Syncope
Prepare to present your playlist in class.
Components of Syncope
- Sudden LOC
- Loss of postural tone
- Short duration
- spontaneous recovery in <5 minutes
Categories of Syncope (1 way to do it)
Orthostatic
- Lightheadedness when standing
- Elderly, diabetes, Parkinson’s, poor PO intake
- Orthostatic Vitals
- supine 5 min-> BP
- stand 1 min-> BP
- drop SBP>20 or DBP>10
- HR>30-> POTS
Reflex
- Vasovagaol (neurocardiogenic)
- prodrome/ stressor/ trigger/ postural
- Situational
- BM, peeing, sneezing (in bathroom)
- Carotid hypersensitivity
Cardiogenic
- Sudden LOC, no prodrome
- exertional syncope, CP, palps with inc freq
- PMHx: cardiac dz
- FMH: sudden cardiac death
- EKG/ Tele/ Echo
Neurogenic/ Other
- Seizure
- subclavian steal
- vertebrobasilar insufficiency
- alcohol/ drugs
- psychogenic
- trauma
Categories of Syncope by symptom
3 step Syncope Workup
Components of Syncope
- Sudden LOC
- Loss of postural tone
- Short duration
- spontaneous recovery in <5 minutes
Prepare to present your playlist in class.
1. Risk Stratification
- risk of serious adverse event within 30 days of ED visit.
- Canadian Syncope Risk Score
- High Risk- 10+% bad dx
- Low Risk- <2.1% bad dx so can discharge.
2. Estimate PE Risk
- if no etiology for syncope, consider sWell’s + D-dimer
- if either positive, then image
- Lots of studies since PESIT 2016, 1 of which prospective
3. Echo needed?
- r/o Structural Heart Disease
- Aortic Stenosis
- pulmonary htn
- HOCM
- EF<40%
- pts with EF<40% have much higher risk of arrythmias
Risk of Serious Diagnosis with Syncope
CSRS Cutoffs
Role of Echo in Syncope
Role of Echo in otherwise negative workup
