SYNKOPA

Doporučené postupy

pro diagnostiku a léčbu

M. Táborský

27.11.2015

Poslední verze DP: 2009

European Heart Journal (2009) 30, 2631–2671; doi:10.1093/eurheartj/ehp298

Update 2012

J Am Coll Cardiol 2012;59:1583-91

Syncope Unit: EHRA/HRS

Definice synkopy:

o Synkopa je přechodná ztráta vědomí ( Transient Loss of Consciousness - T-LOC)

díky přechodné globální cerebrální

hypoperfuzi charakterizovaná

1. náhlým vznikem

2. krátkou dobou trvání

3. spontánní kompletní úpravou

Figure Legend:

Classification of Syncope According to Etiology

AV = atrioventricular; BP = blood pressure; ECG = electrocardiogram; ESC = European Society of Cardiology; ISSUE = International Study on

Syncope of Uncertain Etiology.

Nový koncept klasifikace synkop 2012

Brignole M: J Am Coll Cardiol. 2012;59(18):1583-1591. doi:10.1016/j.jacc.2011.11.056

University of Utah

The Faint-Algorithm as Currently Used at the University of Utah

The case of a patient referred for unexplained syncope without ECG abnormalities or structural heart disease is shown. After all of the essential information obtained from history, physical examination, 12-lead ECG, echocardiogram, and appropriate blood tests was entered, the software determined the short-term risk and need for admission (A, red arrow). If the decision is made not to admit the patient, the software uses the available information to verify whether a certain diagnosis can be made or not as defined in the recent ESC guidelines.

If no diagnosis can be made, the software suggests the most likely diagnosis (B, red arrow) and recommends the appropriate tests to be performed in a sequential manner, resulting in cost-effective practices (C, red arrow). At any step, the health care provider is given the opportunity to agree or disagree with the software recommendation.

In addition, he or she has access to the most recent educational material, including the guidelines, by clicking on the “?” button. AHA = American Heart Association; TIA = transient ischemic attack; other abbreviations as in Figure 1.

Webové algoritmy vyšetřování synkopy

J Am Coll Cardiol. 2012;59(18):1583-1591. doi:10.1016/j.jacc.2011.11.056

Diagnostické testy

Figure Legend:Time-Dependent Cumulative Diagnostic Yield of ILR

The actuarial curve with its 95% confidence intervals is presented. ILR = implantable loop recorder.

Úloha ILR v detekci příčiny synkopy

J Am Coll Cardiol. 2012;59(18):1583-1591. doi:10.1016/j.jacc.2011.11.056

Terapie

Koncept Syncope Unit

Proč vytvářet SU