Syncope. Medical students Medical students

Overview Syncope
Dr. Adenwali Hassan Ahmed:
(Mwn, Bsc-Medical Doctor, Bsc- Public Health Officer,
Msc-Gyn/Obest.

of 27
Introduction of Syncope
• Syncope is also known as fainting. This is a
temporary loss of consciousness with a quick
recovery.
• Syncope is caused by decreased cerebral blood
flow leading to transient loss of consciousness
and postural tone, associated with spontaneous
recovery.
• Most people don’t need follow-up treatment.
However, you need treatment for certain causes,
such as heart issues.

of 27
Overview
• Syncope (pronounced “sin-ko-pea”) is the
medical term for fainting or passing out.
• Fainting is a brief loss of consciousness due to a
drop in blood flow to the brain.
• It happens when you have a sudden, temporary
drop in the amount of blood that flows to your
brain.
• Most of the time, a harmless, short-term cause
makes you faint.
Pass out from weakness, physical or emotional distress due
to a loss of blood supply to the brain

of 27
Cont---
• Syncope can happen if you have:
– A sudden drop in blood pressure.
– A drop in your heart rate.
– Changes in the amount of blood in areas of
your body.

of 27
Cont---
• If you pass out, you’ll likely become conscious
and alert after a few seconds or minutes.
• However, you may feel confused or tired for a
bit.
• You can recover fully in minutes or hours.

of 27
Cont---
• Syncope can be a sign of a more serious
condition. It’s important to get treatment right
away after you have an episode of syncope.
• Most people can prevent problems with syncope
once they get an accurate diagnosis and proper
treatment.

of 27
Types of Syncope
1. Vasovagal syncope (also called
neurocardiogenic syncope). This is the most
common type of syncope. Nearly half of
syncope cases are the vasovagal type.
2. Situational syncope (a type of vasovagal
syncope). Situational syncope happens only
during certain situations that affect the nervous
system
3. Postural or orthostatic syncope (also called
postural hypotension). Upright standing position.

of 27
Cont---
4. Cardiac syncope (Cardiac syncope is a transient
loss of consciousness due to a defect, either
structural or electrical, which prevents the
generation of enough cardiac output to perfuse
the brain adequately.
5. Neurologic syncope (Neurologic syncope can
happen when you have a neurological condition
such as a seizure, stroke or transient ischemic
attack (TIA). Other less common conditions that lead
to neurologic syncope include migraines and normal
pressure hydrocephalus).

of 27
How common is syncope?
• Syncope is a common condition. It affects 3% of
men and 3.5% of women at some point in life.
• Syncope is more common as you get older and
affects up to 6% of people over age 75.
• The condition can occur at any age and happens
in people with and without other medical issues.

of 27
Symptoms of syncope
The most common syncope symptoms include:
• Nausea or vomiting
• Sweaty palms
• Blacking out
• Feeling lightheaded
• Falling for no reason
• Feeling dizzy
• Fainting, especially after eating or exercising
• Feeling unsteady or weak when standing
• Changes in vision, such as seeing spots or having tunnel
vision
• Headaches

of 27
Causes syncope
• Syncope or passing out, happens when you don’t
have enough blood flowing to your brain.
• There are many causes for this, depending on the
type of syncope.
• Many people have a medical condition they may
or may not know about that affects their nervous
system or heart.

of 27
Cont---
• You may also have a condition that affects blood
flow through your body and causes your blood
pressure to drop when you change positions (for
example, going from lying down to standing).

of 27
TYPES:
1. Vasovagal syncope causes
• Vasovagal syncope happens when you have a
sudden drop in blood pressure, which causes a
drop in blood flow to your brain.
• Occurs when the part of your nervous system
that regulates heart rate and blood pressure
malfunctions in response to a trigger, such as the
sight of blood. Your heart rate slows and the
blood vessels in your legs widen (dilate).
• It often occurs after standing for a while or under
emotional distress.

of 27
Cont---
• Normally, when you stand up, gravity makes blood
settle in the lower part of your body, below your
diaphragm.
• When that happens, your heart and autonomic
nervous system work to keep your blood pressure
stable.
• In vasovagal syncope, your heart rate and blood
pressure inappropriately decrease severely.
• This causes decreased blood flow to your brain and
leads to passing out.

of 27
2. Situational syncope causes
• Situational syncope happens only during certain
situations that affect your nervous system and lead
to syncope.
 Some of these situations are:
• Dehydration
• Intense emotional stress
• Anxiety
• Fear
• Pain
• Hunger

of 27
Cont---
• Use of alcohol or drugs.
• Hyperventilation (breathing in too much oxygen
and getting rid of too much carbon dioxide too
quickly).
• Coughing forcefully, turning your neck or
wearing a tight collar (carotid sinus
hypersensitivity).
• Urinating (micturition syncope)

of 27
3. Postural syncope causes
• Postural syncope (also called postural
hypotension or orthostatic
hypotension) happens when your blood pressure
drops suddenly due to a quick change in position,
such as standing up after lying down.
• Certain medications and dehydration can lead to
this condition.

of 27
Cont---
• People with this type of syncope usually have
changes in their blood pressure that cause it to
drop by at least 20 millimeters of mercury
(systolic/top number) and at least 10 millimeters
of mercury (diastolic/bottom number) when they
stand.

of 27
4. Cardiac syncope causes
• Cardiac syncope can occur if you have a heart or
blood vessel condition that affects blood flow to
your brain.
• These conditions can include:
– Abnormal heart rhythm (arrhythmia)
– Obstructed blood flow in your heart because of
your heart’s structure (hypertrophic
cardiomyopathy).

