic syncope (2.37, 1.72–3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45–2.48) and Pisa-/metronome syndrome (3.61, 2.51–5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10–0.37), akathisia (0.47, 0.29–0.76), liver dysfunction (0.63, 0.48–0.82), weight gain (0.07, 0.04–0.14), sexual dysfunction (0.03, CI 0.00–0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02–0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26–1.40)—especially selective serotonin reuptake inhibitors (1.57, 1.26–1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80–2.29)—and lithium (1.74, 1.52–2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71–0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07–1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22–1.34). ADRs in older patients were 6.4 times more likely to result in death. Conclusions: Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered "safe". [ABSTRACT FROM AUTHOR]

Tpeak-Tend interval (Tp-Te) is an indicator of transmural dispersion of repolarization, which is often related to ventricular arrhythmias. The relationship between Tp-Te and vasovagal syncope (VVS) has been reported in previous studies, but very little is known about Tp-Te in differentiation between psychogenic pseudosyncope (PPS) and VVS in children. We aim to discuss the predictive value of Tp-Te of supine and orthostatic electrocardiogram (ECG) in the diagnosis between PPS and VVS in children. The 31 children with PPS and 40 children with VVS from July 2014 to November 2023 were enrolled as the study group. Meanwhile, 30 healthy children who underwent a physical examination in the same hospital were selected as the control group. Tp-Te and QT interval in 12-lead supine and orthostatic ECG were measured. (1) Supine ECG: ① The Tp-Te/QT in PPS group was significantly lower than that in control group in II lead (P < 0.05). The Tp-Te/QTc in PPS group was significantly lower than that in control group in II and aVR lead (P < 0.05). There was no significant difference in Tp-Te between PPS group and control group (P > 0.05). ② The Tp-Te in VVS group was significantly higher than that in control group in aVR, aVF, and V4 lead (P < 0.05). The Tp-Te/QT in VVS group was significantly higher than that in control group in aVF lead (P < 0.05). The Tp-Te/QTc in VVS group was significantly higher than that in control group in aVL, aVF and V1 lead (P < 0.05). ③ The Tp-Te, Tp-Te/QT in PPS group were significantly lower than those in VVS group in some leads (P < 0.05). The Tp-Te/QTc in PPS group was significantly lower than that in VVS group in some leads. (2) Orthostatic ECG: ① The Tp-Te in PPS group was significantly higher than that in control group in V1, V2 lead (P < 0.05). The Tp-Te/QT, Tp-Te/QTc in PPS group were significantly higher than those in control group in V2 lead (P < 0.05). ② The Tp-Te and Tp-Te/QTc in V4 lead, Tp-Te/QT in V1, V4 lead in VVS group were significantly higher than those in control group (P < 0.05). ③ The Tp-Te in PPS group was significantly lower than that in VVS group in some leads (P < 0.05). The Tp-Te/QT in PPS group was significantly lower than that in VVS group in some leads (P < 0.05). The Tp-Te/QTc in PPS group was significantly lower than that in VVS group in some leads. (3) The receiver-operating characteristic (ROC) curve analysis: Tp-Te of supine ECG and orthostatic ECG in some leads had a predictive value on diagnosis between PPS and VVS (P < 0.05). Tp-Te, Tp-Te/QT, and Tp-Te/QTc of supine and orthostatic ECG in some leads have a certain predictive value in the diagnosis between PPS and VVS in children. [ABSTRACT FROM AUTHOR]

Permanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4–8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications. We present a case where the right ventricular lead was placed in the coronary sinus, which resulted in the loss of pacing capture with further syncope after the pacemaker implant. This was apparent in the post-procedure electrocardiogram (ECG) with right bundle branch pacing and the lead was repositioned in the right ventricular apex the following day. Furthermore, the patient was discharged home without a chest X-ray (CXR), and she represented a week later with a haemo-pneumothorax and pericardial effusion. A chest drain was placed and was discharged after a slow recovery following several complications that could have been avoidable. [ABSTRACT FROM AUTHOR]

