1. SYNCOPE
Prof JD Marx

2. Short transient episode of loss of consciousness
DEFINITION
Short transient episode
of loss of consciousness

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

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

5.  Aortic stenosis

6.  Mitral stenosis

7.  Myxoma LA

8. Aortic dissection

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

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

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

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

16. 4. OTHER
a.) Pulmonary Embolism
b.) Vertigo (BPPV)

17. c.) Differential Diagnosis

18. 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

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

20. Thank You