Fainting or a sudden temporary loss of consciousness.

1. Syncope:
Krishnakumar D
AVMC&H

2. Syncope:
I. Introduction
II. Classification
III. Etiology
IV. Diagnosis
V. Treatment
VI. Special Issues

3. Syncope – A Symptom, Not a Diagnosis:
• Sudden transient loss of consciousness with associated loss of
postural tone,
• Relatively rapid onset,
• Variable warning symptoms,
• Spontaneous, complete, and usually prompt recovery without
medical or surgical intervention.
Underlying mechanism is
transient global cerebral hypoperfusion.

4. Syncope:
• Syncope as a symptoms can be caused by a variety of medical
diseases that produce a transient interruption of cerebral blood flow.
• A genuine effort should be made to determine a specific cause of
syncope as identifying a specific cause can help in the selection of
therapy, prevent recurrences, minimize expensive evaluations, and
decrease morbidity.
• Patients with cardiac syncope have higher rates of mortality and
sudden death at follow up.
• Identifying and treating cardiac syncope can improve outcome.

5. • Real or Apparent TLOC
Syncope
Neurally-mediated reflex
syndromes
Orthostatic hypotension
Cardiac arrhythmias
Structural cardiovascular disease
Disorders Mimicking
Syncope
With loss of
consciousness, i.e.,
seizure disorders,
concussion
Without loss of
consciousness, i.e.,
psychogenic “pseudo-
syncope”

6. Causes of True Syncope:
Neutrally-Mediated
 VVS
 Situational
 Cough
 Post-
 Micturition
Orthostatic
 Drug-Induced
 • ANS Failure
 Primary
 Secondary
Cardiac Arrhythmia
 Brady
 SN Dysfunction
 Causes of True Syncope AV Block Tachy
 VT
 SVT
 Long QT Syndrome
Structural Cardio- Pulmonary
 Acute Myocardial Ischemia
 Aortic Stenosis
 Pulmonary Hypertension
 Aortic Dissection

7. Clinical Features:
• Prior faintness
• Dizziness or light-headedness occurs in 70% of patients experiencing true syncope.
• Vertigo
• Diaphoresis
• Weakness
• Diaphoresis
• Epigastric discomfort
• Nausea
• Blurred or faded vision
• Pallor
• Paresthesia

8. Investigation:
• Serum glucose level
• CBC count
• Serum electrolyte levels with renal function
• Urinalysis/dipstick
Imaging:
oChest radiography
oBrain MRI/magnetic resonance arteriography (MRA)
oEchocardiography

9. Pre-hospital management:
• Airway-Advanced airway techniques
• Breathing-High flow Oxygen, If needed assist ventilation
Circulation
• Intravenous access
• Advanced airway techniques
• Glucose administration
• Pharmacologic circulatory support
• Pharmacologic or mechanical restraints
• Defibrillation or temporary pacing