Syncope resident survival guide: Difference between revisions
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{{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}} | {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}} | ||
{{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }} | {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }} | ||
{{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis | {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain syncope diagnosis''' | D02= Uncertain etiology | D03= Confirm with specific test OR specialist}} | ||
{{familytree | | |!| | | |,|-|-|-|^|-|-|-|.| | | | | | }} | {{familytree | | |!| | | |,|-|-|-|^|-|-|-|.| | | | | | }} | ||
{{familytree | | |!| | | E01 | | E02 | | E03 | | |E01= '''High risk:''' <br><div style="float: left; text-align: left;"> ❑ Early Evaluation and treatment</div> |E02='''Low risk, recurrent syncopes:''' <br><div style="float: left; text-align: left;"> ❑ Cardiac or neurally mediated tests as appropriate '''OR''' <br> ❑ Delayed treatment guided by EKG documentation </div>|E03='''Low risk, single or rare syncope:''' <br> <div style="float: left; text-align: left;"> ❑ No further evaluation </div> }} | {{familytree | | |!| | | E01 | | E02 | | E03 | | |E01= '''High risk:''' <br><div style="float: left; text-align: left;"> ❑ Early Evaluation and treatment</div> |E02='''Low risk, recurrent syncopes:''' <br><div style="float: left; text-align: left;"> ❑ Cardiac or neurally mediated tests as appropriate '''OR''' <br> ❑ Delayed treatment guided by EKG documentation </div>|E03='''Low risk, single or rare syncope:''' <br> <div style="float: left; text-align: left;"> ❑ No further evaluation </div> }} | ||
{{familytree | | |`|-|-|-|^|-|-|-| | {{familytree | | |`|-|-|-|^|-|-|-|+|-|-|-|'| | | | }} | ||
{{familytree | | | | | | | | | | |!| | | | | | | | | }} | {{familytree | | | | | | | | | | |!| | | | | | | | | }} | ||
{{familytree | | | | | | | | | | F01 | | | | | | | | F01= Specific etiology diagnostic evaluation}} | {{familytree | | | | | | | | | | F01 | | | | | | | | F01= Specific etiology diagnostic evaluation}} |
Revision as of 00:03, 10 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]
Definition
Syncope is defined as a transient LOC, characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Syncope in the Context of Transient LOC
Determine if there was LOC | |||||||||||||||||||||||||||||||||
If yes: ❑ Rapid onset? ❑ Short duration? ❑ Spontaneous complete recovery? | If no: | ||||||||||||||||||||||||||||||||
If no to ≥1; exclude the following before proceeding with syncope evaluation: ❑ Coma ❑ Aborted SCD ❑ Epilepsy ❑ Metabolic disorders: ♦ Hypoglycemia ♦ Hypoxia ♦ Hyperventilation with hypocapnia ❑ Intoxication ❑ Vertebrobasilar TIA | If yes: ❑ Transient LOC | ||||||||||||||||||||||||||||||||
Non traumatic | Traumatic | ||||||||||||||||||||||||||||||||
Suspect: | |||||||||||||||||||||||||||||||||
Diagnostic Flowchart in Patients with Suspected Syncope
❑ Initial Assessment: | |||||||||||||||||||||||||||||||||||||||||
Syncope | T-LOC non syncopal | ||||||||||||||||||||||||||||||||||||||||
Certain syncope diagnosis | Uncertain etiology | Confirm with specific test OR specialist | |||||||||||||||||||||||||||||||||||||||
High risk: ❑ Early Evaluation and treatment | Low risk, recurrent syncopes: ❑ Cardiac or neurally mediated tests as appropriate OR ❑ Delayed treatment guided by EKG documentation | Low risk, single or rare syncope: ❑ No further evaluation | |||||||||||||||||||||||||||||||||||||||
Specific etiology diagnostic evaluation | |||||||||||||||||||||||||||||||||||||||||
Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. [3]
Do's
Don'ts
CSM should be avoided in patients with previous TIA or stroke within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.
References
- ↑ Khoo, C.; Chakrabarti, S.; Arbour, L.; Krahn, AD. (2013). "Recognizing life-threatening causes of syncope". Cardiol Clin. 31 (1): 51–66. doi:10.1016/j.ccl.2012.10.005. PMID 23217687. Unknown parameter
|month=
ignored (help) - ↑ Kapoor, WN. (2000). "Syncope". N Engl J Med. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Unknown parameter
|month=
ignored (help) - ↑ Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A; et al. (2009). "Guidelines for the diagnosis and management of syncope (version 2009)". Eur Heart J. 30 (21): 2631–71. doi:10.1093/eurheartj/ehp298. PMC 3295536. PMID 19713422 Check
|pmid=
value (help).