Syncope and Sudden Death - PowerPoint PPT Presentation

Loading...

PPT – Syncope and Sudden Death PowerPoint presentation | free to download - id: 40859d-NzQzY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Syncope and Sudden Death

Description:

Syncope and Sudden Death Syncope usually benign, but may represent serious cardiac problems. Sudden death in peds d/t cardiac, neurologic, resp., and trauma. – PowerPoint PPT presentation

Number of Views:1602
Avg rating:3.0/5.0
Slides: 17
Provided by: hught2
Learn more at: http://www.sjem.org
Category:
Tags: death | sudden | syncope

less

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

Title: Syncope and Sudden Death


1
Syncope and Sudden Death
2
  • Syncope usually benign, but may represent serious
    cardiac problems.
  • Sudden death in peds d/t cardiac, neurologic,
    resp., and trauma.
  • Syncope is very common in adolescence. Most
    common cause neurally mediated syncope.

3
  • Sudden unexpected death include seizure, asthma,
    or toxic ingestion.
  • Sudden Cardiac death relates to cardiac
    dysfunction and is the most common cause of
    sports related deaths in children.
  • Most commonly d/t hypertrophic cardiomyopathy.

4
  • Syncope-sudden falling with brief LOC. Most
    experience a prodrome of lightheadedness or
    dizziness.
  • May have involuntary motor responses.
  • Sudden cardiac death is usually unexpected and
    unwitnessed.

5
  • Risk factors for serious cause of syncope.
  • Exertion preceding event
  • Cardiac disease
  • Family history of sudden death
  • Recurrent episodes
  • Recumbent episode
  • Chest pain/palpitations
  • On meds that alter cardiac conduction

6
  • Patients history and physical exam is important
    in identifying the cause of syncope.
  • Syncope during exercise is ominous.
  • Cardiac exam should include palpation of cardiac
    impulse, auscultation, eval of peripheral pulses.
  • Orthostatics identify volume depletion.

7
  • Cardiovascular, neuro, and pulmonary exams are
    often normal.
  • EKG is recommended for all pts.
  • Atypical or worrisome presentation should have
    cardiac panel, cbc, bmp, thyroid panel, cxr,
    alcohol, UDS.

8
  • Neurally mediated syncope includes vasovagal,
    vasodepressor, neurocardiogenic, reflex syncope
    and simple fainting. Considered benign.
  • NMS is the most common cause of syncope in
    children.
  • Last lt1 min
  • Due to prolonged standing, emotional upset, sight
    of blood, physcial exertion, etc.

9
  • Orhtostatic- lightheadedness and weakness with
    standing.
  • Drop of 20 in SBP with increase of 20 BPM in HR.
  • Situational-urination, defecation, coughing, and
    swallowing. Due to carotid sinus hypersensitivity
    or valsalva response.

10
  • Cardiac dysrhythmias only seen in 3 of
    pediatrics with syncope.
  • Suspect if syncope occurs with fright, anger,
    surprise, or physical exertion.
  • Long QT syndrome is associated with hypertrophic
    cardiomyopathy, postive family history, and
    medications (Macrolides, TCA, antifungals,
    antihistamines, Trimethoprim, Quinolone).
  • If suspected, holter monitor should be placed.

11
  • Other cardiac dysrhythmias
  • WPW
  • AV block
  • SSS
  • SVT

12
Structural Heart disease
  • Hypertrophic Cardiomyopathy- syncope is common
    presentation. In infant may present with CHF and
    cyanosis.
  • Dilated Cardiomyopathy
  • If diagnosed before 14, 50 10 yr mortality rate.
  • Congenital cyanotic and non-cyanotic disease.
  • Valvular disease
  • Pulmonary HTN

13
Nonvascular causes
  • Seizures-associated with immediate convulsions,
    onset while supine and, prolonged postictal
    phase.
  • Breath holding-common in 6-18 month olds due to
    emotional upset
  • Atypical migraine
  • Hyperventilation
  • Hysteria
  • Hypoglycemia

14
Treatment
  • Child who survives cardiac arrest must be
    stabilized and PALS followed.
  • Unstable rhythms-cardiovert
  • Wide QRS tachydysrhythmias should not be treated
    with procainamide if LQTS is suspected. Use
    amiodarone instead.

15
Disposition
  • Admit pts with documented dysrhythmia.
  • Admit those with high risk factors
  • Treat any identified causes and admit.
  • Normal EKG but suspicious for dysrhythmia may be
    able to follow up for ambulatory cardiac
    monitoring

16
  • Pts with sudden cardiac arrest who survive should
    be transferred by appropriate crew to the nearest
    PICU.
About PowerShow.com