Your SlideShare is downloading. ×
  • Like
  • Save
Syncope (nx power lite) /certified fixed orthodontic courses by Indian dental academy
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.


Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Syncope (nx power lite) /certified fixed orthodontic courses by Indian dental academy


The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit ,or call

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads


Total Views
On SlideShare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. SYNCOPE INDIAN DENTAL ACADEMY Leader in continuing dental education 1
  • 2. This is a story of a patient who fainted in a dental chair… 2
  • 3. What is SYNCOPE.. •Definition •Predisposing factors •Pathophysiology and clinical manifestations. •Management •Drugs used in management 3
  • 4. Definition  Greek word `SYNKOPTEIN` - to cut or break  Syncope is defined as transient loss of consciousness due to reduced cerebral blood flow.  A transient, self limited loss of consciousness usually leading to falling. The onset of syncope is relatively rapid, and the subsequent recovery is spontaneous, complete, and relatively prompt. 4
  • 5. Types of Syncope  Vaso-Vagal syncope  Cardiogenic syncope  Postural syncope  Carotid Sinus syncope  Reflex syncope 5
  • 6. Causes  Cardiogenic syncope Insuffficient pumping action of heart - Arrythmia - Structural cardiac disease e.g. valvular disease, obstructive cadiomyopathy  Postural syncope - Drugs e.g. antidepressants, beta blockers - Fluid depletion, prolonged standing 6
  • 7.  Insufficient vascular tone -Autonomic failure - Primary e.g. multiple system atrophy - Secondary e.g. diabetic & other neuropathy - Drugs e.g. antidepressants, beta blockers  Insufficient circulatory volume - Hypovolemia e.g. Addisons disease, hemorrhage, diuretics  Reflex Syncope - Inappropriate neural control: - cough, micturition, sneezing: reflex vagal stimulation 7
  • 8. Predisposing Factors  Psychogenic factors Fright Anxiety Emotional stress Pain esp. unexpected &sudden Sight of blood or surgical instrument  Non-psychogenic factors Erect sitting or standing posture Hunger or missed meal Poor physical condition Hot, humid, crowded environment Exhaustion 8
  • 9. PATHOPHYSIOLOGY & CLINICAL MANIFESTATIONS ENGLE classified mechanisms producing syncope into 4 categories:  Inadequate delivery of blood / O2 to brain ∴ ↓ed cerebral metabolism.  General / local metabolic deficiencies ∴ ↓ed cerebral metabolism  Direct /Reflex effects on that part of CNS that regulates consciousness and equilibrium.  Psychic mechanisms affecting levels of consciousness with their respective mechanisms of actions. 9
  • 10. PATHOPHYSIOLOGY & CLINICAL MANIFESTATIONS OF VASODEPRESSOR SYNCOPE: Grouped into 3 different phases: Pre-Syncope Syncope Post-Syncope 10
  • 11. Pre-Syncope Phase STRESS Emotionally triggered ex: fear Sensorially triggered ex: unexpected pain Release of CATECHOLAMINES in blood (Epinephrine and Norepinephrine) ‘FIGHT-OR-FLIGHT’ response 11
  • 12. ‘FIGHT-OR-FLIGHT’ response ↓ in peripheral vascular resistance. ↑ in blood flow to skeletal muscles. MUSCULAR ACTIVITY OCCURS Blood from muscles pumped back to heart MUSCULAR ACTIVITY DOES NOT OCCUR Pooling of blood in muscles No peripheral pooling of blood Decreased blood return to heart BP remains at / alone baseline level Signs and symptoms of vasodepressor syncope do not develop Decrease in circulating blood volume Drop in arterial BP Decrease in cerebral blood flow. 12
