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Syncope
Fainting within the first 20 seconds of arising from lying or
sitting almost always have orthostatic hypotension
...
Define
• Syncope
– transient
– loss of consciousness
– rapid onset
– short duration,
– spontaneous recovery,
– associated ...
Aim
 Structural substrate ?
 Risk factors?
 Syncope spell detail?
 Induce syncope under controlled conditions(Tilt tab...
Tests
Beyond an electrocardiogram are not usually needed
The most commonly used tests
 implantable loop recorders-30-40...
History
• 4 distinct phases
(1) the context before symptoms;
(2) prodromal symptoms
(3) how the patient felt afterward
(4)...
Physical Examination
• No physical findings are completely diagnostic of syncope or its
causes
– aortic stenosis
– hypertr...
High risk markers for syncope
Future syncope
Risk score
Diagnostic Tests
• Positive - 1%-4%
12-lead ECG
• Low detection
• Inexpensive
• Detects
– Conduction disease
– repolarization abnormalities
– QT prolongation/...
ECG monitoring
• Arrhythmic
• Low detection rate
• Telemetry
– Structural heart disease
– High risk of arrhythmic events
–...
Echocardiography
• Structural heart disease.
Tilt Table test
• The most common provocative test
• The goal is to trigger clinically reminiscent presyncope or
syncope
•...
To avoid syncope during MRI
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Syncope

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Syncope

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Syncope

  1. 1. Syncope Fainting within the first 20 seconds of arising from lying or sitting almost always have orthostatic hypotension  1%-2% of emergency  30%-50% of 1-2% are admitted  Most common is vasovagal syncope-50%  orthostatic hypotension -7%  Cardiac syncope -7%  Structural heart disease - 3%  The 30-day mortality - 0.7%,  30-day adverse outcome-4.5%
  2. 2. Define • Syncope – transient – loss of consciousness – rapid onset – short duration, – spontaneous recovery, – associated with at least 1 of – (1) Specific forms of syncope (like vasovagal syncope); and/or – (2) the absence of features suggesting another cause of loss of consciousness (like epileptic convulsions or hypoglycemia).
  3. 3. Aim  Structural substrate ?  Risk factors?  Syncope spell detail?  Induce syncope under controlled conditions(Tilt table)
  4. 4. Tests Beyond an electrocardiogram are not usually needed The most commonly used tests  implantable loop recorders-30-40% diagnosis in 2-3 yrs Tilt table testing  Neither are needed most of the time  A good history provides more useful and more accurate information in most
  5. 5. History • 4 distinct phases (1) the context before symptoms; (2) prodromal symptoms (3) how the patient felt afterward (4)Try to get a bystander • Vasovagal syncope and orthostatic vs from arrhythmic • Strenuous exertion –Arrhythmias
  6. 6. Physical Examination • No physical findings are completely diagnostic of syncope or its causes – aortic stenosis – hypertrophic cardiomyopathy – dilated left ventricle – carotid sinus supersenistivity, – orthostatic hypotension.
  7. 7. High risk markers for syncope
  8. 8. Future syncope
  9. 9. Risk score
  10. 10. Diagnostic Tests • Positive - 1%-4%
  11. 11. 12-lead ECG • Low detection • Inexpensive • Detects – Conduction disease – repolarization abnormalities – QT prolongation/abbreviation, – ischemic heart disease – ventricular hypertrophy – Brugada, ARVD – Cardiomyopathy –
  12. 12. ECG monitoring • Arrhythmic • Low detection rate • Telemetry – Structural heart disease – High risk of arrhythmic events – 72-hour :16% – 1 month -12% • Loop recorders : 30%-40% of patients are detected over 2-3 years.
  13. 13. Echocardiography • Structural heart disease.
  14. 14. Tilt Table test • The most common provocative test • The goal is to trigger clinically reminiscent presyncope or syncope • Result of hypotension or bradycardia or both
  15. 15. To avoid syncope during MRI

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