Reflex syncope (RS) is the most prevalent form of syncope, yet its pathophysiology and clinical presentation are not well understood. Despite controversy, the 'ventricular theory' remains the most plausible hypothesis to explain RS in susceptible patients. Certain assumptions regarding the geometry and function of the heart are essential in supporting this theory. Given these considerations, the goal of this review was to try to integrate data on heart morphology and function in a phenotype of a patient susceptible to RS. Previous research suggests that a small left ventricle and atria, in addition to a normo- or hypercontractile myocardium, predispose to more syncopal events. These findings have been confirmed in different subsets of patients, including those with small heart and chronic fatigue syndrome, highlighting common pathophysiologic pathways in these subgroups of population. Heart geometry and function seem to play a role in different treatment strategies for RS patients, including the administration of medications, pacing, and possibly cardioneural ablation. In addition, parameters related to the geometry of the heart chambers and of the electrical activation of the heart seem to have predictive value for syncope recurrence. These parameters could be included in the future and improve the accuracy of predictive models for RS. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology Background: Diffuse large B-cell lymphoma is the most prevalent form of non-Hodgkin lymphoma, representing around a quarter of newly diagnosed cases of B-cell non-Hodgkin lymphoma. Diffuse large B-cell lymphoma is a disease that affects mostly older persons, with a median presentation in the 7th decade of life. Clinically, it has a variety of presentations, ranging from constitutional symptoms to local or systemic pressure effects caused by a rapidly growing mass. Only rarely do head and neck lymphomas present as syncopal events. Although diffuse large B-cell lymphoma frequently involves the cervical region, syncope from the condition without cardiac involvement has only been documented in a few cases to date. Case Report: A 66-year-old man experienced a sudden onset of recurrent syncopal episodes triggered by neck movement that had been ongoing for 2 weeks before his presentation. A rapidly enlarging left neck mass was first noticed 6 weeks earlier and he was treated with antibiotics. During a workup of the syncope, a diffuse large B-cell lymphoma was discovered to be encasing his left internal carotid artery without obstructing blood flow. Chemotherapy was initiated and resulted in complete neck mass and related syncope resolution. Follow-up positron emission tomography scan after 3 months of chemotherapy revealed an excellent response. Conclusions: Sudden onset of syncopal episodes may be the first or only indication of a neck or head malignancy. As a result, we should be aware of the possibility of an underlying malignancy in individuals with unexplained syncope. [ABSTRACT FROM AUTHOR]

Background Study Design and Methods Results Discussion Donation‐related fears are prevalent even among regular donors and can hinder both recruitment and retention. This cross‐sectional study aimed to estimate the prevalence of these fears in Italian whole‐blood and plasma donors, across different levels of donation experience.A sample of 615 voluntary, unpaid donors from Italy (64.1% male, mean age 45.42 ± 11.80 years) completed an online survey assessing their fear of common donation‐related stimuli (fear of blood, needles, pain, and fainting), experience of vasovagal symptoms at the last donation, and their intention to donate again. Donors were grouped based on donation history and their most recent donation type (whole‐blood or plasma).A significant negative relationship was found between donation history and most types of donation‐related fears, suggesting that greater experience corresponds to reduced fear. Plasma donors reported lower levels of fear across all stimuli compared to whole‐blood donors. Despite this, nearly one‐third of the most experienced whole‐blood donors and 20% of plasma donors still reported some level of fear. Greater fear was associated with increased reports of pain and vasovagal symptoms during donation, regardless of donation type. However, no significant association emerged between donation‐related fears and the intention to donate again.Donation‐related fear persists even among experienced donors, for both whole‐blood and plasma donors. Given its potential to impact donor comfort and retention, the assessment and management of donation‐related fears should be integrated into donor care, with appropriate strategies to help donors regulate their fear throughout their donation careers. [ABSTRACT FROM AUTHOR]

Surgical decompression is the recommended treatment for patients with nonfunctioning pituitary macroadenomas (NFPMAs) with associated visual impairment. Other relative indications for surgery include endocrinopathies, craniopathies, and headaches. Nevertheless, patients without these classical indications who would otherwise be considered asymptomatic with regard to the NFPMA and treated conservatively with clinical radiological surveillance may experience higher rates of other morbidities related to the NFPMA. We aimed to evaluate the prevalence of newly diagnosed comorbidities in conservatively treated patients with NFPMAs. We reviewed the medical records of 55 patients with NFPMAs from 2012 to 2022 who lacked classical indications for surgery at diagnosis. During the follow-up period, we searched for any of the following potentially associated newly reported symptoms and signs: headache, dizziness, syncope, gastrointestinal symptoms, hyponatremia, falls, weakness and general deterioration, cerebrovascular accident–related symptoms, and endocrine-related symptoms including type 2 diabetes mellitus. Patients were compared with a matched control group. Cohort patients were further analyzed to detect specific endocrine axis deficiencies, and tumor volumes were measured using magnetic resonance imaging at diagnosis. The final cohort included 55 patients. NFPMAs were associated with the development of newly diagnosed headaches, hypertension, and hypopituitarism. Other symptoms associated with NFPMAs included dizziness, syncope/presyncope, gastrointestinal-related symptoms, hyponatremia, general weakness and falls, and infection-related symptoms. Average associated emergency department visits in this group were higher compared with the control group. These results may suggest the advantages of early surgical intervention for NFPMAs to mitigate comorbidities and improve health-related quality of life. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Be aware of potential severe interactions between aged honey containing grayanotoxins and alcohol. Such combinations can exacerbate symptoms like syncope and hypotension, especially in elderly patients with pre‐existing conditions, necessitating careful evaluation and management. [ABSTRACT FROM AUTHOR]

