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Biomedical subjects

D Samoil

Publications and source records attributed to D Samoil.

12 recordsLinked to original sources
PubMed1995

Postpartum syncope.

Recurrent unexpected syncope may have severe consequences and result in serious injury. This is especially the case in the immediate postpartum period when maternal syncope may have a disastrous effect on the infant as well as the mother. We report on 12 women who developed episodic hypotension resulting in syncope in the immediate postpartum period and describe the distinguishing characteristics of their presentation, tilt table results, and responses to therapy. Postpartum syncope represents a unique subgroup of syncopal patients who need to be recognized and treated in order to prevent potentially serious injury to both mother and infant.

1-Naphthylamine↗
PubMed1994

Fluoxetine hydrochloride for the treatment of severe refractory orthostatic hypotension.

OBJECTIVE: To evaluate the usefulness of fluoxetine hydrochloride in the treatment of patients with severe refractory orthostatic hypotension. DESIGN: Prospective, nonrandomized study. PATIENTS: Five patients (3 men, 2 women with a mean age of 67 +/- 7 years with chronic symptomatic orthostatic hypotension resistant to or intolerant of other therapies. METHODS: Symptoms and orthostatic responses were recorded in the baseline state. Fluoxetine hydrochloride 20 mg orally once daily was started and patients were reevaluated after 6 to 8 weeks of therapy. RESULTS: All patients demonstrated orthostatic hypotension (20 mm Hg or greater decline in systolic blood pressure) associated with symptoms (eg, dizziness, vertigo, near syncope) in the baseline state. After 6 to 8 weeks of fluoxetine therapy, 2 patients reported resolution of all symptoms, 2 had a marked reduction in symptoms, and 1 patient experienced no effect. Orthostatic responses were attenuated in 4 of the 5 patients (80%). CONCLUSION: Fluoxetine hydrochloride may be an effective therapy for some patients with recurrent severe orthostatic hypotension refractory to other forms of therapy.

Aged↗
PubMed1994

Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents.

OBJECTIVES: The purpose of our study was to determine whether the serotonin reuptake inhibitor sertraline hydrochloride could prevent neurocardiogenic syncope in children and adolescents resistant to or intolerant of other therapies. BACKGROUND: The serotonin reuptake inhibitor fluoxetine hydrochloride has been reported to be effective in preventing neurocardiogenic syncope in adults. METHODS: Seventeen consecutive young patients (mean age 15 years, range 10 to 18; 7 male, 10 female) with recurrent syncope and a positive head-upright tilt table test, and in whom standard therapies (fludrocortisone, transdermal scopolamine, beta-adrenergic blocking agents, disopyramide) were ineffectual, poorly tolerated or contraindicated, were referred for study. Sertraline was administered orally at 50 mg daily for 4 to 6 weeks. A head-upright tilt table test was then reperformed, and the clinical effect was noted. RESULTS: Three patients (18%, 95% confidence interval [CI] 1 to 44) were intolerant of the drug, and it was discontinued. Nine patients became asymptomatic and tilt negative (53%, 95% CI 26 to 76), and five remained tilt positive (36%, 95% CI 15 to 65). Over a mean follow-up period of 12 +/- 5 months, the tilt-negative patients remained symptom free while taking sertraline. CONCLUSIONS: The serotonin reuptake inhibitor sertraline hydrochloride can be effective in preventing recurrent neurocardiogenic syncope in selected patients unresponsive to or intolerant of other therapeutic modalities.

1-Naphthylamine↗
PubMed1994

Sotalol: a new agent for the treatment of ventricular arrhythmias.

Sotalol was developed as a nonselective beta-blocker in the 1960s for the treatment of hypertension and later for cardiac risk management after myocardial infarction. Extensive research has since well described class III type electrophysiologic effects on the repolarization of myocardial fibers. Sotalol prolongs and homogenizes ventricular refractoriness, resulting in good antifibrillatory/antitachycardia protection. The unique combination of beta-blockade and antiarrhythmic effects probably will promote sotalol's use in postmyocardial infarction patients with ventricular tachycardia and sudden death. This article summarizes the pharmacologic and cardiovascular effects of this new drug, outlining its clinical use.

Animals↗
PubMed1994

The use of serotonin reuptake inhibitors for the treatment of recurrent syncope due to carotid sinus hypersensitivity unresponsive to dual chamber cardiac pacing.

Carotid sinus hypersensitivity can be a cause of recurrent unexplained syncope in the older patient. Dual chamber cardiac pacing may relieve the bradycardia, but may not affect the vasodilatory component of this disorder. We report on two patients with carotid sinus hypersensitivity with a predominant vasodilatory component who experienced recurrent syncope following permanent pacemaker implantation. Both patients were treated with serotonin reuptake inhibitors and after 4-6 weeks of therapy had complete resolution of symptoms. We conclude that serotonin reuptake inhibitors may be useful in the treatment of recurrent syncope due to carotid sinus hypersensitivity resistant to dual chamber cardiac pacing.

