1. SYNCOPE Prof JD Marx

2. DEFINITION Short transient episode of loss of consciousness

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

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

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. 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?

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

20. Thank You