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SYNCOPE

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by

Nasira Sultana

on 17 January 2013

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Transcript of SYNCOPE

SYNCOPE DEFINITION Temporary impairment of consciousness due to transient global cerebral hypoperfusion. SYNCOPE vs. SEIZURE CAUSES OF SYNCOPE Characterised by a rapid onset, short duration and usually a spontaneous rapid and complete recovery. Nasira Sultana Symptom not a disease! CARDIOGENIC CAUSES TAKING A HISTORY Funny turn Fit Faint Dizzy Light-headed Blackout Legs gave way Was it really syncope? Collapse Passed out LOC
Duration
Prodrome
Urinary incontinence
Tongue-biting
Abnormal posturing/movement
serious injury
Recovery
Post-ictal response
Amnesia Syncope

YES
Seconds
Autonomic
Possible
Rare
Rare
Less common
Minutes
No
No Seizure

YES
Minutes
Aura, dejavu, jaimevu
Common
Common
Yes
Common
Hours-days
Yes
Yes COLLATERAL HISTORY CARDIOGENIC NON-CARDIOGENIC Inability to maintain cardiac output Arrhythmias Ventricular outflow obstruction -Paroxysmal SVT, VT
-Atrioventricular conduction disease: heart block, sick sinus
-Inherited arrhythmias- Long QT, Brugada Syndrome
-Iatrogenic: drugs, pacemaker dysfunction -Aortic stenosis
-HOCM
-Acute MI
-PE
-Acute aortic dissection
-Pericardial tamponade
-Atrial myxoma NON-CARDIOGENIC CAUSES REFLEX 'NEUROGENIC' SYNCOPE: -VASOVAGAL SYNCOPE: Reflex bradycardia + peripheral vasodilation provoked by a stimulus -SITUATIONAL SYNCOPE: cough, sneeze, GI, micturition -ORTHOSTATIC: Primary autonomic failure, diabetic neuropathy, Postural hypotension, Drugs, -CAROTID SINUS HYPERSENSITIVITY NON-CARDIOGENIC CAUSES cont. CEREBROVASCULAR Subclavian Steal Syndrome PSYCHOGENIC Factitious
Panic attacks: anxiety, hyperventilation
Substance abuse INVESTIGATIONS CARDIOVASCULAR & NEUROLOGICAL EXAMINATION LYING AND STANDING BP Bloods: U&E, FBC, glucose
ECG
CXR INITIAL INVESTIGATIONS SPECIAL TESTS MANAGEMENT CARDIOGENIC - Anticoagulation, secondary prevention of risk factors
- Arrythmias: rate control, rhythm control, ablation, pacemaker
- Ventricular outflow: valve replacement, structural correction, pacemaker, etc VASOVAGAL - No further management, avoidance of trigger, patient education
- If tilt-table shows drop in BP >30mmHg (vasodepressor), consider beta blockers
- If tilt-table shows bradycardia (cardioinhibitory), consider pacing CARDIAC SYNCOPE:
-exercise ECG, 24 hour ECG
-ECHO, TOE
-Coronary angiography
-ATP test REFLEX SYNCOPE:
-Tilt-table test
-Carotid sinus massage OTHER:
-EEG, sleep EEG
-CT-MRI brain ORTHOSTATIC - Adjust antihypertensives, adequate fluid intake
- Mineralocorticoids REFLEX 'NEUROGENIC' SYNCOPE cont. San Fransisco Syncope Rule:
-Abnormal ECG
-SOB
-Hct <30%
-SBP<90mmHg
-CCF
OESIL score
EGSYS score
Full transcript