Health

Understanding the basis of bedwetting and arrhythmia


The researchers present a compelling evidence-based case to expand the diagnostic work-up to include arrhythmia when a normal continental individual experiences nocturnal enuresis. Their research and recommendations on how it was addressed were discussed in the journal

.

Usually, when a person on this continent develops nocturnal enuresis, treating physicians consider different diagnoses of urinary tract infections, anatomical disorders, emotional disturbances, epilepsy, Sleep apnea and the effects of diuretics or anesthetics. Despite the fact that spontaneous nocturnal enuresis can be indicative of a number of dangerous arrhythmias, they are rarely considered in the diagnostic evaluation.


The sudden death of a 23-year-old woman with chronic QT syndrome type 2 after experiencing episodes of urinary incontinence in two isolated beds, with no other symptoms, prompted researchers to consider actual procedures among physicians treating patients with unexplained bedwetting. They conducted an anonymous web-based survey, asking doctors to choose which diagnostic tests they would perform on a patient with sudden and unexplained bedwetting and no other symptoms. other symptoms. Of the 346 respondents, 102 pediatricians, 73 family physicians, 57 internists, 35 residents, 37 residents, and 42 advanced medical students. Of these, 114 are doctors with more than three years of experience.

Most of the survey respondents said that they would undergo ureteral dialysis and renal ultrasound after aneurysm appearance to diagnose urinary tract disease. Many people also choose to be tested for diabetes and urinary tract abnormalities. Although 19% of people recommend brain scans, they consider the possibility of nocturnal seizures as a possible cause. This finding demonstrates that arrhythmic seizures should not be considered part of the differential diagnosis with bedwetting not described in practice.

We are surprised and deeply concerned by the lack of awareness among primary physicians about the possibility of nocturnal arrhythmia seizures caused by long QT syndrome,Lead investigator Sami Viskin, MD, Sourasky Medical Center Tel Aviv and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, said.This condition is potentially fatal when left undiagnosed and untreated, is easy to detect by electrocardiogram, and is highly responsive to appropriate therapy.

The medical community recognizes that arrhythmias are the main cause of daytime syncope, and the electrocardiogram is considered an essential tool to evaluate it. It is important to raise awareness of the fact that vertigo-like arrhythmias in “awake patients” can also cause nocturnal seizures during sleep. If these nocturnal seizures are not seen, the only clues left from the dramatic event are urination or fishing.

Dr. Viskin also says that the underlying diagnosis for most aneurysms is not arrhythmic syncope, especially in younger patients. However, it is important to explore this possibility, especially when events are so close, and also to note that “The electrocardiogram is an inexpensive and easy to perform test that is invaluable for diagnosing potentially fatal and easily curable diseases.

Dr. Viskin added, “Asking about a family history of sudden death should be an integral part of every medical consultation.“Failure to identify a family history of malignancy could be key: post-mortem investigation of the family history revealed their patients to include genetic predisposition and sudden death.

In an accompanying editorial, Dr. Patrina HY Caldwell, FRACP, PhD, and Professor Jonathan R. Skinner, MBChB, MRCP (UK), FRACP, MD, FHRS, of Sydney Children’s Hospital (Randwick and Westmead) , Australia), agree that monitoring family history of premature death, together with electrocardiogram, is recommended as a rapid, inexpensive, common and effective way to prevent a rare fatal outcome meet.

Source: Medindia



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