Arrhythmic syncope: From diagnosis to management

Syncope is a concerning symptom that affects a large proportion of patients.It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death.However,benign causes are the most frequent,and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis,initiate effective therapy,and alter the prognosis.The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder,while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders.Indeed,arrhythmias are the most common cause of cardiac syncope.Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope.In this review,we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin.Therefore,we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients,risk stratification,and the management of syncope in different scenarios such as structural heart disease and channelopathies.

Cardiac monitoring for patients with palpitations

Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although there are otheretiologies. For diagnosis, it is essential to be able to reliably correlate the symptomswith an electrocardiographic record allowing the identification or rulingout of a possible rhythm disorder. However, reaching a diagnosis is not alwayssimple, given that they tend to be transitory symptoms and the patient isfrequently asymptomatic at the time of assessment. In recent years, electrocardiographicmonitoring systems have incorporated many technical improvements thatsolve several of the 24-h Holter monitor limitations. The objective of this review isto provide an update on the different monitoring methods currently available,remarking their indications and limitations, to help healthcare professionals toappropriately select and use them in the work-up of patients with palpitations.

Activation of Wnt/β-catenin signaling in abdominal aortic aneurysm:A potential therapeutic opportunity?

Abdominal aortic aneurysm (AAA) is a common degenerative vascular disease with a prevalence up to 8% in males over 60 years of age.1 This is a complex disorder characterized by permanent and focal dilation of abdominal aorta that exceeds at least 50% of the normal diameter. In these patients, the aortic diameter progressively expands boosted by smoking and aging as major risk factors. Unfortunately, aneurysm growth increases the risk of aortic rupture, a life-threatening emergency that carries a mortality rate of 80%. Despite the increasing effort of the scientific community to identify therapeutic strategies for AAA, there are currently no pharmacological tools that ameliorate aneurysm expansion, while the underlying mechanisms involved in this disease are not completely understood.