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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