Syncope - PowerPoint PPT Presentation

Loading...

PPT – Syncope PowerPoint presentation | free to view - id: 40859b-MzBjM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Syncope

Description:

Syncope is a common disorder, affecting 30% of adults Syncope is responsible 1% to 6% of emergency department visits 0.6% to 1.0% of hospital admissions Bimodal ... – PowerPoint PPT presentation

Number of Views:20
Avg rating:3.0/5.0
Slides: 28
Provided by: PAUL2265
Category:
Tags: syncope

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Syncope


1
Syncope
2
  • Syncope is a common disorder,
  • affecting 30 of adults
  • Syncope is responsible
  • 1 to 6 of emergency department visits
  • 0.6 to 1.0 of hospital admissions
  • Bimodal presentation
  • Peak at early adulthood
  • Neurocardiogenic
  • Late in life
  • degenerative

3
  • Difficulty in diagnoses
  • Episodes may be sporadic
  • Multiple possible causes

4
(No Transcript)
5
(No Transcript)
6
Neurocardiogenic syncope
  • Normal reflex
  • Venous pooling
  • Drop in BP
  • Increased symp drive
  • Myocardial C fibres also affect vagal tone

7
Neurocardiogenic syncope
  • Abnormal reflex
  • Increased venous pooling
  • Increased symp drive
  • Marked pressure effect on C fibres
  • Paradoxical increase in vagal tone
  • Reduces contraction
  • Increases dilatation

8
Diagnostic tests and yields
  • ECG 2-11
  • Holter Monitoring 2
  • External Loop Recorder 20
  • Tilt Table 11-87
  • EP Study without structural heart disease11
  • EP Study with structural heart disease 49
  • Neurological (CT scan, carotid doppler) 0-4

9
(No Transcript)
10
Diagnostic tests and yields
  • ECG 2-11
  • Holter Monitoring 2
  • External Loop Recorder 20
  • Tilt Table 11-87
  • EP Study without structural heart disease11
  • EP Study with structural heart disease 49
  • Neurological (CT scan, carotid doppler) 0-4
  • Implantable loop recorder 43-88

11
Syncope increases mortality
  • Study of survival rates with and without syncope
  • Cardiac syncope carried a 6-month mortality rate
    of greater than 10
  • Cardiac syncope doubled the risk of death

12
Case 1
  • 64yo male
  • Suddenly felt unwell, strange, dizzy LOC for 2
    minutes
  • ECG, Echo, 48hr Holter, Tilt, MRI and sleep
    deprived EEG all NAD
  • Loop recorder inserted
  • Similar episode
  • 25s pause
  • DDD PM inserted

13
Case 1
  • He collapsed again several weeks later, while
    sitting for a meal at a wedding.
  • Repeat EEG
  • Temporal-lobe epilepsy was diagnosed,
  • Treated with oxcarbazepine.
  • He remains asymptomatic at 1 year of follow-up.

14
Case 1
  • Ictal bradycardia is a rare manifestation of
    epileptic seizures.
  • There is limited evidence of a preferential left
    temporal-lobe onset.
  • Most patients are male and gt60 years of age
  • This pattern of epilepsy may induce central or
    obstructive apneas as well as SCD
  • Temporal-lobe epilepsy may present with feelings
    of panic and impending doom, palpitations,
    diaphoresis, dyspnea, and paresthesias.
  • Hence, it is easily misdiagnosed as an anxiety
    attack.
  • The discovery of a major arrhythmia without EEG
    monitoring may lead to an incorrect diagnosis
  • Cardiac pacemakers may be indicated in
    symptomatic ictal bradycardia or asymptomatic
    bradycardia lasting more than 5 seconds.

15
CASE 2
  • 73yo male
  • Under care of diabetic service
  • Referred to cardiology for work-up of black-outs
  • ECG, Echo, 24hr and 7 day holter normal
  • Loop recorder implanted

16
Case 2
  • After 6 months
  • will you check this mans Loop
    Recorder.........Neurologist reckons he had a 52
    second pause on an EEG
  • Id say its a typo!....meant 5.2 seconds
  • Loop recorder revealed no patient activated
    episodes
  • Automatic episodes all later than date of EEG

17
Case 2
18
Case 2
19
Case 2
20
Case 2
21
Case 2
22
Case 3
  • 22yo female
  • Referred to Cardiology from Neurology for
    implantation of loop recorder due to syncope
  • No significant medical Hx
  • Admitted to previous ectasy use, smokes cannabis
    every day
  • ECG, 7day Holter, Echo NAD
  • MRI, CT, Sleep deprived EEG NAD
  • Loop recorder inserted

23
Case 3
  • Presented following syncopal episode
  • No awareness of onset
  • When full awareness regained sitting up in
    chair
  • Speaks gibberish for minutes prior to episode
  • Interrogation revealed

24
Case 3
4.2 second pause
25
Case 3
26
Case 3
  • Also had one episode of speaking gibberish for
    five minutes, no syncope
  • No associated arrhythmia

27
Case 3
  • Questions
  • Would you pace this patient now
  • What is the sensitivity/specificity of an EEG in
    this setting
  • What is the usefulness of repeat EEG
About PowerShow.com