‘patients with suspected syncope should be investigated by cardiologists’
DESCRIPTION
‘Patients with suspected syncope should be investigated by cardiologists’. Antagonist Maw Pin Tan Locum Consultant Physician Falls and Syncope Service Royal Victoria Infirmary Newcastle upon Tyne. http://www.nice.org.uk. Guideline Development Group. NICE guidelines for TLoC. - PowerPoint PPT PresentationTRANSCRIPT
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‘Patients with suspected syncope should be investigated by
cardiologists’
Antagonist
Maw Pin TanLocum Consultant Physician
Falls and Syncope ServiceRoyal Victoria InfirmaryNewcastle upon Tyne
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Guideline Development Group
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NICE guidelines for TLoC
• 1.2.3.1 Refer all people with TLoC (apart from the
exceptions below) for a specialist cardiological
assessment
Exceptions are:
• people with a firm diagnosis, after the initial assessment, of:– uncomplicated faint – situational syncope – orthostatic hypotension
• people whose presentation is strongly suggestive of epileptic seizures.
cardiovascular
by the most appropriate local service
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Points
• Syncope is a problem of older people• Who is best skilled to conduct the
assessments?• Overlap between epilepsy and syncope• Overlap between falls and syncope• Most common cause– neurally-mediated
syncope
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Incidence of Syncope
Soteriades et al. NEJM 2002
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1.3.1.1 Carry out a specialist cardiovascular assessment as follows.
• Reassess the person’s: − detailed history of TLoC including any previous events− medical history and any family history of cardiac disease or an
inherited cardiac condition− drug therapy at the time of TLoC and any subsequent changes.
• Conduct a clinical examination, including full cardiovascular examination and, if clinically appropriate, measurement of lying and standing blood pressure.
• Repeat 12-lead ECG and obtain and examine previous ECG recordings.
WHO?
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Overlap between Epilepsy and Syncope
• Syncope presenting as epilepsy1
– 74 recurrent ‘seizure-like’ activity– 26% HUT+, 10% CSM+– 42% alternative diagnosis
• Epilepsy presenting as syncope2
– Ictal bradycardia1. Zaidi et al JACC 20002. Tinuper et al Brain 2001;124:2361-71
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Overlap between Falls & Syncope
• CSH – unexplained falls1
– Drop attacks2
• Amnesia for LOC3
McIntosh et al. Age Ageing 1993
1. Richardson et al PACE 1997
2. Parry et al JAGS 20053. Parry et al Heart 2005
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Causes of Syncope
Parry & Tan BMJ 2010
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