Download - Icm Syncope
SyncopeVonny F. Goenawan
Siloam Hospital Lippo Karawaci
Definition of syncope
Transient loss of consciousness with an inability to maintain postural tone
followed by spontaneous recovery
Transient disruption of cerebral perfusion that results from decrease of cardiac output, profound vasodilation, or both
Syncope occurs due to
Accounts for 3% of ER visits
Accounts for 1-6% hospital admission
Increase incidence with advancing age
Common problem
Some causes of syncope are potentially fatal
sincope
Syncope must be differentiated from other non syncopal conditions which
cause a transient loss of consciousness
Cardiac arrthymias as a primary cause◦Bradyarrhythmias
Sinus node disease AV nodal disease Pacemaker dysfunction Drug induced
◦Tachyarrhythmias VT, torsade de pointes
Cardiac syncope
14%
Structural cardiac or cardiopulmonary disease◦ Valvular heart disease◦ Acute MI or ischemia◦ Pericardial disease/ tamponade◦ Pulmonary embolus/pulmonary hypertension◦ Obstuctive cardiomyopathy
4%
Neurally mediated reflex syncope (NM)
1. Carotid sinus syncope ( head turning, shaving)
2. Situational faint • Coughing/sneezing• GI stimulation – defecating, swallowing• Micturation
3. Vasocagal *common faint*• Also called neurocardiogenic• Often situational
Non Cardiac syncope
24%
- Upon positional change neurohormonal events maintain cerebral perfusion
- normally decreased venous return and subsequent decreased left ventricular filling
increase sympathetic tone
- - overly sensitive left ventricular response misinterpret hypercontractility as volume overload
inhibit sympathetic stimulation hypotension, bradychardia, syncope
Increased pressure in carotid sinus parasympathetic stimulation
syncope
Orthostatic Automonic failure
◦Primary autonomic dysfunction Pure autonomic failure Parkinson’s
◦Secondary autonomic dysfunction Diabetic neuropathy Drugs
◦Volume loss Internal bleeding, diarrhea
Non Cardiac Syncope
11%
Cerebrovascular Almost never the cause of true
fainting Vascular steal syndromes
Non Cardiac Syncope
Physical examination
History of syncope after head turning, shaving or while wearing a tight collar, older patients with unexplained presyncope or falls, negative cardiovascular and neurologic investigations.
With patient supine massage each carotid 5-10 secs while monitoring BP and HR
Positive response is asystole of 3 seconds or drop in systolic BP of 50 mmHg
Non spesific – 25% of nonsyncopal elderly patients will have positive response
Carotid sinus syndrome
Tilt patient passive (60 degrees, 45 minutes) in absence of pharmacologic provocation
Administer Isoprotenol, nitroglycerin, tilt again for 10 minute
Positive results reproduction of patient’s typical syncopal symptoms with hypotension, bradycardia or both
Tilt table testing
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