|
Generalized SZ
|
Trigger:
• Fever
• Hypoglycemia
• Sleep deprivation
Clx:
• +/- Aura
• Loss of consciousness & tone, tonic-clonic convulsions
• Postictal state
|
|
Vasovagal Syncope
|
Trigger:
standing
Physical/emotional
Clx:
-Presyncope (lightheadedness, pallor, diaphoresis)
-Immediate retum to baseline
|
|
Cardiogenic Syncope
|
Trigger:
• Exertion
• Dehydration
Clx:
-Sudden loss of
consciousness
without prodrome
– Immediate retum to
baseline after event
|
|
Syncope
|
Path
|
Hx
|
Physical
|
Dx
|
|
VV (Vaso Vagal)
|
– Visceral Organs (micturition, defecation, cough)
– Carotid Stimulus (turning head, shaving)
– Psychogenic (see blood)
|
– Situation- related
– Prodrome (eg, pallor, nausea, diaphoresis)
|
Vagal stimulation
produces asystole
or a ⤵️SYS BP of
50 mmHg
|
Tilt table
|
|
Orthostatics
|
– ⤵️ Volume
– Autonomic Nervous Dysfunction
|
Orthostatic
hypotension
|
Defined as
⤵️SYSBP by 20
⤵️DIA BP by 10
⤴️HR by 20
Sxs of orthostasis
|
Volume and Reassess, chase causes of hypotension if
refractory to fluid
|
|
Mechanical Cardiac
|
Exertional syncope
|
Murmur
|
Echo
|
|
|
Arrhythmia
|
Onset is sudden,
unprovoked,
|
None
|
24-hour Holter
|
|
|
Neuro (vertebrobasilar insufficiency
|
Onset is sudden,
unprovoked, very rare
|
Focal Neurologic Deficit
|
CTA
|
|
|
Pulmonary Embolism
Electrolytes (bG, TSH)
|
PE
None
|
PE
None
|
Wells criteria, CT scan
BMO
|
|
Vasovagal syncope
|
|
|
Clx
|
• Inciting event (stress, prolonged standing)
• Prodrome (pallor, nausea, diaphoresis)
• Rapid regain of consciousness (<1 minute)
|
|
Dx
|
• Primarily clinical diagnosis
• Upright tilt table testing in uncertain cases
|
|
Tx
|
• Reassurance
• Triggers avoiding
• Counterpressure techniques for recurring episodes
|
|
Types of syncope
|
||
|
Types
|
Causes
|
Characteristic
|
|
Cardiogenic
|
Mechanical (AS. PS, HOCM…)
Arrhythmias
|
No prodome
|
|
Vasomotor (the most common)
|
• Excessive vagal tone
• Impaired reflex control of the peripheral circulation
|
Has prodome: Lightheadness. nausea, sweating, ringing ears. Trigger: stressful situation
|
|
Orthostatic Hypotension
|
• Hypovolemia
• Decrease BP > 20/10 mmHg
|
Think in elderly. blood loss. use of diuretics, vasodilators
|
|
Neurogenic
|
• Loss of sympathetic nervous system tone
|
Decrease BP due to vasodilation
|
Fast HY Review 