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    L1 - Syncope

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    Muthukumaran
    This document defines and describes syncope (transient loss of consciousness), its types, causes, symptoms, diagnosis, and treatment. It notes that syncope can be neurally-mediated (most common), cardiac-related, or due to orthostatic hypotension. Neurally-mediated syncope includes vasovagal and situational reflex causes. Cardiac syncope may result from arrhythmias or structural heart issues. Diagnosis involves ECG, echocardiogram, Holter monitor, and tilt table testing. Treatment depends on the underlying cause but may include fluid/salt intake, medication, cardiac pacing or ablation, and lifestyle changes.

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    L1 - Syncope

    Uploaded by

    Muthukumaran
    45 views5 pages
    This document defines and describes syncope (transient loss of consciousness), its types, causes, symptoms, diagnosis, and treatment. It notes that syncope can be neurally-mediated (most common), cardiac-related, or due to orthostatic hypotension. Neurally-mediated syncope includes vasovagal and situational reflex causes. Cardiac syncope may result from arrhythmias or structural heart issues. Diagnosis involves ECG, echocardiogram, Holter monitor, and tilt table testing. Treatment depends on the underlying cause but may include fluid/salt intake, medication, cardiac pacing or ablation, and lifestyle changes.

    Original Description:

    Notes on syncope

    Original Title

    L1 - syncope

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    This document defines and describes syncope (transient loss of consciousness), its types, causes, symptoms, diagnosis, and treatment. It notes that syncope can be neurally-mediated (most common), cardiac-related, or due to orthostatic hypotension. Neurally-mediated syncope includes vasovagal and situational reflex causes. Cardiac syncope may result from arrhythmias or structural heart issues. Diagnosis involves ECG, echocardiogram, Holter monitor, and tilt table testing. Treatment depends on the underlying cause but may include fluid/salt intake, medication, cardiac pacing or ablation, and lifestyle changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    45 views5 pages

    L1 - Syncope

    Uploaded by

    Muthukumaran
    This document defines and describes syncope (transient loss of consciousness), its types, causes, symptoms, diagnosis, and treatment. It notes that syncope can be neurally-mediated (most common), cardiac-related, or due to orthostatic hypotension. Neurally-mediated syncope includes vasovagal and situational reflex causes. Cardiac syncope may result from arrhythmias or structural heart issues. Diagnosis involves ECG, echocardiogram, Holter monitor, and tilt table testing. Treatment depends on the underlying cause but may include fluid/salt intake, medication, cardiac pacing or ablation, and lifestyle changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    Lesson - 1

    Syncope

    Summary
    1. Definition
    2. Symptoms
    3. Types
    4. Causes
    5. Differential diagnosis
    6. Investigation
    7. Treatment

    Definition:

    Syncope is defined as transient loss of consciousness due to diminished cerebral


    perfusion(blood supply).

    Symptoms:

    1. Light headedness
    2. Visual blurring
    3. Dizziness
    4. Sweating
    5. Nausea

    Types:

    1. Neurally mediated (MOST COMMON)


    a. Vasovagal syncope
    b. Situational reflex syncope
    2. Cardiac syncope (SECOND MOST COMMON)
    a. Stokes-Adams syncope - due to atrioventricular block

    1
    3. Orthostatic hypotension

    Causes:

    Neurally mediated :

    1. Vasovagal
    2. Situational reflex
    a. Cough
    b. Sneeze
    c. Airway instrumentation
    d. Postmicturition syncope
    e. Swallow syncope
    f. Git instrumentation
    g. Rectal examination
    h. Defecation syncope
    i. Carotid sensitivity
    j. Carotid sinus massage

    Cardiac syncope :

    1. Arrhythmia
    a. Sinus node infection
    b. Sinus bradycardia
    c. Heartblocks
    d. Ventricular and supraventricular tachycardia
    2. Cardiac structural disease
    a. Aortic stenosis
    b. Left ventricular dysfunction
    c. Hypertrophic obstructive cardiomyopathy
    d. Pericardial effusion and tamponade

    Orthostatic hypertension :

    1. Volume depletion

    2
    2. Iatrogenic (drud induced)
    3. Primary autonomic failure due to idiopathic central and peripheral
    neurodegenerative diseases
    a. Parkinson’s disease
    b. Multiple system atropy( Shy-Drager syndrome)
    c. Secondary autonomic failure due to autonomic peripheral
    neuropathies
    d. Diabetes
    e. Amyloidosis
    f. Autonomic neuropathies

    Differential diagnosis:

    1. Anxiety
    2. Hypoglycaemia
    3. Seizures
    4. Hysterical fainting

    Investigation:

    Diagnose:

    ● ECG
    ● echocardiography
    ● Holter ECG
    ● electrophysiological studies

    Confirmation - Upright tilt test

    For neurological cause diagnosis

    ● EEG
    ● CT
    ● MRI

    3
    Treatment:

    Neurally mediated syncope:

    1. Plasma volume expansion (fluids and salts)


    2. Avoidance of precipitating factors
    3. Reassurance

    Orthostatic hypotension:

    1. Staged movement (supine to upright position)


    2. Raising the head of the bed
    3. Increased dietary fluid and salts
    4. Use of fludrocortisone acetate and vasoconstricting agents (midodrine,
    pseudoephedrine)

    Cardiac syncope:

    1. Anti-arrhythmia drugs
    2. Radiofrequency ablation
    3. Cardiac pacing (AV block and sinus node disease)
    4. Cardioverter defibrillator implantation (atrial and ventricular arrhythmia)

    Action during syncope:

    ● Supine position, head tilted to side - maximise cerebral blood flow,


    avoid aspiration
    ● Peripheral stimulation (water sprinkle to face)
    ● Not allowed to rise till weakness persists

    Patient instruction:

    ● Avoid situation that causes syncope

    4
    ● During premonitory symptoms, assume recumbent position
    ● In recurrent syncope, avoid ladders, swimming alone, driving, operating
    machines

    Stokes-Adams syncope:

    Stokes-Adams syndrome is a condition where you suddenly feel faint and can pass
    out. It’s caused by a change in your heart rate.

    This affects how much blood flows to your brain because your heart either beats too
    slowly or too quickly. That’s what causes you to faint.

    It’s also known as Adams-Stokes disease or Stokes Adams attacks.

    Holter ECG:

    A Holter monitor (often simply Holter) is a type of ambulatory


    electrocardiography device, a portable device for cardiac monitoring (the
    monitoring of the electrical activity of the cardiovascular system) for at least
    24 to 72 hours (often for two weeks at a time).

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