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Syncope

Syncope. Jeffrey Chen 7/6/09. Syncope. Definition: Abrupt loss of consciousness and postural tone that reverses without intervention. Differential Diagnosis. Cardiac Non-Cardiac Neurological Systemic/Metabolic Psychiatric Other Neurocardiac (Vasovagal). Cardiac.

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Syncope

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  1. Syncope Jeffrey Chen 7/6/09

  2. Syncope • Definition: Abrupt loss of consciousness and postural tone that reverses without intervention.

  3. Differential Diagnosis • Cardiac • Non-Cardiac • Neurological • Systemic/Metabolic • Psychiatric • Other • Neurocardiac (Vasovagal)

  4. Cardiac • Structural Abnormalities • Cardiomyopathy (hypertrophic, restrictive, dilated) • Aortic Stenosis • Myocarditis • Pulmonary Hypertension • Postop Congenital heart disease (ex. Fontan) • Congenital coronary abnormality • Electrical Disorders • Long QT syndrome • WPW syndrome • AV block • Ventricular tachycardia • Ventricular Fibrillation

  5. Non Cardiac • Neurologic • Seizures • Migraine Headaches • Transient Ischemic Attacks • Acute Vestibular Syndrome

  6. Non Cardiac • Systemic/Metobolic • Hypoglycemia • Electrolyte Abnormalities • Drugs/Toxins • Carbon Monoxide • Endocrinopathies

  7. Non-Cardiac • Psychiatric • Panic Attacks/Hyperventilation • Conversion Reaction • Depression

  8. Non-Cardiac • Other • Situational syncope • Cough • Micturation • Defecation • Neck stretching • Hair grooming • Breath Holding Spells

  9. Neurocardiac (Vasovagal) • Most Common variety of syncope • 25% precipitated by acute illness and anemia or by noxious stimuli (fear, pain, exhaustion) • Prodromal symptoms • nausea/vomiting • Lightheadedness/vertigo • Visual disturbances • Sweating • SOB • Mental alertness following the episode helpful in distinguishing from seizure

  10. Neurocardiac (vasovagal) cont. • Caused by: 1. venous pooling which 2. leads to vigorous contractions of an underfilled ventricle 3. This stimulates ventricular mechanoreceptors which produces a paradoxic withdrawal of sympathetic activity 4. leading to hypotension, bradycardia or both

  11. Management • Goal is to increase circulating volume • Increased fluid intake • Mention potential diuretic effect of caffeine • Use more salt or salt tablets • Elastic Stockings • Stress importance of “paying attention” to the warning signs • Avoid Noxious stimuli • Lying down before losing consciousness

  12. Management • Medications • Mineralocorticoids (hydroflurocortisone) • Beta-blockers • Alpha-agonists • Serotonin agonists

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