Medical Archive

Introduction

Epidemiology and natural history

Pathophysiology

Classification

Neurally mediated syncope

Vasovagal syncope

• Pathophysiology
  • Pure vasodepressor: sympathetic withdrawal? ?? inappropriate vasodilation
  • Cardioinhibitory: vagal activity? ??? ?? bradycardia
  • Mixed type: BP & HR ?? ??.
• Clinical presentation
  • Inciting event: ??? ??. ??? ??, ??/?? ??
  • Prodrome (eg, pallor, nausea, diaphoresis)
  • Consciousness regained rapidly (eg, <1 minute)
• Diagnosis
  • Mainly clinical diagnosis
  • Tilt table test ? ???? x ? BP, HR ??
• Treatment
  • Reassurance
  • Avoidance of triggers
  • Counterpressure techniques for recurrent episodes
    • Leg crossing with tensing of muscles, handgrip and tensing of arm muscles with clenched fists during the prodromal phase
    • Improve venous return and cardiac output

Situational reflex syncope

• Pulmonary
• Urogenital
  • Postmicturition syncope
• Gastrointestinal
• Cardiac
• Carotid sinus
• Ocular

Orthostatic hypotension

Primary autonomic failure due to idiopathic central and peripheral neurodegenerative diseases—the “synucleinopathies”

Secondary autonomic failure due to autonomic peripheral neuropathies

• ?? ??? ?. ?????,TCA? ????
• ???? ??? ??? 20/10?? ??? ?.
• ??: ????(????) ??

Cardiac syncope

Arrhythmias

Cardiac structural diseases

Approach to the patient

Differential diagnosis

Initial evaluation

Normal P/E & ECG -> head tilt table test ?? (vasovagal syncope ??)
Abnormal P/E & ECG -> ?? ?? (Echo, stress test, Holter)