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Timely diagnosis of convulsive syncope can avert imminent death

Oscar MP Jolobe
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DOI: https://doi.org/10.7861/clinmedicine.10-1-94
Clin Med February 2010
Oscar MP Jolobe
Manchester Medical Society, Manchester
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Editor – Timely diagnosis of convulsive syncope is crucial to the correct management of underlying causes such as implantable defibrillator malfunction,1 long QT syndrome,2 and Brugada syndrome,3 which may present with self-limiting ventricular tachyarrhythmia.1–3 Timely identification of convulsive syncope becomes a diagnosis of immediate life-saving importance when ventricular tachyarrhythmia is no longer self-limiting, and the window of opportunity for successful defibrillation is narrow and finite, as was the case in 50% of 14 young athletes aged 14–17, in whom potentially irreversible exercise-related ‘collapse’ was associated with convulsive syncope.4 In the same study, similar brief seizure-like activity was noted in 13% of 22 older persons aged 42–71 who collapsed within range of defibrillators installed on that high school campus.4 One of the conclusions from that study was that, in young athletes ‘brief myoclonic activity after collapse… could be mistaken for a seizure’, especially if rescuers mistook agonal or occasional gasping for normal breathing, and if they falsely identified the presence of a pulse.4 Accordingly, the opportunity to make a rapid life-saving diagnosis can only be optimised by heightened awareness of the entity of convulsive syncope even where ventricular tachyarrhythmia might not be self-limiting and by heightened awareness that rescuers may fail to recognise sudden death as a ‘signature’ of that subtype of ventricular tachyarrhythmia when they misidentify the pulse,4 or when they mistake agonal gasping for normal breathing.4,5

Footnotes

  • Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk

  • © 2010 Royal College of Physicians

References

  1. ↵
    1. Pemberton J
    .McComb JM. Blackout? cause: misdiagnosis of cardiac arrest. Clin Med 2009; 9: 392–3.
    OpenUrlFREE Full Text
  2. ↵
    1. Ratshin RA
    .Hunt D.Russell RO.Rackley CE. QT-interval prolongation, paroxysmal ventricular arrythmias, and convulsive syncope. Ann Intern Med 1971; 75: 919–24.
    OpenUrlPubMed
  3. ↵
    1. Paydak H
    .Telfer A.Kehoe RF, et al. Brugada syndrome An unusual cause of convulsive syncope. Ann Intern Med 2002; 162: 1416–9.doi:10.1001/archinte.162.12.1416
    OpenUrlCrossRef
  4. ↵
    1. Drezner JA
    .Rao A.Heistand J, et al. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation 2009; 120: 518–25.doi:10.1161/CIRCULATIONAHA.109.855890
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Berdowski J
    .Beekhuis F.Zwinderman AH.Tijssen JGP.Koster RW. Importance of the first link. Description and recognition of an out-of-hospital cardiac arrest in an emergency call. Circulation 2009; 119: 2096–102.doi:10.1161/CIRCULATIONAHA.108.768325
    OpenUrlAbstract/FREE Full Text
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Timely diagnosis of convulsive syncope can avert imminent death
Oscar MP Jolobe
Clinical Medicine Feb 2010, 10 (1) 94-95; DOI: 10.7861/clinmedicine.10-1-94

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Timely diagnosis of convulsive syncope can avert imminent death
Oscar MP Jolobe
Clinical Medicine Feb 2010, 10 (1) 94-95; DOI: 10.7861/clinmedicine.10-1-94
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