![]() ![]() Non-cardiogenic diseases such as those that result in increased intracranial pressure can result in syncope also by reducing cerebral perfusion pressure by compressing intracranial vessels. Poor myocardial contractility, impaired filling as with pericardial disease or outflow obstructions can all result in an inability of the heart to maintain sufficient cardiac output to meet increased demand during excitable states even under normal cardiac rhythms. Underlying cardiac functional or structural abnormalities exacerbate the negative effect of arrhythmias on cardiac output. Most of these are related to rhythm disturbances which are secondary to inherent cardiac disease. Two-thirds of dogs and cats with syncope also have a cardiac disease. The most common causes we see in our patients are cardiogenic in nature. A sudden decrease in cardiac output (CO) or vascular resistance reduces mean arterial pressure may both result in reduction of cerebral blood flow. The vast majority of syncopal events in veterinary medicine are due to a transient reduction in brain blood flow. There are numerous diseases that can result in any one or a combination of these mechanisms. These mechanisms usually involve reduced cardiac output resulting from arrhythmias or decreased cardiac filling, obstruction of blood flow from the heart, hypoxia or hypoglycemia (with normal cerebral flow) or severe decreased vascular resistance related to neurocardiogenic reflexes. The mechanisms underlying syncope are usually rather acute in nature. Typically CSE are preceded by loss of muscle tone whereas seizure activity is usually preceded by atypical limb or facial movement or even staring spells prior to the loss of body tone. What may often confuse one who witnesses a syncopal event is that on occasion some animals may have "convulsive syncopal episodes" (CSE) that results from severe hypotension or asystole. However it is uncommon to see persistent facial fits, persistent tonic/cloned motion, defecation, postictal dementia and neurologic deficits with cardiovascular mediated syncope. This number may be due to the fact that one it is a referral database and two that often to both the trained and untrained eye it may be difficult to distinguish syncope from seizure activity.ĭuring a syncopal event, animals will usually collapse into lateral recumbency and may have concurrent stiffening of the limbs, opisthotonous, urination and vocalization. The true incidence of syncope is unknown however it has been reported to occur in a referral database in 0.15% of dogs and 0.03% of cats. The identification of these infants will permitt to develop a correct strategy of treatment.Syncope is the sudden temporary loss of consciousness that is associated with loss of postural tone as a result of an abrupt decrease in cerebral perfusion or decreased delivery of essential nutrients (i.e. The cases presented are in favour of a routine search of gastroesophageal reflux in infants presenting with one or recurrent ALTE(s). The treatment with antiacid drugs was effectual and the infants did not present ALTE(s). The infants resulted affected respectively by a mild and severe gastroesophageal reflux (score: 40, > 50) in one case an episode of GER was recorded by the intraoesophageal pH-monitoring during a syncopal episode. We refer the case of two female infants that developed recurrent ALTE(s) characterized by paleness, change in muscle tone and loss of consciousness. Though a cause-and-effect relationship between GER and the development of ALTE remains to be established a possible direct relationship between oesophageal acidification and the onset of alterations in cardiopulmonary function and impairment of consciousness can be hypothesized. Gastroesophageal reflux, despite the absence of a clinical history of vomiting and regurgitation, is observed in a significant proportion of infants presenting with ALTE (Apparent Life Threatening Event): an episode characterized by some combination of apnea, color change, marked change in muscle tone, choking or gagging. Sometimes gastroesophageal reflux (GER) has been implicated in the development of obstructive apnea. Reflex syncope happens for brainstem involving mediated by peripherical afferents. ![]() Fainting syncopal events are caused by a transient functional neuronal paralysis. ![]()
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