Syncope - PowerPoint PPT Presentation

Loading...

PPT – Syncope PowerPoint presentation | free to view - id: 1618c9-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Syncope

Description:

Urination/ deficaiton- suggest seizure. History. Prodrome ... This can include coughing, eating, drinking cold liquids, urinating, and defecating. ... – PowerPoint PPT presentation

Number of Views:161
Avg rating:3.0/5.0
Slides: 31
Provided by: david856
Category:

less

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

Title: Syncope


1
Syncope
2
Definition
  • Transient loss of consciousness due to reduced
    cerebral blood flow

3
Major considerations
  • Injuries occur in up to 35 of patients who have
    syncope
  • Recurrent episodes can be psychologically
    devastating
  • Syncope can be a sign of underlying disease

4
Etiology of Syncope
  • Cardiac- 23
  • Neurally mediated- 58
  • Neurologic or Psychiatric- 1
  • Unexplained- 18

5
Causes of Syncope
  • Disorders of vascular tone or blood volume
  • Vasovagal (neurocardiogenic)
  • Orthostatic hypotension
  • Drug induced
  • Peripheral neuropathy
  • Idiopathic
  • Physical deconditioning
  • Decreased blood volume

6
Causes of Syncope
  • Carotid sinus hypersensitivity
  • Situational
  • cough urination defication valsalva
    deglutination

7
Causes of Syncope
  • Cardiovascular disorders
  • Arrhythmias
  • Bradyarrhythmias
  • Sinus bradycardia sino-atrial block sinus
    arrest sick-sinus syndrome
  • Atrioventricular block
  • Tachyarrhythmias
  • Supraventricular tachycardia
  • Atrial fibrillation with Wolff-Parkinson-White
    syndrome
  • Atrial flutter

8
Causes of Syncope
  • Cardiopulmonary
  • Pulmonary embolism
  • Pulmonary Hypertension
  • Atrial myxoma
  • Myocardial disease (massive MI)
  • Left ventricular restriction or constriction
  • Pericardial constriction or tamponade
  • Aortic outflow tract obstruction
  • Aortic valvular stenosis
  • Hypertrophic obstructive cardiomyopathy

9
Causes of Syncope
  • Cerebrovascular disease
  • Vertebrobasilar insufficiency
  • Basilar artery migraine
  • Cerebrovascular accident

10
Causes of Syncope
  • Other disorders that may resemble syncope
  • Metabolic
  • Hypoxia
  • Anemia
  • Low CO2
  • Hypoglycemia
  • Psychogenic
  • Anxiety attacks
  • Hysterical fainting
  • Seizures

11
Modalities to determine etiology
  • History
  • Physical examination
  • Tests/ Labs
  • ECG

12
History- Major Considerations
  • History and PE can lead to dx in up to 45 of
    patients
  • Prior history of heart disease is a strong
    predictor of a cardiac cause
  • Occurs in supine position or during effort
  • Blurred vision
  • Convulsive syncope (not a seizure)
  • Neurally mediated syncope
  • Four years between episodes
  • Abdominal discomfort before syncope
  • Nausea and diaphoresis during recovery phase

13
History
  • Number of Episodes
  • Benign causes- usually one episode
  • Multiple episodes indicate an underlying disorder
  • Associated Symptoms
  • Dyspnea- think PE
  • Angina- think cardiac
  • Nausea, vominting, diaphoreses, pallor- think
    vagal
  • Urination/ deficaiton- suggest seizure

14
History
  • Prodrome
  • Nausea, warmth, pallor, lightheadedness, and/ or
    diaphoresis- think vasovagal syncope (also called
    neurocardiogenic syncope)
  • Auras- think seizure
  • Position
  • Erect- think vasovagal
  • Supine to errect- think orthostatic hypotenstion
  • Supine- consider an arrhythmia

15
History
  • Warning
  • Sudden loss of conciousness- think arrhythmia
  • Preceding events
  • This can include coughing, eating, drinking cold
    liquids, urinating, and defecating. This is
    referred to as situational syncope
  • Duration of symptoms
  • Prolonged- more indicative of seizure or aortic
    stenosis
  • Brief- more indicative of an arrhythimia or
    vasovagal. The supine position returns blood flow
    to the head, even if the arrhythmia persists.