  • 13. Compensatory Mechanisms  Baroreceptor reflex Carotid sinus Hering N Aortic Arch Aortic N IX N XN NTS VMC Spinal Centre Blood Vessel Nucleus Ambiguus XN Heart 13
  • 14. What to Look For?? Early: 1.Feeling of warmth. 2.Loss of color, pale/ ashen-gray skin. 3.Heavy perspiration. 4.complaints of feeling bad/faint. 5.Nausea Late: 1. Pupillary dilatation. 2. Yawning. 3. Hyperpnoea 4. Visual disturbances. 5. Dizziness. 6. Loss of consciousness 14
  • 15. SYNCOPE PHASE… (Did you know??)  CRITICAL LEVEL of cerebral blood flow for the maintenance of consciousness. 30ml of blood / 100gm of brain tissue/ min.  NORMAL VALUE of blood flow is 50-55 ml/100gm/min. - Equivalent to 70mm Hg SBP in normotensive patients. - Reached with SBP>70mm Hg in patients with atherosclerosis and high BP.  Human brain uses- 20% of total body O2 - 6.5% of total glucose consumed by body.  For a normal individual in supine position - Cerebral blood flow – 750ml/min. 15
  • 16. Clinical Features:  Breathing -Irregular, jerky and gasping.  Dilation of pupils.  Cerebral ischemia -     Convulsive movements. Muscular twitching of hands, legs or facial muscles. Bradycardia ↓ BP Pulse-weak and thready. Loss of consciousness + Generalized muscular relaxation. ↓ Partial / complete airway obstruction 16
  • 17. For recovery ↓ Remove factor that precipitated episode. Place victim in supine position with legs elevated slightly. ↓ Improvement in venous return to heart Increase in blood flow to brain. ↓ Cerebral blood flow exceeds critical level necessary for consciousness. 17
  • 18. MANAGEMENT OF VASOVAGAL SYNCOPE  As soon as signs and symptoms are noted- Terminate all procedures ↓ Place patient in supine position with legs slightly elevated and back of dental chair at 10° i.e. TRENDELENBURG POSITION ↓ muscular movement aids in return of blood from periphery. ↓ O2 if necessary (monitor vital signs) ↓ Aromatic ammonia vapours crushed and held under patients nose. ↓ Speeds recovery by direct stimulation of respiratory center Note –if no response-- BASIC LIFE SUPPORT 18
  • 19. Pregnant woman in supine position ↓ Gravid uterus presses on inferior vena cava. ↓ ∴CAVAL COMPRESSION / SUPINE HYPOTENSION SYNDROME ↓ Acute fall in cardiac output ↓ Recovery delayed 19
  • 20. Clinical Features      Pallor, nausea, weakness and sweating. Disorientation and confusion. Increase in arterial BP Heart rate – returns to baseline level. Pulse becomes stronger. Tendency for patient to faint again may persist for many hrs if patient assumes a sitting position or stands too soon. 20
  • 21. DEFINITITIVE CARE Administration of O2. Monitoring of vital signs – BP, HR, Respiratory rate. Performing additional procedures:     Loosening of tight clothes such as ties, collars. Ammonia vapours – stimulates both breathing and muscular movements. Cold towel over patient’s forehead. Blanket if patient is shivering. If bradycardia persists – Atropine (i.v./i.m.)  Reassure patient.     21
  • 22. POST-SYNCOPE STAGE  Determine precipitating factors and prevent recurrence of syncope.  No dental treatment for next 24 hours.  Arrange for patient to be escorted home. 22
  • 23. DRUGS USED IN MANAGEMENT OF VASOVAGAL SYNCOPE  Atropine given if bradycardia persists competitively inhibits acetyl-choline Dose - 0.5 mg i.v./i.m./ s.c.  Dextrose – Restores blood glucose levels. Dose – 1-2 ampules of 5% dextrose i.v.  Midoprine HCl – Vasopressor α1-agonist ↓ acts on receptor of arteriolar and venous vasculature ↓ ∴↑ in vascular tone ↑ in BP Dose – 10mg tid  Beta blockers – propranolol, atenolol 23
  • 24. ….. and then, the doctor and the patient lived happily ever after. 24