Syncope Priya Victor M.D. Introduction ► Syncope is defined as transient loss of consciousness and postural tone ► Accounts for 3% of all ER visits and.

Slides:

Advertisements

Similar presentations

SYNCOPE Rasim Enar, M.D. Professor of Cardiology

Advertisements

Down for the Count! The Evaluation of Syncope Wyatt W. Decker, M.D. Department of Emergency Medicine Mayo Clinic and Mayo Medical School.

Syncope in Children.

بسم الله الرحمن الرحيم. PROBLEMS OF SPATIAL DISORIENTATION BY PROF. DR. MOHAMED SAAD.

POTS Postural Orthostatic Tachycardia Syndrome Lorna Busmer Nurse Practitioner Rotherham.

Assessing Syncope and Loss of Consciousness. SYNCOPE 70 yr old male presents following syncopal episode while shopping. He has had 2 previous syncopal.

Neurologic Origins of Dizziness & Vertigo Clinical presentations of Dizziness or Vertigo that is of Neurologic Origin  Neurologically mediated dizziness.

PICTURE Study P lace of Reveal I n the C are pathway and T reatment of patients with U nexplained R ecurrent Syncop E.

Patients with suspected syncope should be investigated by cardiologists Dr NR Stout.

SYNCOPE Tim Evans July 30, Syncope Background Syncope Podcast—Steve Carroll, DO Syncope—Saklani P, Circulation. 2013;127: Clinical Policy:

DIZZINESS AND SYNCOPE « PAIN OR PLEASURE » Jacques Bédard MD CSPQ FRCP (C)

W. Kissinger Tintinalli Sixth Edition Chapter 52

Atrial Fibrillation in Patients with Cryptogenic Stroke Gladstone DJ et al. N Engl J Med 2014; 370: Presented by Kris Huston | July 21, 2014.

J. Stephen Huff, MD, FACEP Transient Ischemic Attack Patient Update: The Optimal Management of Emergency Department Patients With Suspected Cerebral Ischemia.

Syncope AM Report 6/25/10 Nicole Wilde. Syncope  Cause Not Obvious Neurally Mediated (vasovagal) 58% Cardiac Disease (arrhythmias) 23% Neurologic or.

Video-EEG Monitoring in Childhood Epilepsy

SYNCOPE. 42 yo man comes to the ER with syncope He was standing in line waiting to renew his driver’s license Felt tired, nauseated, few seconds later.

An Emergency Department Diagnostic Protocol For Patients With Transient Ischemic Attack: A Randomized Controlled Trial Michael A. Ross MD Scott Compton.

FERNE/EMRA The Management of ED TIA Patients: What is the optimal outpatient work-up, treatment and disposition?

Syncope & serial troponins don’t mix Cost Containment Project June 2015 Alex Raufi PGY2.

Consultant Neurologist,

COLLAPSE ? CAUSE. WHY IS THIS AN IMPORTANT TOPIC TO MASTER? One of the great skills in EM is the ability to risk stratify patients accurately and to formulate.

Sean Mindra, MS3 Thursday July 30th, 2015

Management of the Patient Presenting with Palpitation Samir Saba, MD Director, Cardiac Electrophysiology University of Pittsburgh.

Abdullah Tawakul R2 Neurology. Introduction The assessment of a patient with a transient loss of consciousness can be difficult. These patients fall into.

Syncope Darius Sholevar, MD FACC. Disclosures – Research Collaboration Medtronic St. Jude Boston Scientific Angel medical systems Biosense Webster.

Syncope J. Ned Pruitt II, MD Associate Professor of Neurology Medical College of Georgia.

SWOONING AND VAPORS Syncope and near syncope. Syncope accounts for 3% ER visits Syncope/pre-syncope symptoms are due to a reduction in cerebral perfusion,

Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine

Syncope Teresa Menendez Hood, M.D. Definition Syncope is a symptom in which there is transient (

Devices and the older patient with syncope Michael Gammage, Reader in Cardiovascular Medicine MHRA Committee for Safety of Devices.

Jobs in Diagnostic Services 1. Basic Job Duties Perform test or evaluations Aid in detection, diagnosis, and treatment of diseases, injury, or other physical.

Syncope diagnostic algorithm and management MUDr. Jakub Honěk Kardiologická klinika, 2.LF UK a FN Motol, Praha.

Interesting Case. 82 year old man Brought in to RAZ by EMS Brought in to RAZ by EMS.

SYNCOPE Prof JD Marx. DEFINITION Short transient episode of loss of consciousness.

F. Khorvash Assistant Professor Of Neurology.  Drop attacks are sudden spontaneous falls while standing or walking, followed by a very swift recovery,

晕厥 -Syncope 浙江大学医学院附属第二医院心内科项美香. Definition Syncope is a T-LOC (transient loss of conscious) due to transient global cerebral hypo-perfusion characterized.

Syncope David Robertson February 9, Objectives Recognize and treat: –Severe orthostatic hypotension (AF) –Postural tachycardia syndrome (POTS) –Neurally.

Ordering Echocardiograms for Syncope Cost Conscious Project Marvin Chang, PGY2.

ECHOs in Syncope Cost Consciousness Project Aceela Muqri, PGY-2.

