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Vonny F. Goenawan Siloam Hospital Lippo Karawaci
Vonny F. Goenawan Siloam Hospital Lippo Karawaci
Transient loss of consciousness with an inability to maintain postural tone followed by spontaneous recovery
Transient disruption of cerebral perfusion that results from decrease of cardiac output, profound vasodilation, or both
Common problem
sincope
Syncope must be differentiated from other non syncopal conditions which cause a transient loss of consciousness
14%
Tachyarrhythmias
4%
1. 2.
Situational faint
Coughing/sneezing GI stimulation defecating, swallowing Micturation Also called neurocardiogenic Often situational
3.
24%
-Upon positional change neurohormonal events maintain cerebral perfusion - normally decreased venous return and subsequent decreased left ventricular filling increase sympathetic tone -- overly sensitive left ventricular response misinterpret hypercontractility as volume overload inhibit sympathetic stimulation hypotension, bradychardia, syncope
Orthostatic
Automonic failure Primary autonomic dysfunction Pure autonomic failure Parkinsons Secondary autonomic dysfunction Diabetic neuropathy Drugs Volume loss Internal bleeding, diarrhea
11%
Cerebrovascular
Almost never the cause of true fainting Vascular steal syndromes
History of syncope after head turning, shaving or while wearing a tight collar, older patients with unexplained presyncope or falls, negative cardiovascular and neurologic investigations. With patient supine massage each carotid 510 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
Tilt patient passive (60 degrees, 45 minutes) in absence of pharmacologic provocation Administer Isoprotenol, nitroglycerin, tilt again for 10 minute Positive results reproduction of patients typical syncopal symptoms with hypotension, bradycardia or both