Timely diagnosis of convulsive syncope can avert imminent death
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
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- Pemberton J
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- Drezner JA
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- Berdowski J
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