1. SYNCOPE

2. 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.

3. INCIDENCE OF SYNCOPE IN FRAMINGHAM STUDY

4. Limits driving abilities
Anxiety/ Depression
Affects daily living
Limits driving abilities
Change work

5. ETIOLOGY Age-induced syncope Cardiac syncope Reflex-induced syncope
Orthostatic hypotension
Neurological syncope
Idiopathic syncope

6. AGE-INDUCED SYNCOPE AGE-INDUCED MODIFICATIONS OF: Vascular system
Cardiac system
Autonomous nervous system
Non-cardiac modifications

7. VASCULAR SYSTEM Ats  blood vessels become rigid Decrease NO release
Increment of endothelin release

8. 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

9. NON-CARDIO FACTORS HYPOVOLEMIA Dehydration Drugs (diuretics)
Sedentary life
Poor fluid intake

11. REFLEX-MEDIATED SYNCOPE
defecation, urination, sneezing, coughing, big meals, shifting position too quickly
Vagal reflex
Hypotension

12. 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

13. POSTPRANDIALĂ HYPOTENSION
Decrease of systolic BP with ≥ 20 mmHg in the first 90 minutes after a big meal

14. 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

15. OTHER CAUSES
Polimedication
Alcohol
Severe anemia
Fever

16. LIFE-THREATENING CAUSESMI
Acute pericarditis - tamponade
Dissecting aneurysm
Pneumothorax
Internal bleeding
Severe cardiac arrhythmia

17. 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