syncope vonny

7/22/2019 Syncope Vonny

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Vonny F. Goenawan

Siloam Hospital Lippo Karawaci


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Transient loss of consciousness with aninability to maintain postural tone followedby spontaneous recovery


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Transient disruption of cerebral perfusionthat results from decrease of cardiac output,profound vasodilation, or both

Syncope occurs due to


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Accounts for 3 of ERvisits

Accountsfor 1-6hospital admission

Increase incidencewith advancing age

Commonproblem

Some causes of syncopeare potentially fatal

sincope


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Syncope must be differentiated from othernon syncopal conditions which cause atransient loss of consciousness


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Cardiac arrthymias as a primary cause Bradyarrhythmias

Sinus node disease

AV nodal disease

Pacemaker dysfunction

Drug induced

Tachyarrhythmias

VT, torsade de pointes

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Structural cardiac or cardiopulmonarydisease Valvular heart disease

Acute MI or ischemia Pericardial disease/ tamponade

Pulmonary embolus/pulmonary hypertension

Obstuctive cardiomyopathy

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Neurally mediated reflex syncope (NM)1. Carotid sinus syncope ( head turning,

shaving)

2. Situational faint Coughing/sneezing

GI stimulation defecating, swallowing

Micturation

3. Vasocagal *common faint* Also called neurocardiogenic

Often situational

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-Upon positional change neurohormonal eventsmaintain cerebral perfusion-normally decreased venous return and subsequent

decreased left ventricular filling increase sympathetic tone-- overly sensitive left ventricular response misinterprethypercontractility as volume overload inhibit sympatheticstimulation hypotension, bradychardia, syncope


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Increased pressure in carotid sinusparasympathetic stimulation syncope


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Orthostatic Automonic failure

Primary autonomic dysfunction Pure autonomic failure rkinsons

Secondary autonomic dysfunction Diabetic neuropathy Drugs

Volume loss Internal bleeding, diarrhea

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Cerebrovascular Almost never the cause of true fainting Vascular steal syndromes


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History of syncope after head turning,shaving or while wearing a tight collar, olderpatients with unexplained presyncope or falls,negative cardiovascular and neurologic

investigations. With patient supine massage each carotid 5-

10 secs while monitoring BP and HR

Positive response is asystole of 3 seconds or

drop in systolic BP of 50 mmHg Non spesific 25% of nonsyncopal elderly

patients will have positive response


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Tilt patient passive (60 degrees, 45 minutes)in absence of pharmacologic provocation

Administer Isoprotenol, nitroglycerin, tiltagain for 10 minute

Positive resultsreproduction of patients

typical syncopal symptoms with hypotension,bradycardia or both


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