SYNCOPE

Definition:

A sudden, transient loss of consciousness and postural tone with or without
prodromal symptoms.
Generally, the absence of prodromal symptoms are more ominous and indicate
cardiac origin.
Prodromal symptoms are: blurry vision, lightheadedness, nausea,
anxiety, diaphoresis, etc.
 

Etiology:

1. CARDIOVASCULAR
1. Valvular =AS, IHSS, MS, MVP, Atrial Myxoma
2. Pulmonary =PE,
3. Myocardial= MI, Pericardial effusion, Angina,  Dissecting Aortic Aneurysm, CHF.
4. Arrhythmia = Tachycardia, Bradycardia, Sick Sinus, VT/VF, >QT, AVB.
   The presence of  AVB that leads to Syncope is known as Stokes-Adams Syndrome
    
2. NEURO
1. CVA (rarely causes syncope)
2. TIA (mainly vertebrobasilar)
3. Steal syndrome
4. SZ
5. Neuropathy ( e.g. Diabetic)
6. SAH
    
3. VASOVAGAL (this, after undetermined causes, remains the most common cause)
1. Anxiety, Panic disorder,
2. Carotid sinus hypersensitivity
3. Valsalva (urination, cough)
    
4. OTHER
1. Hypovolemia, Drugs (b-blockers), Hypoglycemia, Hyperventilation, Heat, Intoxication, Venous pooling, Anemia, ETOH, Fever, Pregnancy.

1. Syncope W/U:
• Sudden onset: consider Cardiac origin ® admit to telemetry.
• Gradual: consider Hypoglycemia, Orthostatic, Pregnancy, etc.
• Activity prior the event: urinating, exercising UE (steal syndrome), shaving (carotid
  sensitivity), incontinence (SZ), aura (SZ).
   
2.  Physical:
• BP measured bilaterally. If this shows a difference of >20mmHg consider aortic dissection.   If BP is low/orthostatics consider hypovolemia.
• Bruits on the carotids.
• Heart murmur.
• Abdominal masses.
3. Labs and DX tools:
        FS, POx, ABG, Orthostatics, EKG, Guaiac, CBC, SMA, CXray, UA/UPT, CPK,  CT (prn), V/Q
        (prn), Holter/EPS/EEG/cerebral angio/tilt table test (as needed and when admitted)

1. Guided by results of above findings.

[BACK]