SYNCOPESYNCOPE

Prof JD MarxProf JD Marx

DEFINITIONDEFINITION

Short transient episode of loss of consciousness

ETIOLOGYETIOLOGY

1. CARDIAC

2. NEUROGENIC

3. NEURO-CARDIOGENIC SYNCOPE

4. OTHER

1. CARDIAC

a.) Structural Heart Disease

Hypertrophic obstructive cardiomyopathy

Aortic stenosis

Mitral stenosisMitral stenosis

Myxoma LAMyxoma LA

Aortic dissectionAortic dissection

b.) Dysrhythmias

Tachy-arrhythmiasTachy-arrhythmias•Ventricular Ventricular •SupraventricularSupraventricular

Brady-arrhythmiasBrady-arrhythmias•AV BlockAV Block

1. CARDIAC

c.) Other

Orthostatic hypotensionOrthostatic hypotension

DrugsDrugs

1. CARDIAC

2. NEUROGENIC

a.) Epilepsy

b.) TIA

c.) Autonomic neuropathy

Diabetes mellitusDiabetes mellitus

Shy Drager syndromeShy Drager syndrome

3. NEURO-CARDIOGENIC SYNCOPY

a.) Carotid sensitivity

b.) Situational syncope

CoughCough

MicturitionMicturition

4. OTHER

a.) Pulmonary Embolism

b.) Vertigo (BPPV)

c.) Differential Diagnosis

Do the findings suggest a cardiac diagnosis?

SPECIAL EXAMINATIONS

Consider• EEG• Carotid doppler• CT/MRI brain scan

Consider• Tilt test

Consider• Ambulatory ECG• Echo• Electrophysiological Study

Obtain history of patient and witness, physical examination,12-lead ECG

ECG with carotid sinus massage

NOYES

NOYES

Do the findings suggest a neurological diagnosis?

TREATMENT

1. Underlying Condition

2. Neurocardiogenic syncope

• Β blocker

• Disopyramide

• Tricyclic antidepressants

Thank YouThank You