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SYNCOPE

SYNCOPE. 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. 2008 Jan 22; 51(3):284-7. INCIDENCE OF SYNCOPE IN FRAMINGHAM STUDY.

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SYNCOPE

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  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. 2008 Jan 22; 51(3):284-7.

  3. INCIDENCE OF SYNCOPE IN FRAMINGHAM STUDY

  4. 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

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

  11. 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

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

  13. 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

  14. OTHER CAUSES • Polimedication • Alcohol • Severe anemia • Fever

  15. LIFE-THREATENING CAUSES • MI • Acute pericarditis - tamponade • Dissecting aneurysm • Pneumothorax • Internal bleeding • Severe cardiac arrhythmia

  16. 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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