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SYNCOPE

SYNCOPE. Rasim Enar, M.D. Professor of Cardiology İstanbul University – Cerrahpaşa Medical Faculty Department of Cardiology . Neuro- Cardiogenic Syncope. Neuro- Cardiogenic Syncope. Syncope - Definition. Syncope; is a transient loss of conciousness and

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SYNCOPE

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  1. SYNCOPE Rasim Enar, M.D. Professor of Cardiology İstanbul University – Cerrahpaşa Medical Faculty Department of Cardiology

  2. Neuro- Cardiogenic Syncope

  3. Neuro- Cardiogenic Syncope Syncope - Definition • Syncope; is a transient loss of conciousness and • postural tone with spontaneous recovery • Loss of consiousness is a result of , • sudden and shorterm serebral hipoperfusion • Restoration of conciousness or orientation after a • syncopal episode is usually immediate, and • does nor require electrical or chemical therapy • for reversal

  4. Neurocardiogenic Syncope Prevelans • 1- 6 % of all hospital admissions • 3 % of Emergency Department visits Prognosis – 1 year mortality risc • Cardiogenic Syncope : 24 % • Non-Cardiogenic Syncope : 4 %

  5. Neurocardiogenic Syncope Etiology – Cardiac Causes

  6. Neurocardiogenic Syncope “Primary Evaluation” • Detailed clinical history obtained from the patient or • the witness of the syncopal episode, about the period • just before or after the episode will give clues about • the etiology • Ortostatic blood pressure measurements and careful • physical examination including oscultation of • cardiac murmurs and carotis bruits • Standart ECG

  7. Neurocardiogenic Syncope Classification of syncope • Neurocardiogenic syndromes • e.g. vasovagal, carotid sinus hypersensitivity, situational • Ortostatic • Primary cause : cardiac arrhythmia – conduction disturbances • e.g. Bradycardia, Tachycardia, AV-Block, etc • Structural cardiac or cardiopulmonary diseases • e.g. acute myocardial infarction, aortic dissection, • acute pulmonary emboli, etc

  8. Neuro- Cardiogenic Syncope Non-syncope seizures • Syncope-like conditions, with loss or impairment of • consciousness • e.g. epileptic seizures, TIA, etc • Syncope-like conditions, where the patient is conscious • e.g. Psycogenic syncope (histerical, somatization disorders), etc

  9. Neuro- Cardiogenic Syncope Clinical features associated with non-syncope seizure • Post-seizure >5 min confusion • (epileptic seizure) • Long lasting tonic-clonic movements with the onset of the seizure • (epileptic seizure) • Frequent somatic complaints without accompanying organic heart disease • (psycogenic) • Vertigo, dizartria, diplopia (Transient Ischemic Attack)

  10. Neuro- Cardiogenic Syncope Diagnostic Criteria – Certain (I) Vasovagal syncope; Syncope with typical prodromal symptoms which is provoked with fear, severe pain, emotional stress, catheter instrumentation, or after prolonged standing in hot enviorement Situational syncope; Syncope produced with vagal stimuli, like diüresis, frequeny coughing, defecation or swollowing Ortostatic syncope;Syncope or presyncope associated withg documented ortostatic hipotension (Sudden fall of SBP > 20 mmHg or < 90 mmHg)

  11. Neuro- Cardiogenic Syncope Diagnostic Criteria – Certain (II) • Syncope secondary to cardiac ischemia; • ECG documentation of acute ischemia or infarction • Syncope secondary to cardiac arrhythmia ; • ECG documentation of • Sinüs bradycardia (< 40 beat/min or repetitive sinoatrial block or sinus pause > 3 second) • Atrioventriküler block (2nd degree Mobitz Type II or • 3rd degree) • Alternating LBBB or RBBB • Rapid paroxismal supraventricular tachycardia or ventricular tachtcardia • Pace-maker dysfunction associated with cardiac pause

  12. Neuro- Cardiogenic Syncope Diagnostic Criteria - Probable • Conditions related with CARDIAC syncope ; • Supine • Post egzersize • Post palpitation • Known serious organic heart disease • ECG disturbances • - wide QRS complex (>0.12 sec) • - AV conduction disturbances • - Post-meal at 1 hour • - Post egzersize • - Following with new drug administration or • after change of the dose June 2004

  13. Neuro - Cardiogenic Syncope

  14. Neuro- Cardiogenic Syncope Which patients should be hospitalised • Syncope secondary to a cardiac pathology • Syncope resulted with serious injury • Frequent syncope attacks

  15. Neuro- Cardiogenic Syncope Diagnostic Tests • Carotid Sinus Massage • Tilt Table Test • Holter monitorörization • Echocardiyography • Egzersize Test • External or Internal Loop Recorders • Electrophysiologic Study (EPS) • Cardiac Catheterisation and coronary anjiography • Neurologic and pschchiatric evaluation

  16. Neuro- Cardiogenic Syncope Syncope (unknown etiology) History, Physical Exam, ECG Probable Diagnosis (10%) Unclassified syncope (60%) Definite Diagnosis (10%) Spesific tests Echocardiography Spesific treatment & F/U Organic Heart Disease / Arrhythmia ? Vazovagal syncope ? EPS Tilt Table Test Diagnosis (+) Diagnosis (-) Diagnosis (-) Diagnosis (+) Spesific tx & F/U Holter / Tilt TT Spesific tx & F/U Holter / Tilt TT

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