Background: The relationship between collapse and a diagnosis of hypoadrenocorticism is not well understood in dogs. Hypothesis: To assess the prevalence of episodes of collapse in dogs screened for hypoadrenocorticism, and to assess the prevalence of confirmed hypoadrenocorticism in dogs presenting with reported collapse. Animals: Seventy‐three client‐owned dogs with resting cortisol concentrations were measured and presented to a University teaching hospital for collapse. Methods: Retrospective review of medical records of dogs at a single center. Results: The prevalence of episodes of collapse in dogs that had a resting cortisol measurement was 73/856 (8.5%; 95% confidence interval [95% CI], 6.7%‐10.6%). Resting cortisol concentration was <2 μg/dL (<55 nmol/L) in 19 dogs. Cortisol concentration after ACTH stimulation was <2 μg/dL (<55 nmol/L) in 1 of the 73 dogs in this cohort, consistent with a diagnosis of hypoadrenocorticism, giving a prevalence estimate of hypoadrenocorticism of 1.3% (95% CI, 0.15%‐6.2%). In 8 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). The most common diagnosis was vasovagal syncope (10/73), followed by sick sinus syndrome and third‐degree atrioventricular block (2/73). The final diagnosis was unknown in 24/73 dogs. Conclusions and Clinical Importance: Hypoadrenocorticism was the final diagnosis in 1 of 73 dogs presented to a teaching hospital either in a collapsed state or with a previous history of episodes of collapse. No dog presenting as cardiovascularly stable for intermittent collapse was found to have hypoadrenocorticism. [ABSTRACT FROM AUTHOR]

Background/Purpose: Implantable loop recorders (ILR) are increasingly used in cardiac rhythm monitoring and diagnostic work‐up of unexplained syncope. ILR battery longevity, according to manufacturers' product performance specifications, typically ranges between 2 and 4 years, but real‐world data in this population are lacking. Methods: This monocentric, prospective, observational study included consecutive patients with unexplained syncope undergoing ILR implantation between October 2007 and 2019. The main purpose was to determine real‐world battery longevity of ILRs. Diagnostic yield and relationship between arrhythmogenic diagnosis and duration of ILR monitoring were explored. Results: The study included 309 patients (59 years [38–73], 49% female) with ILR implantation for unexplained syncope. Median battery longevity was 42 [40–45] months. A total of 99.5% of ILRs reached prespecified battery longevity. The time to end‐of‐life varied by up to 33 months among the same ILR models. Overall arrhythmogenic diagnostic yield counted 27% (73% sick sinus syndrome, 20% atrioventricular block, and 7% ventricular tachycardia). Median time to diagnosis was 10 [2–25] months, with the latest event at 43 months. The cumulative diagnostic yield for arrhythmogenic event explaining syncope was 4.2%, 6.1%, 9.4%, 14.6%, 19.4%, and 26.7% at 1, 2, 6, 12, 24, and 48 months, respectively. In univariate analysis, first degree AV block and prolonged HV time on EP study were predictors of diagnosis, while QRS duration abnormality borderline missed significance. Conclusions: Real‐world battery longevity of ILRs matched industry projected longevity in 99.5% of patients implanted with ILR for unexplained syncope. A battery longevity of minimum 3.5 years is recommended to maximize the diagnostic yield in this population. [ABSTRACT FROM AUTHOR]

Background: Implantable loop recorder (ILR) allows rhythm‐monitoring up to 3 years. They are recommended in patients with recurrent syncope and for the detection of atrial fibrillation (AF) in patients with cryptogenic thromboembolic events. AF and syncope occur more often in elderly patients. However, data in this cohort is limited. Methods and results: All patients ≥ 80 years undergoing ILR‐implantation between 2011 and 2022 in our center were included. Permanent pacemaker implantation (PPI) and oral anticoagulation due AF were defined as primary endpoints. Forty‐five patients ≥ 80 years were included, 33 because of recurrent syncope and 12 because of suspected AF. The average follow up (FU) was 17.6 months. Overall in 22 patients, ILR‐implantation led to a therapeutic consequence (48.9%). In the 12 patients who underwent ILR‐implantation for detection of AF, AF was detected in nine patients (75%). In the 33 elderly patients who received ILR‐implantation after syncope, 11 underwent PPI during FU (33.3%). One patient accidentally removed the ILR himself via the implantation‐wound, and no other ILR‐related complications were observed. Conclusion: ILR are effective and safe in elderly patients. AF was often found in patients with suspected AF, especially in patients after catheter ablation of only documented atrial flutter (AFlu). PPI‐rate was high in patients with recurrent syncope and ILR‐implantation. Further investigations are necessary to determine whether PPI may be considered in elderly patients with syncope even in the absence of a bifascicular block. [ABSTRACT FROM AUTHOR]

This review aims to provide hospitalists with a streamlined understanding of the evaluation of syncope, a commonly encountered complaint in hospital medicine. Authors conducted a literature review using the keyword 'syncope' to compile current evidence and recommendations regarding the categorization, risk stratification, and diagnostic evaluation of syncope. The review outlines the categorization of syncope into cardiac, neurally mediated, and orthostatic types, detailing the clinical features, etiologies, and differential diagnoses of each. It provides a structured framework for history-taking, physical examination, orthostatic vital sign assessment, and risk stratification to guide clinicians in efficiently identifying high-risk patients requiring urgent intervention. Additionally, diagnostic modalities including electrocardiography, echocardiography, and point-of-care ultrasound are discussed, along with their respective indications and limitations. By embracing standardized approaches and evidence-based practices outlined in this review, hospitalists can optimize resource utilization, streamline patient care, and improve outcomes in patients presenting with syncope. [ABSTRACT FROM AUTHOR]

