Manejo del síncope en la población pediatrica y pacientes ancianos.

1. Wieling W, et al. Initial diagnostic strategy in the case of transient losses of consciousness: the importance of the medical history. Ned Tijdschr Geneeskd 2003;147:849–854.

2. Romme JJ, et al. Influence of age and gender on the occurence and presentation of reflex syncope. Clin Aut Res 2008; in press. 1% 0% Metabolic 12% 12% No diagnosis 2% 6% Psychogenic 3% 4% Neurological 20% 1% Cardiac syncope 17% 3% Orthostatic hypotension 0% 2% Other reflex sync 5% 4% Situational syncope 7% 0% Carotid sinus sync. 34% 68% Vasovagal syncope > 60 years < 40 years

4. History suggestive of syncope NR NR NR 2.8 0.66 0.81 Paleness 2.6 0.73 0.73 NR NR NR History pre-syncope 4.7 0.94 0.28 14 0.98 0.28 Nausea 5.9 0.94 0.35 18 0.98 0.36 Sweating (prodromal) 20.4 0.98 0.40 NR NR NR Prolonged standing/ sitting LR+ Spec Sens LR+ Spec Sens Sheldon Hoefnagels

5. History suggestive of epilepsy 3.0 0.69 0.94 5.0 0.83 0.85 Postictal confusion 5.8 0.94 0.33 16.9 0.98 0.29 Cyanosis NR NR NR 1.5 0.55 0.68 Prolonged LOC (>5 min) 3.4 0.95 0.16 2.6 0.85 0.39 Muscle ache 13.5 0.97 0.43 NR NR NR Turning head 16.5 0.97 0.45 7.3 0.94 0.41 Tongue bite LR+ Spec Sens LR+ Spec Sens Sheldon Hoefnagels

6. Treatment options: young vs old ++ - Abdominal binders etc ++ (+) Pacing (+) +++ Psychological + + Pharmacological ++ +++ Manoeuvres ++ ++ Explanation and lifestyle advises Older Young