Current approach to the treatment of vasovagal syncope in adults.

Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness. Although not associated with mortality, it causes injuries, reduces quality of life, and is associated with anxiety and depression. The European and North American cardiac societies recently published syncope clinical practice guidelines.

Syncope and the aging patient: Navigating the challenges.

Syncope in the elderly patient is a common presentation and the most common causes are usually non-cardiac. Older adults however are more challenging dilemmas as their presentation is complicated by co-morbidities, mainly cardiovascular and neurodegenerative disorders. Frailty and cognitive impairment add to the ambiguity of the presentation, and polypharmacy is often a major modifiable contributing factor.

A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit.

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12-86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention.

A practical approach to investigation of syncope.

Syncope is caused by cerebral hypoperfusion. Most fainting is simply vasovagal syncope and the challenge lies in identifying the few patients who have potentially life-threatening causes of syncope. Syncope patients constitute 1%-2% of emergency department visits and approximately 30%-50% are admitted to hospital.

Bleeding post coronary artery bypass surgery. Clopidogrel--cure or culprit?

Background: Clopidogrel, in addition to aspirin, has become a common treatment of acute coronary syndrome and for stent thrombosis prevention, when given before percutaneous transluminal coronary angioplasty. However, some patients turn out to have surgical coronary artery disease and are sent for coronary artery bypass grafting (CABG) where the irreversible effect of aspirin and clopidogrel on platelet function becomes a concern. This study was conducted to evaluate the role of preoperative use of clopidogrel in bleeding complications after CABG.

Massive bilateral perirenal hematoma following urinary catheterization for urinary obstruction.

Urinary tract obstruction is a common problem associated with many complications. Decompression of an enlarged bladder has been associated with several complications, mainly vesicular bleeding. We report a case of a 42-year-old male patient who developed bilateral renal subcapsular hematomas secondary to relief of an extremely enlarged bladder.