To explore the influencing factors of syncope in patients after plastic surgery, establish a syncope risk prediction model, and verify its accuracy. A total of 265 patients undergoing craniomaxillofacial surgery were included and divided into a syncope group and non-syncope group. Multivariate logistic regression analysis was used to screen for risk factors of syncope, and R language was used to establish a risk prediction nomogram of syncope in craniomaxillofacial surgery patients. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fit of the model, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model. Syncope occurred in 87 of 265 patients (32.8%), and no syncope occurred in 178 patients (67.8%). Multivariate logistic regression analysis revealed statistical differences in age, orthostatic heart rate, orthostatic diastolic blood pressure, syncope history, weight loss history, and medication history between the 2 groups (P < 0.05). A nomogram was constructed for predicting the risk of syncope after craniomaxillofacial surgery, and the Hosmer-Lemeshow goodness-of-fit test proved that the nomogram fitted well (P = 0.431). The results of ROC curve analysis showed that the alignment graph model had high prediction accuracy; the area under the curve was 0.886 (95% confidence interval, 0.8381–0.9332). Evaluating the risk of syncope after craniomaxillofacial surgery is helpful and provides guidance for the formulation of preventive strategies. [ABSTRACT FROM AUTHOR]

Background Interrupted inferior vena cava (IVC) is a rare developmental defect characterized by azygos continuation following failure of fusion of one or more of the component parts of the embryological IVC. It occurs in approximately one in 5000 of the general population. It is usually an isolated finding and is generally asymptomatic. Case summary A 42-year-old patient presented for further clarification of syncope with a 4-day history of persistent exertional dyspnoea. Computed tomography revealed a central pulmonary artery embolism on both sides, with prominent azygos and hemiazygos veins and paravertebral collaterals. For further clarification, a magnetic resonance imaging (MRI) scan was performed, where hypoplasia or stenosis of the inferior suprarenal vena cava was noted. There were collaterals of the azygos and hemiazygos veins. The finding was consistent with the picture of a venous abnormality in the sense of an 'interrupted IVC (suprarenal) with azygos continuation'. Discussion In the case of an isolated interrupted IVC, the patient is usually asymptomatic, and the vascular anomaly itself does not mandate any treatment. This variation should be considered, especially in young patients with deep venous thrombosis (DVT) when no other reason for thromboembolism is evident. To prevent vascular events such as DVT or pulmonary embolism, lifelong anticoagulation therapy is recommended. An interrupted IVC can also cause procedural difficulties during right heart catheterization, electrophysiological studies, cardiopulmonary bypass surgery, femoral vein catheter advancement, IVC filter placement, and temporary pacing through the transfemoral route. [ABSTRACT FROM AUTHOR]

Background Orthostatic hypotension (OH) is a common cardiovascular disorder typically associated with autonomic dysfunction. However, various other mechanisms can contribute to its occurrence. Case summary An 88-year-old woman was referred to the cardiology unit due to recurrent syncope episodes while standing. Echocardiography revealed a normally contracting left ventricle with severe hypertrophy, a restrictive filling pattern, reduced stroke volume, and a decreased inferior vena cava diameter (4 mm/m²). In the standing position, she experienced syncope, and invasive blood pressure monitoring confirmed OH, alongside a normal increase in heart rate and evidence of mid-left ventricular obstruction (MVO) on echocardiogram. Discontinuation of diuretics and administration of fluids and beta-blockers effectively resolved the OH. Discussion This case underscores the importance of considering mechanisms beyond autonomic dysfunction and volume depletion in the aetiology of OH in elderly patients. Notably, this is the first documented case of OH associated with MVO occurring in an upright posture, resulting in a significant decrease in cardiac output and subsequent syncope. Preventing volume depletion and using non-vasodilating beta-blockers may represent optimal therapeutic strategies in such cases. [ABSTRACT FROM AUTHOR]

In Modern Hebrew, some, but not all, nominals exhibit obligatory /a/-syncope in open syllables if they are antepretonic in a simple (nominal) word. The same vowels optionally syncopate in any pretonic syllable in non-final members of compounds. Here we first show that syncope in compounds fills a gap in the typology of weak positions. We then propose a formal analysis in Gradient Harmonic Grammar (Smolensky and Goldrick 2016), which distinguishes between a weak /a/ and a strong /a/. Only the former undergoes syncope in both configurations; and only in non-compounds is it protected by a positional faithfulness constraint referencing the head foot of the prosodic word. Optionality in compounds is shown to follow from Base-Derivative faithfulness. [ABSTRACT FROM AUTHOR]

Background: This study aims to identify a metabolomic signature that facilitates the classification of syncope and the categorization of the unexplained syncope (US) to aid in its management. Methods: We compared a control group (CTRL, n = 10) with a transient loss of consciousness (TLC) group divided into the OH group (n = 23) for orthostatic syncope, the NMS group (n = 26) for neuromediated syncope, the CS group (n = 9) for cardiological syncope, and the US group (n = 27) for US defined as syncope without a precise categorization after first- and second-level diagnostic approaches. Results: The CTRL and the TLC groups significantly differed in metabolic profile. A new logistic regression model has been developed to predict how the US will be clustered. Using differences in lysophosphatidylcholine with 22 carbon atom (C22:0-LPC) levels, 96% of the US belongs to the NMS and 4% to the CS subgroup. Differences in glutamine and lysine (GLN/LYS) levels clustered 95% of the US in the NMS and 5% in the CS subgroup. Conclusions: We hypothesize a possible role of C22:0 LPC and GLN/LYS in re-classifying US and differentiating it from cardiological syncope. [ABSTRACT FROM AUTHOR]