Syncope Diagnosis and Management Prabhat Hebbar, MD. Electrophysiologist CHI St. Vincent Heart Clinic Arkansas April 25, 2015.

Syncope Courtney McIlduff, M. Sc. Catherine Florio Pipas, M. D. Dartmouth Medical School.

Transient loss of consciousness (‘blackouts’) management in adults and young people Implementing NICE guidance August 2010 NICE clinical guideline 109.

Consultant Cardiologist

THE HEART’S ELECTRICAL SYSTEM Marco Perez, MD Center for Inherited Cardiovascular Disease Inherited Cardiac Arrhythmia Clinic June 20, 2013.

Transient loss of consciousness (‘blackouts’) management in adults and young people – ambulance service slide set Implementing NICE guidance August 2010.

Recurrent Syncope in Childhood 26/11/15. What is Syncope? Syncope is a temporary loss of consciousness resulting from a reversible disturbance of cerebral.

Syncope MUHAMMAD ALI Cardiology Division Department of Child Health University of Sumatera Utara.

Emergency Medicine Junior Teaching Programme Aberdeen Royal Infirmary Adult Syncope Evaluation in the Emergency Department Jamie Cooper Teaching 4 th March.

Alexander Thai Emergency Medicine Resident PGY-1

UCI Internal Medicine Core Curriculum – Mini Lecture Asad Qasim – PGY3

Status Epilepticus Presenting After Traumatic Brain Injury in Infants Kurz, J. E.1; Zelleke, T.1; Carpenter, J.1; Dean, N.2; Singh, J.1; Kadom, N.3; Gaillard,

Cryptogenic Stroke and AF

Ruchi Kapoor, MD, PhD DSR 2 Cost Consciousness Project

Disclosures None.

Dr M.Jalali neurologist

Copyright © 2016, Canadian Cardiovascular Society

Syncope Abdul Gofir Blok 18.

SYNCOPE Prof JD Marx.

Echocardiograms in syncope work-up

Objectives Understand the term syncope.

Cardiac Diagnostics.

Cardiology Consult Update

Updated Guideline Recommendations for the Definitive Diagnosis of Unexplained Syncope.

What is the most important etiology to rule out?

Syncope diagnostic algorithm and management

Resting heart rate according to diagnosis

EMERGENCY Awn khawaldeh.

Presentation transcript:

Syncope Priya Victor M.D

Introduction ► Syncope is defined as transient loss of consciousness and postural tone ► Accounts for 3% of all ER visits and 6% of all hospital admissions ► Could be the manifestation of benign neurocardiogenic or the first manifestation of an occult lifethreatening condition

Objective ► To determine the utility of various diagnostic tests in the evaluation syncope  CT scans  Echo  EKG  Holter monitor  EEG  Tilt table test

Methods ► Retrospective study ► 100 patients from the RCRMC ER admissions with a diagnosis of syncope were identified ► Chart review was performed with attention to the cause of syncope, investigations and results of further testing.

Results of CT scans

Echo cardiogram

EKG

Other tests ► 24 hr holter monitor two were done, both normal. ► One adenosine cardiolyte – normal. ► One ETT – normal. ► Two tilt table test, both were positive for hypotension. ► One dobutamine stress test – normal.

Causes of syncope ► vasovagal 23 ► Orthostatic hypotension 9 ► Hypoglycemia 6 ► Secondary to medications 3 ► Sick sinus syndrome 2 ► Symptomatic bradycardia 2 ► PSVT 2 ► BPV 1 ► Iron defi anemia 1 ► Seizures 1 ► Afib with RVR 1 ► Neck mass 1 ► Unknown etiology 48

Discussion ► ► Of patients visiting ER with syncope: (Alboni et al JACC 2001;37:1921) Cardiac (often arrhythmia) 23% Neurally mediated 58% Neuro-psychiatric 1% Unexplained 18% ► ► Of patients with cardiac syncope, 24% subsequently develop Sudden Death (Kapoor, Medicine (Baltimore) 1990;69:160)

Approach ► ► Accurate diagnosis of etiology is possible from history, examination, basic lab & ECG in 2/3 of patients. ► ► Of those who require detailed work-up: Clinically targeted: Dx. Reached by work-up in 73% Not targeted: Dx. Reached by work-up in 25% (Sarasin et al Am J Med 2001;111:177) ► ► Work-up depends on duration of symptoms,frequency of attacks, known pre- existing disease, and age of the patient.

Neurologic testing ► ► EEG (Hyperventilation, Sleep-deprived, Nasopharyngeal) ► ► Brain CT / MRI ► ► Carotid Duplex Some test is done in over half pts with syncope Rarely useful, except in very well-selected cases Pires et al. Arch Int Med 2001;161:1889

CONCLUSION ► Of all the tests performed, EKG was of greatest yield. ► The most common etiology was vasovagal. ► Even though vasovagal syncope was a common diagnosis, the tilt table test was only ordered for a minority of patients.

CONCLUSION ► Of currently available diagnostic tests, the initial clinical history provides the greatest yield. ► A broad range of specialized tests can be performed for patients with syncope whose initial history and physical examination do not provide a diagnosis.