Escala de Calgary para el diagnóstico del síncope vasovagal. Estudio de pruebas diagnósticas

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Abstract

Objetivo: Evaluar la utilidad de la escala de Calgary en el diagnóstico de síncope vasovagal comparada con los resultados de la prueba de mesa inclinada (Tilt test) bajo protocolo sensibilizado con medicamentos. Metodología: Estudio prospectivo de pruebas diagnósticas en pacientes con sospecha de síncope vasovagal sometidos a prueba de mesa inclinada (Tilt test) con vasodilatación inducida con nitroglicerina por vía sublingual. Se incluyeron pacientes mayores de 18 años de edad y se excluyeron pacientes con cardiopatía estructural documentada. Resultados: Se analizaron 100 pacientes, promedio de 48,7 años (DE 19,7), 69% de género femenino y 4% residentes en área rural. La mediana de síncopes al momento del Tilt test fue de 5 (RIQ 2-15) con presentación del primer episodio a los 41 años (RIQ 21-57), en el 52% de los pacientes no se identificaron desencadenantes y las manifestaciones clínicas referidas en los episodios previos al Tilt test fueron diaforesis (58%), palidez (55%), mareo (70%), palpitaciones (50%) y náuseas (42%); durante el Tilt test se reportaron mareo (65%), diaforesis (19%), náuseas (18%) y visión borrosa (18%). Se obtuvo una sensibilidad del 77,7% (IC 95%: 66,7-88,8) y una especificidad del 40,5% (IC 95%: 23,3-57,7) para la escala de Calgary. Conclusiones: Debido a su buena sensibilidad y fácil aplicación, la escala de Calgary es un instrumento útil para el abordaje diagnóstico de pacientes con sospecha de síncope vasovagal y corazón estructuralmente sano, especialmente en menores de 50 años de edad.

Translated abstract

Objective: Evaluate the utility of Calgary score for the diagnosis of vasovagal syncope compared with the results of the Tilt table test using sensibilized protocol with medicines. Methodology: Prospective study of diagnostic tests in patients with suspected diagnostic of vasovagal syncope who underwent tilt table test with induced vasodilation with sublingual nitroglycerin. Patients over 18 years were included and patients with documented structural heart disease were excluded. Results: 100 patients were analyzed, averaging 48.7 years of age (SD 19.7), 69% of feminine genre and 4% residents in rural area. Medium of syncope at the moment of tilt table test was 5 (IQR 2-15), with presentation of first episode at 41 years (IQR 21-57), in 52% of the patients triggers were not identified and the clinical manifestations referred in episodes previous to Tilt test were diaphoresis (58%), pallor (55%), dizziness (70%), palpitations (50%) and nausea (42%); during the test dizziness (65%), diaphoresis (19%), nausea (18%) and blurred vision (18%) were reported. A sensitivity of 77.7% was obtained (95% CI 88.8 66.7) and specificity of 40.5% (95% CI 23.3 - 57.7) for the Calgary score. Conclusions: Due to its high sensitivity and easy application, the Calgary score is a useful diagnostic approach instrument for patients with suspected vasovagal syncope and who have a structurally healthy heart, especially in those younger than 50 years.

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Common syndromes of orthostatic intolerance.

Norma J. Stewart (2013)

The autonomic nervous system, adequate blood volume, and intact skeletal and respiratory muscle pumps are essential components for rapid cardiovascular adjustments to upright posture (orthostasis). Patients lacking sufficient blood volume or having defective sympathetic adrenergic vasoconstriction develop orthostatic hypotension (OH), prohibiting effective upright activities. OH is one form of orthostatic intolerance (OI) defined by signs, such as hypotension, and symptoms, such as lightheadedness, that occur when upright and are relieved by recumbence. Mild OI is commonly experienced during intercurrent illnesses and when standing up rapidly. The latter is denoted "initial OH" and represents a normal cardiovascular adjustment to the blood volume shifts during standing. Some people experience episodic acute OI, such as postural vasovagal syncope (fainting), or chronic OI, such as postural tachycardia syndrome, which can significantly reduce quality of life. The lifetime incidence of ≥1 fainting episodes is ∼40%. For the most part, these episodes are benign and self-limited, although frequent syncope episodes can be debilitating, and injury may occur from sudden falls. In this article, mechanisms for OI having components of adrenergic hypofunction, adrenergic hyperfunction, hyperpnea, and regional blood volume redistribution are discussed. Therapeutic strategies to cope with OI are proposed.