Avtor/Urednik		Šinkovec, Matjaž; Grad, Anton; Rakovec, Peter; Meglič, Bernard
Naslov		Klinične značilnosti bolnikov s sinkopo in diagnostika
Prevedeni naslov		Clinical characteristics of patients with syncope and diagnostics
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 69, št. 9
Leto izdaje		2000
Obseg		str. 579-86
Jezik		slo
Abstrakt		Background. The objective of our prospective clinical study was to determine charactetistics of patients with recent syncope. In addition, our objective was to determine the cause of syncope and to assess the efficacy of diagnostic tests, recommended in the literature. This is the first study of this kind in our country. Methods. Clinical examination and ECG were performed by a uniform protocol. According to the working diagnosis of syncope - cardiac, reflex (vasovagal, situational), neurological, orthostatic, due to drug side efects and unexplained or syncope-like event in neurotic person or epilepsy - we performed head-up tilt-test (HUT), different ECG- monitoring tests, echocardiogram, neurological examination and EEG, psychiatric examination, electrophysiological examination nad cardiac catheterisation. Results. In 104 patients (mean 51 years, 52 females), we found out that 50% of patients suffered at least minor trauma during the syncopal episode. Trauma was severe in 10%. How-ever, the prognosis of our patients was good. The first-year mortality after syncope was 3% and one year incidence of recurrent syncope was 6.65. Almost half of our syncope patients had arterial hypertension and one-third orthostatic hypotension. We detected 4 patients with valvular heart disease - all with aortic stenosis. The history, physical examnation and ECG gave the best diagnostic results for syncope evaluation, followed by HUT and ECG-monitoring tests. In addition, echocardiogram, neurological examination and EEG were useful in some patients. The sensitivity of HUT was low in patients with situational syncope. The most common was reflex syncope (37%) with vasovagal type twice as often as situational type, followed by cardiac (31%) and unexplained syncope (26%). (Abstract truncated at 2000 characters.)
Izvleček		Izhodišča. Namen naše prospektivne klinične raziskave je bil ugotoviti značilnosti bolnikov z nedavno sinkopo. Poleg tega smo želeli ugotoviti vzrok sinkope in hkrati preveriti učinkovitost diagnostičnih testov, ki jih priporočajo v strokovni literaturi. To je prva raziskava te vrste pri nas. Metode. Pri preiskovancih smo napravili klinični pregled po enotnem protokolu in zabeležili EKG. Glede na delovno diagnozo sinkope, ki je bila lahko kardinalna, refleksna (vazovagalna ali situacijska), nevrološka, ortostatska, zaradi stranskega učinka zdravil in nepojasnjena ali je šlo za sinkopi podobno stanje pri nevrotiku ali za epilepsijo, smo napravili še test z nagibnno mizo (TNM), razne monitorizacije EKG, ultrazvočno preiskavo srca, nevrološki pregled z EEG, psihiatrični pregled, elektrofiziološko preiskavo in srčno kateterizacijo. Rezultati. Pri 104 preiskovancih (srednja strost 51 let, 52 žensk) smo ugotovili, da se je polovica bolnikov ob sinkopi poškodovala in da je bila desetina poškodb resnih. Kljub temu je bila prognoza naših bolnikov dobra. Smrtnost je bila v prvem letu 3-odstotna, letna incidenca ponovitve sinkope pa 6,6-odstotna. Skoraj polovica bolnikov s sinkopo je imela arterijsko hipertenzijo, tretjina pa ortostatsko hipertenzijo. Odkrili smo 4 bolnike s sinkopo v sklopu valvularne srčne bolezni; vsi so imeli aortno stenozo. Vzrok sinkope smo najpogosteje ugotovili z anamnezo, fizikalnim pregledom in EKG. Na drugem mestu so bili TNM in razne monitorizacije EKG. Pri nekaterih bolnikih so dobro dopolnili diagnostični postopek še ultrazvočna preiskava srca, nevrološki pregled in EEG. Občutljivost TNM je bila pri bolnikih s situacijsko sinkopo slaba. Najpogosteje smo ugotovili refleksno sinkopo (37%), nato pa kardialno (31%). Nepojasnjene sinkope je bilo 26%. Vazovagalna sinkopa je bila dvakrat pogostejša od situacijske. (Izvleček prekinjen pri 2000 znakih.)
Deskriptorji		SYNCOPE SYNCOPE, VASOVAGAL MEDICAL HISTORY TAKING HYPOTENSION, ORTHOSTATIC ARRHYTHMIA INTERVIEW, PSYCHOLOGICAL PROSPECTIVE STUDIES PHYSICAL EXAMINATION ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY HEART CATHETERIZATION