Transcript
Syncope(fainting)
Prepared by:Hemin Jamal
Supervised by:Dr. Aso Faiq
What is syncope
Sudden transient loss of consciousness with loss of postural tone(falling) which is followed by spontaneous and complete recovery.
Usually it is due to cerebral hypoperfusion.
Neurologic
Vasovagal syncope(pain,fear,Sight of blood) Situational(cough, defecation,micturition , swallowing….) Breath-holding spells
Causes
Cardiovascular Primary electrical disorder
Tachyarrthmia SVT,WPW VT Braddyarrhythmia Sick sinus syndrome Heart block Long QT syndrome
Outflow obstruction Aortic stenosis Hypertrophic obstructive cardiomyopathy Pulmonary hypertension Pulmonary stenosis
Poor contractility Congestive heart failure Myocarditis Dilated cardiomyopathy
Orthostatic hypotension Hypovolemia(dehydration) Adrenal Insufficiency
Other Anemia Hypoglycemia Medication ingestions Conversion disorder
PATHOPHYSIOLOGY
Cardiogenic
Neurogenic
History Patient: collapsed , passed out ,drop out It is syncope or not? (presyncope ,seizure) Precipitating factor( standing, pain, emotion fear ) Prodrome (sweating, pallor, dizziness, visual
change) Duration of unconsciousness
Was there associated chest pain, palpitations, or rapid heart rate
Were there symptoms of dehydration, vomiting, and diarrhea .
Past medical hx congenital heart disease, cardiac diseases
Drug hx; diuretics , beta blocker, Drugs prolonging QT interval
Family hx : Early cardiac death <45y Familial cardiomyopathy
Physical examination
1.Vital signs
Make sure to take orthostatic vital signs: heart rate and blood pressure in supine, sitting, and standing positions.
2. General hydration status, pallor suggesting anemia
3. Cardiac a. Systolic ejection murmurs: AS, hypertrophic obstructive cardiomyopathy b. S3 and S4 suggest heart failure
4. Neurologic: focal deficits, signs of increased intracranial pressure (ICP)/papilledema
1.Lab investigations
a. glucose and electrolytesb. hematocrit if history or physical examination suggests anemia
Investigations
2. ECG: evaluate for rate, rhythm, and conduction abnormalities.• Holter monitor• Stress ECG
3.Echocardiography: if needed, to evaluate for obstruction, structural abnormalities
• palpitations• syncope in the supine position.• absence of a prodrome.• Family history of sudden death,
• Syncope with exertion• Systolic ejection murmurs
arrhythmia Outflow obstruction
syncopeHistory and examination
ECG echocardiographyPediatric cardiologist
• Symptoms of dehydration, vomiting, and diarrhea suggesting hypovolemia.
• BP drop(>20) during standing.
• Episodes occurring after coughing, urination, defecation, or swallowing?
Orthostatic hypotension
Situational
SyncopeHistory and examination
• Rehydration• Non pharmacotherapy
• Reassurance• Non pharmacotherapy
• Triggered by prolonged standing, pain, or unpleasant environment
• Prodrome of sweating, nausea, vomiting, dizziness, feeling cold
Vasovagal attack
• Reassurance• Non pharmacotherapy
Non pharmacological
Avoidance of precipitating factors Awareness of prodrome Behavior modification with regard to changing position
from supine to standing Avoidance of volume depletion
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