of 27
Cont---
– Blockage in your heart’s blood vessels
(myocardial ischemia).
– Valve disease.
– Aortic stenosis (narrowing).
– Blood clot.
– Heart failure
• If you have cardiac syncope, it’s important to see
a cardiologist for proper treatment.

of 27
5. Neurologic syncope causes
o Neurologic syncope can happen when you have a
neurological condition such as a seizure, stroke
or transient ischemic attack (TIA).
o Other less common conditions that lead to
neurologic syncope include Migraines
and normal pressure hydrocephalus.
An abnormal condition in which
cerebrospinal fluid collects in the ventricles of
the brain.

of 27
Consultation
• If you have syncope, you should see a provider who can
refer you to a syncope specialist for a complete evaluation.
• You may then have one or more tests to help
determine the cause of your syncope.
These tests check things like:
– The condition of your heart.
– How fast your heart beats (heart rate).
– The amount of blood in your body (blood volume).
– Blood flow when your body is in different
positions.

of 27
Syncope
• Definition: sudden and transient loss of
consciousness and loss of postural tone
accompanied by a rapid return to baseline
Pathophysiology: dysfunction of both
cerebral hemispheres or the brainstem
(reticular activating system) usually from
hypo-perfusion.
The Reticular Activating System (RAS) is a
neural system involved in the regulation of
sleep–wake cycles, arousal, alertness, attention,
and motor fight-or-flight responses

of 27
Cont---
 Cardiac:
• Rhythm Disturbances: Dysrhythmias,
Pacemaker issues
• Structural: outflow obstruction (aortic stenosis,
hypertrophic obstructive cardiomyopathy
(HOCM), Myocardial infarction (MI))
• Other CV diseases: Dissection,
Cardiomyopathy, PE (Pulmonary Embolism)

of 27
Cont---
• Non- Cardiac:
Reflex (neurally mediated)
– Vasovagal: sensory or emotional reactions
– Orthostatic: postural related, volume
depletion
– Situational: coughing, straining
– Carotid sinus pressure: shaving
– Subclavian steal: arm exercises

of 27
Cont---
 Medications
• Calcium channel blockers (eg; Atenolol). B-blockers
(eg; Amlodipine), Digoxin, Insulin.
• Prolonging meds, Drugs of abuse.
Focal CNS - (A focal neurologic deficit is a
problem with nerve, spinal cord or brain function)
Hypoperfusion-
• Hypoxia, epilepsy, dysfunctional brainstem

of 27
Assessment
• History: syncope character (ask about exertion!),
cardiac risk factors,
• Comorbidities, Medication/drug use, family
history
• Orthostatic symptoms Rule out
seizure/stroke/head injury.

of 27
Cont---
• Physical Exam:
– Cardiac exam (murmurs, rate)
– CNS exam.

of 27
Investigations
• Labs:
– CBC
– Glucose, lytes,
– Blood urea nitrogen (BUN), CK, B-Hcg
This test measures the amount of creatine kinase (CK) in the blood. High levels
of CK can indicate damage or disease of the skeletal muscles

of 27
Cont---
 ECG rates:
o Tachydysrhythmias- Tachydysrhythmias, or
tachycardias, are classified as dysrhythmias
where the heart rate is greater than 100 beats
per minute.
oThere are several different types of
tachydysrhythmias that include: Sinus tachycardia
(ST): regular heart rhythm with a fast heart rate
Sinus tachycardia is a regular cardiac rhythm in which
the heart beats faster than normal

of 27
Cont---
o Bradyarrhythmias- is an abnormally slow
resting heart rate, typically below 60 beats per
minute.
o A too-slow heart rhythm can result from
changes in the heart's electrical system, a heart
defect or other medical conditions.

of 27
Management
• General
– ABCs, monitors, oxygen, IV access
• Cardiogenic Syncope
– Consult cardiology for workup, pacemaker
consideration
• Non-Cardiogenic Syncope
– Benign causes or low-risk syncope: discharge
with general practitioner follow-up
– Consider outpatient cardiac workup

of 27
Medicines for syncope include:
o Midodrine
o Fludrocortisone (Astonin or Florinef)
Midodrine 5mg tablets is used to treat low blood pressure
(hypotension).
It works by stimulating nerve endings in blood vessels,
causing the blood vessels to tighten.
 Fludrocortisone, is a corticosteroid used to treat
adrenogenital syndrome, postural hypotension and adrenal
insufficiency. In adrenal insufficiency, it is generally taken
together with hydrocortisone.
 Fludrocortisone The usual dose is 0.1 mg.

of 27
Cont---
• Midodrine is used to treat orthostatic
hypotension (sudden fall in blood pressure that
occurs when a person assumes a standing
position).
• Midodrine is in a class of medications called
alpha-adrenergic agonists.
– It works by causing blood vessels to tighten, which
increases blood pressure

of 27
What is the prognosis of patients with
syncope?
12 Month Prognosis for Patients Presenting with Syncope
Group Mortality Incidence of
Sudden Death
Cardiac related 30% 24%
Non cardiac related 12% 4%
Unknown causes
3% 3%

of 27
Summary for Syncope

Syncope. Medical students Medical students

More Related Content

Similar to Syncope. Medical students Medical students

More from Dr. Adenwali Hassan

Recently uploaded

Syncope. Medical students Medical students

Editor's Notes