CAUSES OF OBINCOPAL SYNDROME AND THE ROLE OF PARADOXICAL EMBOLISM IN THE OCCUPATION OF SYNCOPAL CASES IN PATIENTS WITH CONGENITAL HEART DEVICES
Keywords:
Paradoxical embolism, congenital heart defects, deep vein thrombosis, stroke, thrombosis of the arteries of internal organsAbstract
The study of the causes and mechanisms of development of syncope, algorithms for their diagnosis and treatment remains a problematic situation in the healthcare system of our country, including throughout the world, and there are a number of shortcomings in the organization of emergency medical care for such patients. Studying the consequences of paradoxical embolism in patients with congenital heart defects has become an urgent problem, since these patients have a high risk of developing cardiovascular, cerebrovascular and peripheral complications. The article is devoted to the analysis of cases of syncope in patients with ischemic stroke, thrombosis of internal and peripheral arteries, congenital heart defects and deep vein thrombosis. The article discusses the mechanisms of transition of a blood clot or any embolism formed in the venous vessels of the body into the large circulatory system, including what clinical conditions arise depending on which organ and tissue is damaged, diagnostic and treatment algorithms, and assessment of syncope. In a variety of settings, from non-invasive ultrasound to invasive tests, their advantages and limitations are discussed, which may contribute to subsequent effective treatment of this patient population. Therapeutic strategies and perspectives for the treatment of syncope, including pharmacological and non-pharmacological approaches, with particular emphasis on the prevention of complications of vascular thrombosis and embolism. The conclusion emphasizes that additional research is needed to understand the development of paradoxical embolism in patients with syncope, congenital heart disease and deep vein thrombosis. It is important to develop targeted therapeutic strategies that can reduce the negative consequences of paradoxical embolism and improve the prognosis for this vulnerable group of patients.
References
Brignole M., Menozzi C., Bartoletti A., Giada F., Lagi A., Ungar A., et al.. (2006). A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur. Heart J. 27, 76–82. 10.1093/eurheartj/ehi647 [PubMed] [CrossRef] [Google Scholar] [Ref list]
Moya A., Sutton R., Ammirati F., Blanc J. J., Brignole M., Dahm J. B., et al.. (2009). Guidelines for the diagnosis and management of syncope. Eur. Heart J. 30, 2631–2671. 10.1093/eurheartj/ehp298 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
Sheldon R., Rose S., Connolly S., Ritchie D., Koshman M. L., Frenneaux M. (2006). Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur. Heart J. 27, 344–350. 10.1093/eurheartj/ehi584 [PubMed] [CrossRef] [Google Scholar] [Ref list]
Kapoor W. N. (2002). Current evaluation and management of syncope. Circulation 106, 1606–1609. 10.1161/01.CIR.0000031168.96232.BA [PubMed] [CrossRef] [Google Scholar] [Ref list]
Medow M. S., Stewart J. M., Sanyal S., Mumtaz A., Sica D., Frishman W. H. (2008). Pathophysiology, diagnosis and treatment of orthostatic hypotension and vasovagal syncope. Cardiol. Rev. 16, 4–20. 10.1097/CRD.0b013e31815c8032 [PubMed] [CrossRef] [Google Scholar] [Ref list]
Luciano G. L., Brennan M. J., Rothbberg M. B. (2010). Postprandial hypotension. Am. J. Med. 123, e1–e6. 10.1016/j.amjmed.2009.06.026 [PubMed] [CrossRef] [Google Scholar] [Ref list]
Osiro S., Zurada A., Gielecki J., Shoja M. M., Tubbs R. S., Loukas M. (2012). A review of subclavian steal syndrome with clinical correlation. Med. Sci. Monit. 18, RA57–RA63. 10.12659/MSM.882721 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
Rosanio S., Schwarz E. R., Ware D. L., Vitarelli A. (2013). Syncope in adults: systematic review and proposal of a diagnostic and therapeutic algorithm. Int. J. Cardiol. 162, 149–157. 10.1016/j.ijcard.2011.11.021 [PubMed] [CrossRef] [Google Scholar] [Ref list]
Maron BA, Shekar PS, Goldhaber SZ. Paradoxical embolism. Circulation. 2010 Nov 09;122(19):1968-72. [PubMed] [Reference list]
Windecker S, Stortecky S, Meier B. Paradoxical embolism. J Am Coll Cardiol. 2014 Jul 29;64(4):403-15. [PubMed] [Reference list]
Bannan A, Shen R, Silvestry FE, Herrmann HC. Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism. Catheter Cardiovasc Interv. 2009 Dec 01;74(7):1066-9. [PubMed] [Reference list
Kjeldsen AD, Oxhøj H, Andersen PE, Green A, Vase P. Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT). J Intern Med. 2000 Sep;248(3):255-62. [PubMed] [Reference list]
Osgood M, Budman E, Carandang R, Goddeau RP, Henninger N. Prevalence of Pelvic Vein Pathology in Patients with Cryptogenic Stroke and Patent Foramen Ovale Undergoing MRV Pelvis. Cerebrovasc Dis. 2015;39(3-4):216-23. [PubMed] [Reference list]
(Meacham RR 3rd, Headley AS, Bronze MS, Lewis JB, Rester MM. Impending paradoxical embolism. Arch Intern Med. 1998 Mar 9. 158 (5): 438-48.)
Kim SJ, Kim Y, Hwang So Cardiopulmonary resuscation may cause paradoxal embolism. 2020 Aug 38:(8).
