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Syncope

Vonny F. Goenawan
Siloam Hospital Lippo Karawaci

Definition of syncope

Transient loss of consciousness with


an inability to maintain postural tone
followed by spontaneous recovery

Syncope occurs due


to

Transient disruption of cerebral perfusion


that results from decrease of cardiac
output, profound vasodilation, or both

Common
problem

sincope

Some causes of
syncope are
potentially fatal

Accounts for 3% of
ER visits

Accounts for 1-6%


hospital admission

Increase incidence
with advancing age

Syncope must be differentiated from


other non syncopal conditions which
cause a transient loss of consciousness

Cardiac syncope
Cardiac

arrthymias as a primary

cause
Bradyarrhythmias

Sinus node disease


AV nodal disease
Pacemaker dysfunction
Drug induced

Tachyarrhythmias
VT, torsade de pointes

14%

Structural

cardiac or
cardiopulmonary disease

Valvular heart disease


Acute MI or ischemia
Pericardial disease/ tamponade
Pulmonary embolus/pulmonary hypertension
Obstuctive cardiomyopathy

4%

Non Cardiac syncope


Neurally

mediated reflex
syncope (NM)

1.

Carotid sinus syncope ( head turning,


shaving)

2.

Situational faint

3.

Coughing/sneezing
GI stimulation defecating, swallowing
Micturation

Vasocagal *common faint*

Also called neurocardiogenic


Often situational

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

Increased pressure in carotid sinus


parasympathetic stimulation
syncope

Non Cardiac Syncope


Orthostatic

11%

Automonic failure
Primary autonomic dysfunction
Pure autonomic failure
Parkinsons
Secondary autonomic dysfunction
Diabetic neuropathy
Drugs
Volume loss
Internal bleeding, diarrhea

Non Cardiac Syncope


Cerebrovascular

Almost never the cause of true


fainting
Vascular steal syndromes

Physical examination

Carotid sinus syndrome


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
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

Tilt table testing


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

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