SYNCOPE Prof JD Marx

DEFINITION Short transient episode of loss of consciousness

ETIOLOGY 1. CARDIAC 2. NEUROGENIC 3. NEURO-CARDIOGENIC SYNCOPE 4. OTHER

1. CARDIAC a.) Structural Heart Disease   Hypertrophic obstructive cardiomyopathy

  Aortic stenosis

 Mitral stenosis

 Myxoma LA

 Aortic dissection

b.) Dysrhythmias  Tachy-arrhythmias VentricularVentricular SupraventricularSupraventricular  Brady-arrhythmias AV BlockAV Block 1. CARDIAC

c.) Other  Orthostatic hypotension  Drugs 1. CARDIAC

2. NEUROGENIC a.) Epilepsy b.) TIA c.) Autonomic neuropathy  Diabetes mellitus  Shy Drager syndrome

3. NEURO-CARDIOGENIC SYNCOPY a.) Carotid sensitivity b.) Situational syncope  Cough  Micturition

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 NO YES NO YES Do the findings suggest a neurological diagnosis?

TREATMENT 1. Underlying Condition 2. Neurocardiogenic syncope Β blocker Disopyramide Tricyclic antidepressants

Thank You