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The clinical characteristics of situational syncope in children and adults undergoing head-up tilt testing

  • Runmei Zou
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China
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  • Shuo Wang
    Affiliations
    Jishou University School of Medicine, Jishou 416000, China
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  • Ping Lin
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China
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  • Chunyan Hu
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China

    Department of Pediatrics, the Second Hospital Affiliated to Nanhua University, Hengyang, Hunan 421001, China
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  • Yuwen Wang
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China
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  • Fang Li
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China
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  • Yi Xu
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China
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  • Cheng Wang
    Correspondence
    Corresponding author at: Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan, China.
    Affiliations
    Department of Pediatric Cardiovasology, Children's Medical Center, the Second Xiangya Hospital, Central South University & Institute of Pediatrics, Central South University, Changsha, Hunan 410011, China
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Published:November 29, 2019DOI:https://doi.org/10.1016/j.ajem.2019.11.042

      Abstract

      Objective

      Situational syncope is a subtype of neurally mediated syncope and associated with specific circumstances. This paper is to assess the clinical characteristics and underlying causes of situational syncope.

      Methods

      This is a retrospective study of patients who underwent head-up tilt testing (HUTT). Medical records including age at HUTT, gender, number of syncopal episodes, family history of syncope, triggers before the syncopal episode, position during the syncopal episode and the responses to HUTT were reviewed.

      Results

      Among 3140 patients, 354 patients (mean age 28.3 ± 16.6 years old, with 184 males and 170 females) were diagnosed with situational syncope. The causes of situational syncope included micturition (50.85%), defecation (15.82%), bathing (10.45%), swallowing (6.50%), cough (4.80%), post-dinner (3.95%), singing (3.11%), teeth brushing (2.26%), and hair grooming (2.26%). Patients with syncope triggered by micturition, cough, post-dinner were more likely to be men, while those caused by bathing, swallowing, singing, teeth brushing and hair grooming were more likely to be women. 34.75% of patients with situational syncope were between the ages of 10–19 years old, and 20.34% were between the ages of 40–49 years old. 74.01% of situational syncopal events occurred in an upright position. 47.74% of patients had positive responses to HUTT.

      Conclusions

      These findings show that micturition was the most common cause of situational syncope in both children and adults. There were significant gender and age differences among situational syncope triggered by different causes. Most of situational syncope occurred in the upright position and nearly half of the patients had positive responses to HUTT.

      Abbreviations:

      ECG (electrocardiogram), HUTT (head-up tilt testing), OH (orthostatic hypotension), OHT (orthostatic hypertension), POTS (postural orthostatic tachycardia syndrome), VVS (vasovagal syncope), VVS-V (vasodepressor response of vasovagal syncope), VVS-C (cardioinhibitory response of vasovagal syncope), mixed VVS (mixed response of vasovagal syncope)

      Keywords

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