1-Naphthylamine↗
PubMed1993

Head-upright tilt table testing for recurrent, unexplained syncope.

Recurrent episodes of unexplained syncope are a common and often frustrating problem for the practicing physician. Although vasovagally mediated episodes of hypotension and bradycardia have been felt to be a common cause of these idiopathic events, traditionally this was a diagnosis of exclusion. Recently, head-upright tilt table testing has emerged as a method both for confirming the diagnosis of vasovagal syncope and for better understanding the mechanisms by which these events occur. This paper reviews current understanding of the pathophysiology of vasovagal syncope, the development and role of head-upright tilt table testing in its evaluation, and potential therapeutic modalities that can be helpful for the prevention of recurrent episodes.

Humans↗
PubMed1993

Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced syncope.

Recurrent vasovagally mediated episodes of hypotension and bradycardia are a common cause of recurrent syncope that can be identified by head-upright tilt table testing. Although the use of beta blockers, transdermal scopolamine, disopyramide, and fludrocortisone may be helpful in preventing further episodes, some patients are intolerant of or respond poorly to each of these agents. Following anecdotal observations, we investigated the utility of fluoxetine (a serotonin re-uptake antagonist) in preventing head-upright tilt induced hypotension/bradycardia in patients unresponsive to or intolerant of standard therapy. Sixteen patients (7 men and 9 women, mean age 42 +/- 21 years) with recurrent syncope and positive head-upright tilt studies (refractory to normal therapy) were placed on fluoxetine and restudied 5-6 weeks afterward. Three patients were intolerant of the medication. Of the 13 patients who underwent repeat tilt studies, seven patients (53% of the patients retested or 44% of the total group) were rendered tilt table negative, and, over a mean follow-up period of 19 +/- 9 months, have remained asymptomatic. We conclude that fluoxetine may be an effective therapy in patients with recurrent vasovagally mediated syncope refractory to other forms of therapy.

Adult↗
PubMed1993

Adaptive rate pacing controlled by right ventricular preejection interval for severe refractory orthostatic hypotension.

A 72-year-old African-American man with frequent recurrent syncope was found to have severe refractory orthostatic hypotension with concomitant supine hypertension. Pharmacotherapy was successful in controlling his supine hypertension but was unable to resolve his severe orthostatic hypotension. Temporary fixed rate tachypacing was only minimally effective in preventing syncope during upright tilt, while variable rate pacing based on degree of blood pressure fall was far superior. Following these observations, an adaptive rate pacing system controlled by right ventricular preejection interval was implanted (Precept DR Model 1200). The system adequately sensed the patient's fall in blood pressure when sitting or standing and augmented its rate accordingly, thus preventing syncope. While supine, the pacing rate fell to 60 ppm, thereby, avoiding an exacerbation of his concomitant supine hypertension. Over a 3-month follow-up period, he has had no further orthostatic or syncopal episodes. We conclude that adaptive rate pacing using right ventricular preejection interval may be an effective treatment for severe refractory orthostatic hypotension.

Aged↗
PubMed1992

Recurrent unexplained syncope in the elderly: the use of head-upright tilt table testing in evaluation and management.

OBJECTIVE: To investigate the usefulness of head-upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope. DESIGN: Prospective survey. SETTING: Electrophysiology laboratory of a university hospital. PATIENTS: Twenty-five patients (11 male, 14 female; mean age 73 +/- 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 +/- 4 years). METHODS: Each patient underwent head-upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1-3 micrograms/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both. MAIN RESULTS: Syncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow-up period of 24 months, no further syncopal episodes have occurred. CONCLUSIONS: Head-upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.

Aged↗
PubMedDate not supplied

Vasovagal syncope: current concepts in diagnosis and treatment.

Vasovagally mediated episodes of hypotension and bradycardia are thought to be common causes of recurrent unexplained syncope. Head-up tilt table testing, either alone or with a graded-dose infusion of isoproterenol, is a useful diagnostic test for identifying persons who are susceptible to vasovagal syncope. In addition to its diagnostic ability, tilt table testing may provide a means to assess the efficacy of preventive pharmacotherapy for syncope. Further study of tilt table testing is needed to increase understanding of vasovagal syncope and to better define the test's role in the diagnosis and management of this condition.

Bradycardia↗
PubMedDate not supplied

Recurrent unexplained syncope: the role of head-upright tilt table testing.

Recurrent episodes of sudden unexplained syncope are a common complaint of patients referred to health care professionals for evaluation. Traditional evaluations are both time consuming and expensive and leave many patients without a diagnosis. Although vasovagally mediated episodes of hypotension and bradycardia have been thought to be a common cause of unexplained syncope, this was traditionally a diagnosis of exclusion. Head-upright tilt table testing has recently emerged as a valuable method for confirming the diagnosis of vasovagal syncope and has allowed a better understanding of this phenomena. This article reviews the pathophysiology of vasovagal syncope, the use of head-upright tilt table testing in its diagnosis, and potential therapies used to prevent recurrences.

Hemodynamics↗