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Syncope New
Syncope New
Syncope Evaluation The following pathway presents a possible diagnostic sequence based on the preceding information. H*P*, EKG, Labs: (CBC, Lytes, BG, BUN/Cr. Ca+, Sao2) *H&P should include BP (lying & standing BP's) If: Structural heart disease** or Cardiac sx &/or risk or Abn. EKG** or Unsecure Home Environ. or Seizure or Acute neuro sx. or Significant injury ** Structural heart disease = CAD, CHF, Valcular disease, cong. heart disease **Abnormal EKG: old MI, BBB, arrhythmias, conduction syst. disease If none of the above
****************************************************** P ressure 1) Vasovagal 2) Orthostatic Hypotension Causes a) Volume Loss d) Primary Autonomic dz.* b) Medications e) Secondary Autonomic dz.# c) Situational ** f) Adrenal Insufficiency A rrhythmias - Bradyarrhythmias, Tachyarrhythmia's (SVT, NSVT, A.F.), pacemaker malfunctions S eizures S ugar (hypo/hyperglycemia) O utput (cardiac)/O2 (hypoxia) CARDIAC -A.S., P.S., M.S. -IHSS -Cardiomyopathies: -Atrial Myxoma -Cardiac Tamponade -Aortic Dissection -M.I. -CHF U nusual causes Causes:-Anxiety -Panic disorder -Somatization disorder -Major depressive disorder -Hyperventilation syndrome PULMONARY (O2) -P.E. -Pulm. HTN -COPD exacerbation -C.O. poisoning
INPATIENT for -MI r/o -Cardiac Monitor -If Seizure sx do EEG -If Cardiac output sx's do Echo -If neuro sx's or signs do CT
Negative w/u
NO
T ransient Ischemic Attacks & Strokes (and other CNS causes) NO Causes: -CVA's -TIA's (vertebro-basilar) -Subarachnoid hemorrhage -Subdural hematoma -Subclavian steal -Basilar artery migraine -CNS mass effect: (tumor, edema, AVM) Complete the "PASS OUT" evaluation Cardiology & EPS? YES Negative
********************************************************* *Primary ANS dz:Idiopathic, Multi-System Atrophy(Shy-Dragger), Parkin's dz #Secondary ANS dz:Neuropathic (DM, amyloid, alcoholism, autoimmune Cancer, B12 def., porphyria, renal failure) **Situational: micturition, postprandial, cough, carotid sinus sensitivity defecation, laughing & postprandial evv9/7/08
Negative
Negative
Tilt Table?