L 33 a Syncope

What is syncope (TLOC)?

Abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery.

What are common triggers for vasovagal syncope?

Fear, stress, painful stimuli, and situations such as micturition, defecation, swallowing, or coughing.

What is orthostatic hypotension?

A significant reduction in blood pressure upon standing, commonly resulting in symptoms like dizziness or lightheadedness.

What are the high-risk features for syncope?

History of structural heart disease, abnormal ECG, age over 60 years, hypertension, and comorbidities.

What diagnostic test is essential for all patients with syncope?

Electrocardiogram (ECG).

What is the classic presentation of vasovagal syncope?

Syncope with prodromal symptoms such as nausea, pallor, and diaphoresis, typically occurring in sitting or standing positions.

What are some conditions that can mimic TLOC?

Seizures, TIA/stroke, sleep disturbances, accidental falls, metabolic abnormalities, panic attacks.

What initial management steps can be taken for vasovagal syncope?

Reassurance, assuming a supine position with legs raised at onset of prodrome, and avoiding trigger events.

What is the chronic management strategy for orthostatic hypotension?

Patient education, increasing salt and water intake, and using compression stockings.

What are the main mechanisms leading to cardiac syncope?

Arrhythmias and structural heart issues where heart rate is too fast or slow to maintain adequate cardiac output.

What are common arrhythmias that can cause cardiac syncope?

Supraventricular tachycardia (SVT), ventricular tachycardia (VT), atrial fibrillation, and various heart block types.

What is the role of carotid sinus massage in syncope evaluation?

Identifies carotid sinus hypersensitivity in patients over 40 with unknown causes of syncope.

What does an upright tilt table test evaluate?

It assesses susceptibility to reflex syncope and distinguishes between vasovagal and orthostatic syncope.

Which types of patients should undergo electrophysiology studies (EPS)?

Patients with suspected arrhythmic causes of syncope who have abnormal ECG findings or symptoms.

What additional testing can help differentiate cardiac from non-cardiac causes of syncope?

BNP levels; a level greater than 300 predicts serious cardiovascular outcomes.