SYNCOPE Prof JD Marx

Short transient episode of loss of consciousness DEFINITION Short transient episode of loss of consciousness

3. NEURO-CARDIOGENIC SYNCOPE 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

1. CARDIAC b.) Dysrhythmias  Tachy-arrhythmias  Brady-arrhythmias Ventricular Supraventricular  Brady-arrhythmias AV Block

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

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

SPECIAL EXAMINATIONS Obtain history of patient and witness, physical examination, 12-lead ECG ECG with carotid sinus massage Do the findings suggest a cardiac diagnosis? YES NO Consider Ambulatory ECG Echo Electrophysiological Study Do the findings suggest a neurological diagnosis? YES NO Consider EEG Carotid doppler CT/MRI brain scan Consider Tilt test

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

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