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The term "rhythm and blues," often called "R&B," originated in the 1940s when it replaced "race music" as a general marketing term for all African American music, though it usually referred only to secular, not religious music. The term first appeared in commercial recording in 1948, when RCA Victor records began using "blues and rhythm" music as a descriptor for African American secular songs. The migration of African Americans to urban centers in the Northeast and Midwest during the early twentieth century helped to bring various regional styles of African American music together to influence one another. The migration also created new markets for these styles of music. Early on the term "rhythm and blues" was used for boogie woogie, African American swing, jazz, and blues. All of these styles influenced the development of what is called rhythm and blues today.

The meaning of the term continued to change over time, and today it is still used as an umbrella term for many different African-American musical forms. Historically speaking, though, "rhythm and blues" as we understand it today most often describes a style of music that developed after World War II that combines elements of pop, gospel, blues and jazz with a strong back beat. The African American styles that emerged in those years were often played by small groups that emphasized rhythmic drive over the instrumental and harmonic complexity of the swing orchestras. Their vocalists often sang in an uninhibited and emotionally direct style. In major cities, teenaged vocal groups with little or no instrumental accompaniment were a growing presence. They took their inspiration from both gospel singers and successful African American pop stylists such as the Ink Spots. The term "doo-wop" is well known now, but it was not applied to these groups until much later, and it refers to the vocables and nonsense syllables these group sang to compensate for their lack of instruments. All of these styles were significant to the development of rock and roll a few years later.

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The gospel group the Birmingham Sunlights also presents two religious songs in doo-wop style, "If you missed me from singing" (at time code 5:00), and "We're going to move in the room of the Lord" (at time code 00:20:50), in the video of their concert at the Library of Congress in 2005.

Though it began as a general term for African American music, the synthesis of styles that became what is now called rhythm and blues caught on among a wide youth audience during the post war period and contributed to changing the racial divide in American society and music of the mid-twentieth century. Initially, white artists such as Elvis Presley performed and recorded, or "covered," rhythm and blues works by African American composers in order for those songs to be marketed to white audiences. But the effect was to bring both audiences and artists with an interest in this style of music together. The development of rhythm and blues occurred just as segregation became a growing social issue in American society. Both Black and white young people wanted to see the popular performers of the day, and mixed groups of youths sang doo-wop together on the street corners of many urban centers. This provoked a strong reaction of proponents of segregation and was one reason why rhythm and blues and early rock and roll were often seen as dangerous to America's youth. But with young people of all backgrounds identifying with these new musical styles, a generation was becoming ready for a more equal society.

In the 1960s, a rhythm and blues style known as "soul" emerged in which the influence of gospel vocal style was stronger, though the lyrical emphasis was usually very secular. In this presentation is a video of a concert at the Library of Congress by guitarist, singer, and songwriter Barbara Lynn, a successful soul artists of the mid-1960s, performing her style of Texas rhythm and blues in 2009.

Objectives:Identify the etiology of cardiac syncope.Describe the pathophysiology of cardiac syncope.Summarize the treatment of cardiac syncope.Outline the workup of a patient with cardiac syncope and describe the role of the interprofessional team to manage this condition.Access free multiple choice questions on this topic.

Syncope, a sudden, transient loss of consciousness and postural tone, is a phenomenon estimated to affect 30% to 40% of the population, and those numbers are likely underestimated given the high prevalence of patients with syncope who do not present to a hospital or urgent care setting. Syncope is responsible for 740,000 trips to the emergency department and a quarter of a million hospital admissions each year in the United States alone.[1] Causes of syncope range widely, including vasovagal, neurologic, metabolic, pulmonary, volume depletion, and cardiac. While most syncopal events are innocuous, cardiac syncope is often indicative of a potentially fatal, underlying disease process, carrying a one-year mortality rate of 30%.[2] Cardiac syncope occurs when the source of one's loss of consciousness stems from a problem in the heart that prevents it from supplying enough nutrients and oxygen to the brain. This cardiac problem may be a rhythm disturbance, a structural problem, or a structural problem that predisposes a patient to a rhythm disturbance. Cardiac syncope is estimated to be the cause of syncope in 15% of syncopal events.[3] Distinguishing cardiac syncope from the myriad of other syncopal etiologies can be challenging. For this reason, it is imperative for all healthcare providers to have a general understanding of cardiac syncope and how to recognize it.[4][5]

Syncope is caused by a temporary global failure of cerebral perfusion. When cardiac, the brain is not perfused because the heart is failing to generate enough cardiac output to send its freshly oxygenated blood to the brain. This is typically secondary to either a mechanical or structural cardiac defect or an arrhythmia that alters electrical conduction through the myocardium. Arrhythmias are recognized as the more common mechanism of the two. However, structural and mechanical abnormalities in the heart will often induce such arrhythmias. These processes are therefore often interrelated.

Syncope is a relatively common phenomenon encountered among patients of every age range, race, religion, and socioeconomic status. Cardiovascular disease is the second most common cause of syncope, with arrhythmias being far more common than structural diseases. Ventricular tachycardia alone is responsible for 11% of syncopal events. Cardiovascular syncope overall is far more prevalent in the elderly population than the younger population, with 10% to 30% of syncopal events in patients over 60 having a cardiac origin. Cardiovascular syncope is also more common in men than in women.[6]

Structural cardiac diseases are more prevalent among patients with comorbidities such as diabetes, hypertension, hyperlipidemia, and patients who smoke. Pre-excitation syndromes tend to be more common among women than men.[7]

All cases of cardiac syncope have the same general mechanism. When the heart fails to generate adequate cardiac output, the brain is inadequately perfused and temporarily malfunctions, leading to the syncopal event. Bradyarrhythmias lead to this final pathway because the heart is too slow to generate enough flow. Tachyarrhythmias force the heart to pump so fast that it lacks an adequate diastolic phase, leading to ineffective ventricular filling and reduced cardiac output.

Mechanical obstructions to blood flow and cardiac output will have similar effects but through multiple possible mechanisms. A chronic obstruction to forward blood flow out of the heart will lead to an increase in ventricular size and pressure. The increase in size leads to ventricular myocyte irritability, which can potentially induce arrhythmias. The increase in pressure can stimulate mechanoreceptors and induce a vagal response and secondary hypotension and bradycardia. This is in addition to the primary structural problem of the impeded forward blood flow. Obstructive pathologies, such as aortic stenosis, tumors, tamponade, and congenital hypertrophic cardiomyopathy can all follow this pathway, as can myocardial infarction and ischemia. Infarcted or ischemic ventricular tissue will have impaired contractility. Infarction of valves or chordae tendineae can lead to valve rupture, resulting in subsequent mechanical obstruction to forward flow or induction of retrograde blood flow. When cardiac tissue damage is present along with the conduction system, conduction blocks and other arrhythmias can result. Aortic dissection can induce myocardial infarction when the dissection extends into the coronaries supplying vital portions of the myocardium. A leaking or ruptured aortic dissection can also diminish cardiac output through induction of hypovolemia or tamponade (if aortic contents extend into the pericardium). Pulmonary hypertension and pulmonary emboli will lead to a blockade of flow through the pulmonary artery and a reduction in left-sided preload and subsequent cardiac output in addition to the primary potential symptom of hypoxia.[6] 152ee80cbc

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