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Syncope
1. Syncope
Fainting within the first 20 seconds of arising from lying or
sitting almost always have orthostatic hypotension
1%-2% of emergency
30%-50% of 1-2% are admitted
Most common is vasovagal syncope-50%
orthostatic hypotension -7%
Cardiac syncope -7%
Structural heart disease - 3%
The 30-day mortality - 0.7%,
30-day adverse outcome-4.5%
2. Define
• Syncope
– transient
– loss of consciousness
– rapid onset
– short duration,
– spontaneous recovery,
– associated with at least 1 of
– (1) Specific forms of syncope (like vasovagal syncope); and/or
– (2) the absence of features suggesting another cause of loss of consciousness
(like epileptic convulsions or hypoglycemia).
4. Tests
Beyond an electrocardiogram are not usually needed
The most commonly used tests
implantable loop recorders-30-40% diagnosis in 2-3 yrs
Tilt table testing
Neither are needed most of the time
A good history provides more useful and more accurate information in most
5. History
• 4 distinct phases
(1) the context before symptoms;
(2) prodromal symptoms
(3) how the patient felt afterward
(4)Try to get a bystander
• Vasovagal syncope and orthostatic vs from arrhythmic
• Strenuous exertion –Arrhythmias
6. Physical Examination
• No physical findings are completely diagnostic of syncope or its
causes
– aortic stenosis
– hypertrophic cardiomyopathy
– dilated left ventricle
– carotid sinus supersenistivity,
– orthostatic hypotension.
14. Tilt Table test
• The most common provocative test
• The goal is to trigger clinically reminiscent presyncope or
syncope
• Result of hypotension or bradycardia or both