Background: Approximately half of all women develop palpitations during pregnancy, with a quarter experiencing arrhythmias. While most presentations are benign, some cases can result in sudden cardiac death or serious symptom development. Considering such clinical presentation, healthcare providers must acquire knowledge in this area to provide comprehensive prenatal, perinatal, and postnatal care. However, no study could be located that focused on women's life experiences of such complications during or in the post-pregnancy period. Objectives: The study aims to share the results of a study that explored the life experience of one woman who developed non-sustained ventricular tachycardia during her third pregnancy that lasted into the postpartum period. Methods: Using narrative inquiry self-study methodology, a woman's experiences were explored to uncover the challenges she faced in coping with such complications during a period of transition for herself and her family. This methodology allowed for an in-depth understanding of how these complications could affect all aspects of her life. Results: Four narrative threads were produced: (1) diagnostic challenges and delayed recognition; (2) impact on maternal identity and family dynamics; (3) navigating healthcare systems and treatment decisions; and (4) long-term adaptation and resilience. Conclusions: The intention was to add to this topic area to ensure future researchers, current and future healthcare providers, and patients have literature they can refer to when studying, providing care for, or experiencing similar health complications. Acquiring this knowledge can aid healthcare professionals to ensure appropriate care is provided, risks are minimized, and their recovery is well supported. [ABSTRACT FROM AUTHOR]

Introduction Methods and Results Conclusions Long QT syndrome (LQTS) is a cardiac channelopathy characterized by QT prolongation and a potential for arrhythmic syncope, sudden cardiac arrest or deaths (SCA/SCD). It has been speculated that patients with LQTS might have a primary sinoatrial node (SAN) phenotype of chronotropic insufficiency (CI). This has not been demonstrated convincingly before because of the potentially confounding effects of beta blocker (BB) therapy. Herein, we set out to determine whether untreated patients with LQTS demonstrate intrinsic CI.A retrospective review of all treadmill exercise stress tests (TEST) was performed on patients with one of the three most common LQTS genotypes: LQT1, LQT2, and LQT3. For each patient, the first TEST completed while off BB was analyzed. Patients with prior left cardiac sympathetic denervation (LCSD) therapy were excluded. CI was defined as having an age‐ and gender‐predicted peak heart rate (HR) < 85% and/or a predicted HR reserve (HRR) < 80%. Overall, 463 LQTS patients (245 LQT1, 125 LQT2, and 93 LQT3) were included (267 female [58%]; mean age at time of TEST [29 ± 17 years]). Mean % predicted peak HR for all LQTS patients was 87.6% (range 42.9% ‐ 119.1%) and mean % predicted HRR was 80% (range 19.1% ‐ 153%). Overall, half of all LQTS patients (n = 234; 51%) displayed CI; 64% of patients with LQT1 (n = 157), 37% with LQT2 (n = 46), and 33% with LQT3 (n = 31). Patients with LQT1 were most likely to exhibit CI compared to patients with LQT2 (p < .0001) and LQT3 (p < .0001). CI was significantly more common in LQT1 compared to controls (p < .0001), while there was no difference between LQT2 (p = .5) or LQT3 and controls (p > .9). Presence of CI was not a predictor of LQTS‐associated symptoms, BB side effects or likelihood of future breakthrough cardiac events (BCE).Patients with LQTS, particularly LQT1, demonstrate a SAN phenotype of CI. If assessing BB therapy effect by impact on peak HR, the patient's pretreatment peak HR, rather than an age‐ and gender‐predicted maximum HR, should be used. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Carotid sinus syndrome (CSS), characterized by exaggerated vagal responses leading to asystolic pauses with carotid sinus massage (CSM), often necessitates pacemaker implantation. This study investigates cardioneuroablation (CNA) as an alternative strategy for CSS.Prospective study of consecutive patients referred for CNA due to CSS. All patients underwent CSM, atropine test and 24‐h Holter monitoring before the procedure and at 6 months. The primary objective was the absence of any cardioinhibitory response to CSM following CNA. Secondary objectives included the combined endpoint of syncope and presyncope‐free survival, pacemaker‐free survival, differences in heart rate variation (HRV), as well as differences in the pre‐ and postprocedure atropine tests and in the SF‐36 quality‐of‐life questionnaire.A total of 13 consecutive patients (84.6% male, mean age 63.8 ± 12.3 years) were included. CSM revealed a symptomatic asystolic pause in all patients before CNA (7.3 [5.6–10.5] s). After the procedure, all the patients had a negative CSM, and only one patient (7.7%) had a positive CSM at 6 months. After a median follow‐up of 11.2 (10.6–16.3) months, syncope or presyncope‐free survival was 84.6%, and none required pacemaker implantation. There was an improvement in the energy and health change items in the SF‐36 questionnaire. There was a reduction in HR increase in the atropine test at 6 months (pre‐CNA: 66% [52–84] vs. post‐CNA 26.0% (19.8–29.3]; p = .008) and in HRV parameters.In this proof‐of‐efficacy study, performed in patients affected by asystolic CSS, CNA was effective in reducing the rate of cardioinhibitory responses, suggesting a potential efficacy in also reducing syncopal recurrences. Controlled trials are warranted to corroborate clinical findings. [ABSTRACT FROM AUTHOR]

