Consenso para el Diagnóstico y Tratamiento del Síncope
Sociedad Argentina de Cardiología
REVISTA ARGENTINA DE CARDIOLOGÍA / VOL 80 Nº 1 / enero-febrero 2012
Las Guías y los Consensos de Expertos son documentos que tienen como objetivo presentar a la comunidad científica todas las evidencias relevantes disponibles sobre un tema en particular. El objetivo de su elaboración es ayudar a los médicos a evaluar los beneficios y los riesgos de procedimientos diagnósticos y terapéuticos respecto de una patología en especial. Es así que estos documentos, si bien no intentan reemplazar el criterio propio de cada médico, deberían ser útiles para la toma de decisiones clínicas diarias.
http://www.sac.org.ar/files/files/vol80n1a14(2).pdf
La regla de San Francisco Síncope para predecir resultados graves a corto plazo: una revisión sistemática
San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review.
Saccilotto RT, Nickel CH, Bucher HC, Steyerberg EW, Bingisser R, Koller MT.
Basel Institute for Clinical Epidemiology and Biostatistics, Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland. saccilottor@uhbs.ch
CMAJ. 2011 Oct 18;183(15):E1116-26. doi: 10.1503/cmaj.101326. Epub 2011 Sep 26.
Abstract
BACKGROUND: The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been validated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes. METHODS: We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics. RESULTS: We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79-0.93), and the pooled estimate of specificity was 0.52 (95% CI 0.43-0.62). There was substantial between-study heterogeneity (resulting in a 95% prediction interval for sensitivity of 0.55-0.98). The probability of a serious outcome given a negative score with the San Francisco Syncope Rule was 5% or lower, and the probability was 2% or lower when the rule was applied only to patients for whom no cause ofsyncope was identified after initial evaluation in the emergency department. The most common cause of false-negative classification for a serious outcome was cardiac arrhythmia. INTERPRETATION: The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department. Consideration of all available electrocardiograms, as well as arrhythmia monitoring, should be included in application of the San Francisco Syncope Rule. Between-study heterogeneity was likely due to inconsistent classification of arrhythmia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193123/pdf/183e1116.pdf
Manejo y terapéutica del síncope vasovagal. Una revisión
Management and therapy of vasovagal syncope: A review.
Aydin MA, Salukhe TV, Wilke I, Willems S.
Muhammet Ali Aydin, Tushar V Salukhe, Iris Wilke, Stephan Willems, Department of Electrophysiology, University Heart Center Hamburg, Martinistraße 52, Hamburg 20246, Germany.
World J Cardiol. 2010 Oct 26;2(10):308-15. doi: 10.4330/wjc.v2.i10.308.
Abstract
Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
KEYWORDS:Adrenergic β-antagonists, Midodrine, Serotonin uptake inhibitors, Vasovagal syncope
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998831/pdf/WJC-2-308.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Sociedad Argentina de Cardiología
REVISTA ARGENTINA DE CARDIOLOGÍA / VOL 80 Nº 1 / enero-febrero 2012
Las Guías y los Consensos de Expertos son documentos que tienen como objetivo presentar a la comunidad científica todas las evidencias relevantes disponibles sobre un tema en particular. El objetivo de su elaboración es ayudar a los médicos a evaluar los beneficios y los riesgos de procedimientos diagnósticos y terapéuticos respecto de una patología en especial. Es así que estos documentos, si bien no intentan reemplazar el criterio propio de cada médico, deberían ser útiles para la toma de decisiones clínicas diarias.
http://www.sac.org.ar/files/files/vol80n1a14(2).pdf
La regla de San Francisco Síncope para predecir resultados graves a corto plazo: una revisión sistemática
San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review.
Saccilotto RT, Nickel CH, Bucher HC, Steyerberg EW, Bingisser R, Koller MT.
Basel Institute for Clinical Epidemiology and Biostatistics, Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland. saccilottor@uhbs.ch
CMAJ. 2011 Oct 18;183(15):E1116-26. doi: 10.1503/cmaj.101326. Epub 2011 Sep 26.
Abstract
BACKGROUND: The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been validated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes. METHODS: We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics. RESULTS: We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79-0.93), and the pooled estimate of specificity was 0.52 (95% CI 0.43-0.62). There was substantial between-study heterogeneity (resulting in a 95% prediction interval for sensitivity of 0.55-0.98). The probability of a serious outcome given a negative score with the San Francisco Syncope Rule was 5% or lower, and the probability was 2% or lower when the rule was applied only to patients for whom no cause ofsyncope was identified after initial evaluation in the emergency department. The most common cause of false-negative classification for a serious outcome was cardiac arrhythmia. INTERPRETATION: The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department. Consideration of all available electrocardiograms, as well as arrhythmia monitoring, should be included in application of the San Francisco Syncope Rule. Between-study heterogeneity was likely due to inconsistent classification of arrhythmia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193123/pdf/183e1116.pdf
Manejo y terapéutica del síncope vasovagal. Una revisión
Management and therapy of vasovagal syncope: A review.
Aydin MA, Salukhe TV, Wilke I, Willems S.
Muhammet Ali Aydin, Tushar V Salukhe, Iris Wilke, Stephan Willems, Department of Electrophysiology, University Heart Center Hamburg, Martinistraße 52, Hamburg 20246, Germany.
World J Cardiol. 2010 Oct 26;2(10):308-15. doi: 10.4330/wjc.v2.i10.308.
Abstract
Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
KEYWORDS:Adrenergic β-antagonists, Midodrine, Serotonin uptake inhibitors, Vasovagal syncope
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998831/pdf/WJC-2-308.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
No hay comentarios:
Publicar un comentario