16
History
  • Recovery
  • Nausea, pallor, diaphoresis- think vasovagal
  • Prolonged confusion or neurologic changes- think
    stroke or seizure
  • Witness
  • Helpful for information about clonus, pallor,
    diaphoresis, or even absence of pulse

17
History
  • Exertional syncopy
  • Causes ventricular tachycardia aortic stenosis
    hypertrophic cardiomyopathy
  • Vasovagal syncopy is a diagnosis of exclusion in
    the case of exertional syncope
  • Age
  • Vasovagal syncope is more likely in young healthy
    individuals

18
History
  • Injury
  • Syncopy may be an indication of an underlying
    disorder while the body is being stressed by the
    injury
  • Pain can also lead to syncope
  • Also consider significant hemodynamic comprimise
  • Medications
  • Primarily antiarrhythmics and antihypertensive
    agents
  • Also consider EtOH and illicit drugs

19
History
  • Differentiating Seizures and Syncope
  • Seizures
  • Have a slow recovery (post-ictal confusion)
  • Tonic clonic movements
  • May have multiple injury sites due to tonic
    clonic movements
  • May have cut tongue
  • Prodromal Déjà vu/ aura
  • Head turning to one side during loss of
    conciousness

20
History
  • Differentiating Seizures from Syncope
  • Syncope
  • Presyncope- lightheadedness
  • Prodromal symptoms of diaphoresis or pallor
  • Post LOC nausea, diaphoresis, and pallor
  • Recent change in position to standing

21
Physical Examination
  • Vital signs
  • Check for orthostatic hypotension
  • Drop in systolic BP by 20 laying to standing, or
    drop in diastolic by 10
  • Abnormal hearth rhythm
  • Hyperventilation- consider PE or psychiatric
    cause

22
Physical Examination
  • Murmurs- suggestive of pulm stenosis, aortic
    stenosis, or atrial myxoma
  • Physiologic maneuvers- valsalva
  • Abnormal neurologic findings
  • Unilateral deficits are suggestive of CVA
  • Rectal exam-
  • positive stool guaiac may indicate anemia/
    hypovolemia

23
Physical Examination
  • Carotid sinus massage
  • May be indicative of baroreceptor hypersensitivity

24
Testing
  • ECG
  • Ambulatory monitoring
  • Continuous 24- 48 hour monitoring
  • Event recorders
  • Implantable loop recorder
  • Echocardiography
  • Neurologic testing
  • EEG
  • Brain CT, brain MRI, carotid doppler ultrasound

25
Testing
  • Exercise testing
  • Useful in exertion related syncope
  • Upright tilt table test
  • Useful to confirm vasovagal syncope
  • Lab
  • BNP
  • May be useful to distinguish cardiac from
    non-cardiac syncope

26
(No Transcript)
27
When to Hospitalize
  • Reasons to hospitalize
  • Presence of serious injury
  • Recurrent symptoms
  • Old age
  • Diagnosis or suspicion of cardiovascular or
    neurologic cause

28
Treatment
  • Overall- treat the underlying cause of the
    syncope
  • Avoid stimuli that may have caused syncope
  • Avoid situations where sudden loss of
    consciousness may result in injury
  • Place patient in the supine position with head to
    side

29
Treatment
  • Pharmacologic treatment of vasovagal syncope
  • Beta antagonists (metoprolol, atenolol, or
    nadolol)
  • Serotonin reuptake inhibitors (paroxetine, or
    sertraline)
  • Buproprion
  • Hydrofludrocortisone- to treat volume depletion
    or orthostatic hypotension

30
Sources
  • www.uptodateonline.com
  • Harrisons Internal Medicine
  • American Heart Association http//circ.ahajournal
    s.org/cgi/content/full/113/2/316
About PowerShow.com