Background: Acute flank pain is a common presentation in the Emergency Department (ED). Point-of-care ultrasound (PoCUS) has emerged as an invaluable tool in the evaluation of acute flank pain and provides real-time images resulting in the early identification of the underlying pathology. Case Report: Here we report a case of a young lady presented to the ED with a complaint of right flank pain followed by a syncopal episode. The diagnosis of ruptured angiomyolipoma was made using a PoCUS and an immediate consult to interventional radiology and urology was provided. Conclusion: This case highlights the importance of PoCUS in assessing patients presented to the ED with acute flank pain. Its incorporation into clinical practice promises to revolutionize the approach to renal emergencies, emphasizing its important role in delivering timely and effective care. [ABSTRACT FROM AUTHOR]

Detecting unsafe levels of chemical gases and vapors is essential in improving and maintaining a healthy environment for all to enjoy. Propylene glycol is a colorless, synthetic gas commonly used in medications, fragrances, and cosmetics. It causes side effects such as headaches, lightheadedness, nausea, and fainting. So, monitoring of propylene glycol is critically vital. This study uses a defected photonic crystal as a propylene glycol THz sensor. Due to the high absorption of propylene glycol, the intensity of the resonant confined mode is very small. As a result, the performance of the designed sensor seems unsatisfactory. We will use parity-time symmetry for the first time in THz to magnify the resonant confined mode to detect propylene glycol. The effect of microcavity thickness, incident angle, and gain/loss factor will be studied. The optimized sensor recorded distinguished results compared to other studies for the detection of propylene glycol. [ABSTRACT FROM AUTHOR]

Climate change is the greatest threat to global health. As climate change worsens, heat waves will be longer, more intense, and more frequent. Increased health risks from climate change and heat waves include heat-related illness (HRI). HRI increases ED visits, hospitalizations, and mortality. Healthcare providers should be aware of the impact of medications on risk for HRI. This article elucidates signs and symptoms, populations at risk, drugs and mechanisms that increase risk, and patient education to reduce risk. [ABSTRACT FROM AUTHOR]

The editorial "New Challenges and Perspectives in Neurology and Autonomic Disorders: A Leap Forward" explores the autonomic nervous system's role in regulating homeostasis and responses to stimuli, focusing on disorders like POTS, neurocardiogenic syncope, and multiple system atrophy. The document delves into the impact of the COVID-19 pandemic on understanding post-infectious syndromes and highlights the need for biomarkers and effective diagnostic approaches. Various contributions discuss topics such as the extended autonomic system, neuropsychiatric manifestations of mast cell activation syndrome, and the effects of sex hormones on migraine. The text emphasizes the importance of research in autonomic disorders, autoimmunity, and diagnostic testing to advance understanding and treatment options for complex neurologic conditions. [Extracted from the article]

Key Clinical Message: Neurally mediated syncope (NMS) is a well‐known condition that can be subdivided into three subgroups: vasopressor type, cardioinhibitory type, and mixed type. While different degrees of sinus bradycardia occur at the time of syncope in all types, complete heart block is a rare event that can lead to pulselessness during syncope. We present a case of a 14‐year‐old girl with documented NMS before and after temporary pacemaker implantation, who had complete heart block during syncope. The patient's temporary pacemaker placement was ineffective in preventing syncope during a repeat head‐up tilt test, indicating that permanent pacing may not be effective in this patient. Midodrine, an alpha‐adrenergic agonist, was started, and the patient experienced complete control of syncope episodes without recurrence during a 2‐month follow‐up. [ABSTRACT FROM AUTHOR]

Coronary artery anomalies are rare and may involve the coronary origin, course, or termination. Most are benign; however, some can lead to myocardial damage, sudden death, or potential hazards during interventional or surgical procedures. The advancement of imaging studies has led to an increase in their diagnosis. Coronary computed tomography angiography (CCTA) especially has characterized new anomalies that were previously anecdotal. This is the case of the intra‐atrial course of the right coronary artery. The present is a brief review about this rare congenital anomaly. [ABSTRACT FROM AUTHOR]

The significance of detecting faint and diminutive space targets cannot be overstated, as it underpins the preservation of Earth's orbital environment's safety and long-term sustainability. Founded by the different response characteristics between targets and backgrounds to aberrations, this paper proposes a novel aberration modulation correlation method (AMCM) for dim and small space target detection. By meticulously manipulating the light path using a wavefront corrector via a modulation signal, the target brightness will fluctuate periodically, while the background brightness remains essentially constant. Benefited by the strong correlation between targets' characteristic changes and the modulation signal, dim and small targets can be effectively detected. Rigorous simulations and practical experiments have validated the remarkable efficacy of AMCM. Compared to conventional algorithms, AMCM boasts a substantial enhancement in the signal-to-noise ratio (SNR) detection limit from 5 to approximately 2, with an area under the precision–recall curve of 0.9396, underscoring its ability to accurately identify targets while minimizing false positives. In essence, AMCM offers an effective method for detecting dim and small space targets and is also conveniently integrated into other passive target detection systems. [ABSTRACT FROM AUTHOR]

