Biomedical subjects

Steve W Parry

Publications and source records attributed to Steve W Parry.

6 recordsLinked to original sources

PubMed2006

Adenosine test in the diagnosis of unexplained syncope: marker of conducting tissue disease or neurally mediated syncope?

Adenosine test (supine administration of a 20 mg intravenous bolus with electrocardiographic and blood pressure monitoring) has been endorsed by the European Society of Cardiology guidelines on syncope management as an 'experimental' test in the diagnosis of unexplained syncope. The test is quick and cheap, but there is no consensus as to what condition, if any, the adenosine test is exposing, with conducting tissue disease and neurally mediated syncope proposed by various authors. In this article, we review the possible mechanisms underlying a positive adenosine test, its safety, and a comprehensive examination of the literature supporting each of the putative causal diagnoses.

Adenosine↗

PubMed2005

Amnesia for loss of consciousness in carotid sinus syndrome: implications for presentation with falls.

OBJECTIVES: The goal of this study was to compare the clinical characteristics of patients with carotid sinus syndrome who presented with falls with those who presented with syncope. BACKGROUND: Carotid sinus syndrome presents with both falls and syncope. The reasons for this differential presentation are unknown, but amnesia for loss of consciousness may be the underlying cause. METHODS: Two groups of 34 consecutive patients with carotid sinus syndrome as the sole cause of falls and syncope were recruited. Cognitive function and clinical characteristics were compared between the two groups. RESULTS: Syncopal subjects with carotid sinus syndrome were more likely to be older males (18 [53%] vs. 7 [21%] years; p = 0.006) with a longer duration of symptoms (27.9 vs. 13.3 months; p = 0.009) and more soft tissue injuries (19 [56%] vs. 9 [26%]; p = 0.03). Duration of asystole during carotid sinus massage was similar in both groups (5.1 vs. 5.4 s; p = 0.42), but witnessed amnesia for loss of consciousness was more frequent in fallers than those with syncope (21 [95%] vs. 4 [12%]; p < 0.001). Clinical characteristics and cognitive function were otherwise similar in both groups. CONCLUSIONS: Patients with carotid sinus syndrome have similar rates of witnessed loss of consciousness during laboratory testing regardless of symptoms. However, those presenting with falls are far less likely to perceive any disturbance of consciousness than those with syncope, showing for the first time the manner in which such patients manifest symptoms. Cognitive impairment does not explain the amnesia for loss of consciousness seen in fallers with carotid sinus syndrome.

Accidental Falls↗

PubMed2005

Drop attacks in older adults: systematic assessment has a high diagnostic yield.

OBJECTIVES: To investigate the causes of recurrent drop attacks in older patients with a comprehensive battery of investigations in the largest series reported to date. DESIGN: Observational with mean followup of 18 months. SETTING: Inner city emergency department and tertiary facility in Newcastle upon Tyne, United Kingdom. PARTICIPANTS: Ninety-three consecutive patients aged 55 and older with three or more drop attacks in the 6 months before evaluation. METHODS: Subjects underwent a comprehensive diagnostic evaluation, with particular attention to traditional (e.g., gait and balance abnormalities, medications) and more recently identified (e.g., carotid sinus hypersensitivity) risk factors for drop attacks. RESULTS: Subjects tended to be older (mean age+/-standard deviation 77.4+/-9.0) and female (70; 75%) and to have a mean of 10.4 drop attacks before evaluation. Fifty-three (57%) had suffered soft tissue injuries needing medical attention and 32 (34%) fractures secondary to drop attacks. An attributable diagnosis was achieved in all but nine subjects (90%). Cardiovascular diagnoses (49; 53%) were most commonly implicated, with neurological (27; 29%) and gait and balance abnormalities (17; 18%) and drug-related causes (11; 12%) providing the majority of the remaining diagnoses. CONCLUSION: Drop attacks in older subjects are associated with high levels of morbidity and healthcare resource utilization. Attributable diagnoses are achievable in the majority of cases with a systematic investigative approach. The high diagnostic yield more than justifies the approach described.

Age Factors↗

PubMed2004

Unprovoked and glyceryl trinitrate-provoked head-up tilt table test is safe in older people: a review of 10 years' experience.

OBJECTIVES: To test the safety of the head-up tilt test (HUT) in older adults. DESIGN: Direct observation and measurements. SETTING: Tests performed in a quiet room with dim lighting in a laboratory setting. PARTICIPANTS: One thousand ninety-six subjects aged 60 to 74; 873 aged 75 and older. MEASUREMENTS: Blood pressure and pulse at baseline for 10 minutes and 70 degrees tilt for maximum of 45 minutes. Subjects with unprovoked HUT had test repeated on a separate day after 800 mg glyceryl trinitrate (GTN). RESULTS: One thousand four hundred ninety-five drug-free and 474 GTN-provoked HUTs were studied. In those aged 60 to 74, the proportion of hypotensive unprovoked HUT was 16% (27% in those aged > or =75); this was higher with GTN provocation (43% in those aged 60-74, 44% in those aged > or =75; P<.01). Systolic blood pressure decreased during provoked HUT (lowest mean+/-standard deviation=67+/-20 in those aged 60-74, 63+/-24 in those aged > or =75; P<.01). There was one cardiovascular and no neurological complications. CONCLUSION: This study included 10 times as many people as previous studies and demonstrates the safety of HUT in older people.

Aged↗

PubMed2002

Monitoring devices for falls and syncope.

Monitoring devices are an important adjunct to the clinical assessment of patients who experience falls. The use of these devices should be guided by the clinical history, a physical assessment, and routine investigations. Quantitative measures of postural sway should be used in conjunction with clinical measures to provide a more accurate assessment of gait and balance. Assessment of blood pressure changes during the investigation of neurocardiovascular causes of syncope and falls in older adults should be performed with noninvasive digital photoplethysmographic devices, so long as their appropriate use and limitations are applied and understood. Only minimal information can be gained from short-term heart rate and rhythm monitoring in patients with infrequent symptoms. The usefulness of long-term ECG monitoring (with both external and implantable recorders) is well established for the diagnosis of unexplained syncope but requires further assessment in older individuals who experience falls. Twenty-four-hour measurements of ambulatory blood pressure generally are not diagnostically helpful in patients who experience falls or syncope but do have a role in the monitoring of therapeutic interventions.

Accidental Falls↗

PubMed2002

Vasovagal syncope masquerading as unexplained falls in an elderly patient.

The authors report the case of a 78-year-old woman who had recurrent, unexplained falls. No witness account of these episodes was available. During head-up tilt testing, the patient had vasodepressor vasovagal syncope. Afterwards, she had amnesia from loss of consciousness. Her symptoms (falls) responded to the withdrawal of culprit medications.

Accidental Falls↗