Vonny F.

Goenawan Siloam Hospital Lippo Karawaci

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

Accounts for 3% of ER visits

sincope

Accounts for 1-6% hospital admission

Some causes of syncope are potentially fatal

Increase incidence with advancing age

Syncope must be differentiated from other non syncopal conditions which cause a transient loss of consciousness

Cardiac arrthymias as a primary cause

Bradyarrhythmias
Sinus node disease AV nodal disease Pacemaker dysfunction Drug induced

14%

Tachyarrhythmias

VT, torsade de pointes

Structural cardiac or cardiopulmonary disease

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

4%


1. 2.

Neurally mediated reflex syncope (NM)

Carotid sinus syncope ( head turning,
shaving)

Situational faint
Coughing/sneezing GI stimulation defecating, swallowing Micturation Also called neurocardiogenic Often situational

3.

Vasocagal *common faint*

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

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