Ventricular diverticula are saccule‐like structures formed by the protrusion of the ventricular myocardium from the endocardial surface towards the free wall. Most diverticula are muscular structures, and patients usually have no obvious clinical symptoms. However, diverticula may contribute to arrhythmogenesis due to localized myocardial structural disturbances. Right ventricular apical diverticulum (RVAD) is very rare, and we report a case of highly symptomatic accelerated idioventricular rhythm (AIVR) originating from the RVAD that underwent intracardiac echocardiography (ICE)–guided catheter ablation with no recurrence during follow‐up. [ABSTRACT FROM AUTHOR]

Introduction: Cardioneuroablation (CNA) has proven effectiveness in addressing hypervagotonia symptoms, such as neurocardiogenic syncope. Methods and Results: In this case, we present the first‐time application of CNA in a case of vago‐glossopharyngeal neuralgia (VGPN). A 59‐year‐old female with near‐syncope, sinus bradycardia, and sinus pauses triggered by recurrent right‐sided neck pain was diagnosed with VGPN. The patient underwent successful treatment with carbamazepine and CNA. Subsequent follow‐up revealed the sustained absence of sinus bradycardia or pauses, even upon neck pain resurgence after discontinuing carbamazepine. Conclusion: In this patient, CNA successfully prevented pauses associated with VGPN, avoiding permanent pacemaker implantation. [ABSTRACT FROM AUTHOR]

Background: Bee and wasp (including hornet and yellow jacket) stings can cause various adverse effects that range from relatively mild-moderate, such as burning pain at the sting site, erythema, and edema, to allergic reactions, like nausea or vomiting, urticaria, difficulty breathing, swelling of the throat and tongue, weak and rapid pulse, dizziness, syncope, anaphylaxis, and possibly death. Bee and wasp stings can occur under many circumstances, including while people do yardwork, such as mowing lawns and fields. The study objective was to describe mowing-related bee and wasp sting patients treated at United States (US) emergency departments (EDs). Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS), a database of consumer product-related injuries collected from a representative sample of approximately 100 US hospital EDs. Mowing-related bee and wasp stings during 2000-2023 were identified, and the distribution of estimated mowing-related bee and wasp stings was determined for various factors. Results: A total of 957 patients with mowing-related bee and wasp stings treated at a sample of US hospital EDs were identified, resulting in a national estimate of 47,636 stings. Multiple stings were reported in 58.9% of the estimated incidents. The patient age distribution was 0.0% 0-5 years, 0.2% 6-12 years, 6.2% 13-19 years, 9.5% 20-29 years, 17.1% 30-39 years, 22.9% 40-49 years, 19.7% 50-59 years, 13.2% 60-69 years, 9.3% 70-79 years, and 1.7% 80 years or older; 74.2% of the patients were male, and 25.8% were female. The most commonly reported diagnoses were 31.0% anaphylaxis, allergic reaction, or general reaction; 17.7% edema; 10.5% urticaria; 7.1% erythema; and 5.8% dyspnea, difficulty breathing, or shortness of breath. The patient was treated or examined and released in 95.6% of the estimated incidents. Conclusion: The majority of patients with mowing-related bee and wasp stings treated at hospital EDs involved multiple stings. Most patients were aged 30-59 years, and the majority were male. Most patients were treated or evaluated and released from the ED. [ABSTRACT FROM AUTHOR]

The objective was to assess if post‐exercise ingestion of carbonated water in a hot environment ameliorates hypotension, enhances cerebral blood flow and heat loss responses, and positively modulates perceptions and mood states. Twelve healthy, habitually active young adults (five women) performed 60 min of cycling at 45% peak oxygen uptake in a hot climate (35°C). Subsequently, participants consumed 4°C carbonated or non‐carbonated (control) water (150 and 100 mL for males and females regardless of drink type) at 20 and 40 min into post‐exercise periods. Mean arterial pressure decreased post‐exercise at 20 min only (P = 0.032) compared to the pre‐exercise baseline. Both beverages transiently (∼1 min) increased mean arterial pressure and middle cerebral artery mean blood velocity (cerebral blood flow index) regardless of post‐exercise periods (all P ≤ 0.015). Notably, carbonated water ingestion led to greater increases in mean arterial pressure (2.3 ± 2.8 mmHg vs. 6.6 ± 4.4 mmHg, P < 0.001) and middle cerebral artery mean blood velocity (1.6 ± 2.5 cm/s vs. 3.8 ± 4.1 cm/s, P = 0.046) at 20 min post‐exercise period compared to non‐carbonated water ingestion. Both beverages increased mouth exhilaration and reduced sleepiness regardless of post‐exercise periods, but these responses were more pronounced with carbonated water ingestion at 40 min post‐exercise (mouth exhilaration: 3.1 ± 1.4 vs. 4.7 ± 1.7, P = 0.001; sleepiness: −0.7 ± 0.91 vs. −1.9 ± 1.6, P = 0.014). Heat loss responses and other perceptions were similar between the two conditions throughout (all P ≥ 0.054). We show that carbonated water ingestion temporarily ameliorates hypotension and increases the cerebral blood flow index during the early post‐exercise phase in a hot environment, whereas it enhances mouth exhilaration and reduces sleepiness during the late post‐exercise phase. What is the central question of this study?Post‐exercise hypotension can cause syncope, and an established practical countermeasure to mitigate this response is currently lacking: does ingestion of carbonated water restore post‐exercise hypotension and positively modulate mood states?What is the main finding and its importance?Carbonated water ingestion transiently increased blood pressure and cerebral blood flow index post‐exercise in the heat. Additionally, carbonated water ingestion increased exhilaration for the mouth and decreased sleepiness post‐exercise. Thus, carbonated water ingestion may mitigate post‐exercise hypotension, increase cerebral perfusion and improve mood states. [ABSTRACT FROM AUTHOR]

