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Hypotension due to straining in a patient with a high spinal cord lesion: Difference between revisions
Hypotension due to straining in a patient with a high spinal cord lesion (view source)
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[[File:Bloodphobia_Fig1.jpg | thumb | left | 300px | Figure 1. EKG recording. Time (seconds) is taken from the original recording.]] | [[File:Bloodphobia_Fig1.jpg | thumb | left | 300px | Figure 1. EKG recording. Time (seconds) is taken from the original recording.]] | ||
[[File:Bloodphobia_Fig2.png | thumb right | 300px | Figure 2 | [[File:Bloodphobia_Fig2.png | thumb right | 300px | Figure 2. Continuous blood pressure recordings during 50 seconds of asystole. Time (seconds) is taken from the original recording.]] | ||
His blood-injury phobia was treated using systematic desensitization with muscle tensing and cognitive techniques [2,3] under surveillance of the pediatric resuscitation team. Cognitive behavioral therapy was used to teach him to apply realistic and reassuring thoughts to the physical symptoms he saw as alarming. | His blood-injury phobia was treated using systematic desensitization with muscle tensing and cognitive techniques [2,3] under surveillance of the pediatric resuscitation team. Cognitive behavioral therapy was used to teach him to apply realistic and reassuring thoughts to the physical symptoms he saw as alarming. | ||
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Vasovagal syncope is a frightening but usually benign condition. A vasovagal collapse can occur after certain triggers (emotional or prolonged standing) which cause a reduction in sympathetic outflow to the systemic circulation and augmentation of efferent vagal activity. In the present case only thinking about blood taking induced an emotional faint. Usually vasodilatation is the most important cause of hypotension in syncope, while bradycardia is often moderate and of late onset. | Vasovagal syncope is a frightening but usually benign condition. A vasovagal collapse can occur after certain triggers (emotional or prolonged standing) which cause a reduction in sympathetic outflow to the systemic circulation and augmentation of efferent vagal activity. In the present case only thinking about blood taking induced an emotional faint. Usually vasodilatation is the most important cause of hypotension in syncope, while bradycardia is often moderate and of late onset. | ||
Treatment with a pacemaker, therefore, has no effect on hypotension in the vast majority of such patients or on the speed with which hypotension occurs [4-6]. The asystole clearly was instrumental in causing syncope in this patient. The pronounced sinus arrhythmia during Holter monitoring and forced breathing indicate this patient’s susceptibility to vagal stimulation. Vasovagal syncope with prolonged asystole is uncommon. Deal et al found a cardioinhibitory response (asystole | Treatment with a pacemaker, therefore, has no effect on hypotension in the vast majority of such patients or on the speed with which hypotension occurs [4-6]. The asystole clearly was instrumental in causing syncope in this patient. The pronounced sinus arrhythmia during Holter monitoring and forced breathing indicate this patient’s susceptibility to vagal stimulation. Vasovagal syncope with prolonged asystole is uncommon. Deal et al found a cardioinhibitory response (asystole ≥ 5 seconds) in 4.5% of syncopal children during tilt-table testing [7]. | ||
Intense fear of seeing blood is seen in 2-4.5% of children and adults. Blood-injury phobia usually starts in childhood, is often familial and is a distinctive focal phobia. Exposure therapy has been described as a valuable method to treat it [8]. In serious cases like this, great care must be taken to motivate patients for treatment, because of their tendency to withdraw from any confrontation with fear-provoking stimuli. | Intense fear of seeing blood is seen in 2-4.5% of children and adults. Blood-injury phobia usually starts in childhood, is often familial and is a distinctive focal phobia. Exposure therapy has been described as a valuable method to treat it [8]. In serious cases like this, great care must be taken to motivate patients for treatment, because of their tendency to withdraw from any confrontation with fear-provoking stimuli. | ||