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SYNCOPE
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Constantino G, Perego F et al: Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study. J Am Coll Cardiol Jan 22; 51(3):284-7.
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INCIDENCE OF SYNCOPE IN FRAMINGHAM STUDY
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Limits driving abilities
Anxiety/ Depression Affects daily living Limits driving abilities Change work
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ETIOLOGY Age-induced syncope Cardiac syncope Reflex-induced syncope
Orthostatic hypotension Neurological syncope Idiopathic syncope
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AGE-INDUCED SYNCOPE AGE-INDUCED MODIFICATIONS OF: Vascular system
Cardiac system Autonomous nervous system Non-cardiac modifications
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VASCULAR SYSTEM Ats blood vessels become rigid Decrease NO release
Increment of endothelin release
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CARDIAC SYSTEM post-load (vascular rigidization)
Hypodiastolic HF (fibrosis of myocardium muscle) Hyposistolic HF (hypertension, ischemia) Degeneration of valvular system (calcification) Decrease function of pace-maker increase arrhythmias (AF, SSS) and AV blocks
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NON-CARDIO FACTORS HYPOVOLEMIA Dehydration Drugs (diuretics)
Sedentary life Poor fluid intake
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REFLEX-MEDIATED SYNCOPE
defecation, urination, sneezing, coughing, big meals, shifting position too quickly Vagal reflex Hypotension
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CAROTIDIAN SYNUS SYNDROME
Exaggerated sensitivity to normal pressure 20% of cases of syncope Frequent causes: movements of the head, tie too tight, shaving the neck Stimulation of baroreceptors from carotidian synus Bradycardia + vasodilation Asystola > 3 s + systolic BP with > 50mmHg
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POSTPRANDIALĂ HYPOTENSION
Decrease of systolic BP with ≥ 20 mmHg in the first 90 minutes after a big meal
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CEREBROVASCULAR, NEUROLOGICAL AND PSYCHIATRIC CAUSES
Ischemia in posterior cerebral arteries teritory Subclavicular stenosis syncope when rising the hands Subarahnoidian hemorrhage Seizures Hysteria Panic/anxiety attack
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OTHER CAUSES Polimedication Alcohol Severe anemia Fever
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LIFE-THREATENING CAUSES
MI Acute pericarditis - tamponade Dissecting aneurysm Pneumothorax Internal bleeding Severe cardiac arrhythmia
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DA NU Negativ Negativ Negativ
Anamneza Examenul fizic ECG Ecocardiografie Boala cardiacă Aritmie DA NU Explorări cardiace suplimentare Proba de efort ABPM Studii electrofiziologice Testarea sistemului autonom: Manevra Valsalva Tilt-test Negativ Negativ Negativ Ia în considerare alte cauze: Neurologice Psihiatrice Testarea sistemului autonom: Manevra Valsalva Tilt-test
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