The article reviews the evaluation of pediatric syncope in the emergency department, emphasizing that while most cases are benign, there are critical, potentially life-threatening causes that must not be overlooked. Topics discussed include common causes like vasovagal syncope, the differential diagnosis of loss of consciousness, and the importance of identifying cardiac-related etiologies in children.

Background One of the most important and relatively frequent complications of aortic valve replacement is atrioventricular block. It typically occurs by direct injury of the infranodal conduction system due to intra-operative manipulation and persists post-operatively, necessitating permanent pacemaker implantation in many cases. Case summary A 66-year-old man presented to our hospital after experiencing syncope while walking after drinking. He had experienced two episodes of alcohol-induced syncope several years earlier. His electrocardiogram (ECG) and transthoracic echocardiogram revealed complete atrioventricular block and severe aortic stenosis, respectively. He received a temporary pacemaker on the day of admission and underwent surgical aortic valve replacement on hospital Day 9. The native aortic valve was bicuspid. Unexpectedly, the ECG immediately after aortic valve replacement showed complete restoration of atrioventricular conduction during temporary atrial pacing. The atrioventricular block did not recur, and he was discharged to home on post-operative Day 13. Discussion This remarkably rare clinical course, complete restoration from complete and persistent atrioventricular block after surgical aortic valve replacement, can be explained by multifactorial mechanisms: (i) surgical removal of the aortic annulus calcification directly hindering the infranodal conduction system; (ii) relief from the ventricular pressure overload stressing the conduction system within the septum; and (iii) improvement of substantial autonomic dysregulation as manifested by alcohol-sensitive syncope in the present patient, which was a result of unloading of the intraventricular pressure affecting the left ventricular mechanoreceptor. [ABSTRACT FROM AUTHOR]

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Autoimmune encephalitis (AE) associated with autoantibodies against γ-aminobutyric acid-B receptor (GABABR-AE) is frequently identified in middle-aged and elderly males. The disease is characterized by seizures, mental, and behavioral abnormalities, as well as recent memory decline. Anti-GABABR antibody-associated encephalitis, presenting with syncope as the first symptom is rare. Here we report a case of AE with syncope as the first symptom. A 55-year-old male presented to the emergency department with transient loss of consciousness, initially diagnosed as syncope. As the disease progressed, the patient exhibited seizures, abnormal mental behavior, and cognitive impairment. Ultimately, the patient was diagnosed with right lung small cell lung cancer. The initial atypical symptoms and the lack of clear imaging features of GABABR encephalitis hinder early diagnosis. This case highlights the importance of screening for the underlying etiology of syncope in middle-aged and elderly patients.

Abstract The objective was to assess if post‐exercise ingestion of carbonated water in a hot environment ameliorates hypotension, enhances cerebral blood flow and heat loss responses, and positively modulates perceptions and mood states. Twelve healthy, habitually active young adults (five women) performed 60 min of cycling at 45% peak oxygen uptake in a hot climate (35°C). Subsequently, participants consumed 4°C carbonated or non‐carbonated (control) water (150 and 100 mL for males and females regardless of drink type) at 20 and 40 min into post‐exercise periods. Mean arterial pressure decreased post‐exercise at 20 min only (P = 0.032) compared to the pre‐exercise baseline. Both beverages transiently (∼1 min) increased mean arterial pressure and middle cerebral artery mean blood velocity (cerebral blood flow index) regardless of post‐exercise periods (all P ≤ 0.015). Notably, carbonated water ingestion led to greater increases in mean arterial pressure (2.3 ± 2.8 mmHg vs. 6.6 ± 4.4 mmHg, P

Coronary artery aneurysm (CAA) is a rare form of coronary artery disease characterized by abnormal dilation of a coronary artery segment. While CAAs can present with various symptoms, syncope is notably uncommon, with limited documented cases. We present the case of a 24-year-old woman with a 2-month history of recurrent syncope, occurring in the absence of other symptoms. Initial evaluations, including MRI and cardiac examinations, revealed no abnormalities. However, a transthoracic echocardiogram identified a ring-like structure adjacent to the tricuspid valve, and subsequent computed tomography angiography confirmed a large right coronary artery aneurysm. This case highlights the rare presentation of recurrent syncope as a manifestation of CAA, emphasizing the need for timely diagnosis and intervention in similar cases.