SYNCOPE
Křivan L.,
IKK FN Brno - Bohunice
Syncope
Transient loss of consciousness connected with a postural
tone dicrease, caused by reversible brain ischaemia.
Patient gets conscious again without any electric, or
pharmacological intervention.
Syncope x Collaps
• Syncope – loss of
consciousness is due to
brain hypoperfusion
• Collapses
- without unconsciousness
(psychogenic, cataplexia, TIA)
- with unconsciousness
(hypoglycaemia, hypoxia,
hyperventilation, seizures,
intoxication)
Hospital admissions due to syncope
1 - 6% - all hospitalizations
3% - hosp. in the ICU
50% - out hospital diagnosis
92% - syncope
6% - non syncopal collapses
2% - syncope of unknown etiology
Etiology of the syncope
• Reflex (neurovegetative) 71%
• Ortostatic hypotension 11%
• Cardiac arrhythmias 12%
• Structural heart disease 5%
• Cerebrovascular 1%
Reflex - neurovegetative
• Vasovagal
• Hypersenzitive carotic sinus
• Caugh, micturial, deffecation, pain, brass instruments,
weight lifting …)
Mechanism of VVS
pooling of the blood in LE and GIT
decreased blood return to the RV - volumoreceptors
sympathetic activation + hypercontraction
mechanoreceptor irritaion
aferentation n.IX, X, C sympathetic fibres
centre of the reflex NTS
eferentation - vasodilatation, bradycardia
VVS
asthenic patients
increased dermografismus
standing, sitting
long standing in crowded places
Clasification VVS
Type I - mixed
Type II - cardioinhibitory
Type III - vasodepresoric
Head upright tilt test - HUT
passive phase - 40 min ortostasis ( 60st.)
farmacologic provocation
- 5 min horiz. position isoproterenol
( 3microg/kg/min )
- nitroglycerin ( l/2 - l tbl.)
- 20 min active ortostatic position
NIBPM
Therapy of the VVS
regimen recommendation !!!
beta I selective BB
teophyllin
verapamil
disopyramid
scopolamin
cardiac pacing DDI
Orthostatic hypotension
• Sympathetic dysfunction
- Primary: Shy-Drager, Parkinson, atrofie
- Secondary: DM, amyloidosis
- Postexercise
- Postprandial
• Drug and alcohol induced
• Volume depletion (hemorrhagia, diarrhea)
Cardiac arrhytmias
• SA node (SSSy)
• AV node (AVB II.-III.st)
• Supraventricular, ventricular tachycardias
• Genentic channel disorders (LQT, Brugada)
• Dysfunction PM, ICD
• Proarrhythmia
Bradycardia
Bradycardia
SVT
NSVT
TdP - torsade de pointes
Structural heart disease
• Vavlvular disease
• HOCMP
• Atrial myxoma
• Accute aortic dissection
• Pericardial tamponade
• Pulmonary embolism
Ao stenosis
Myxoma
HOCMP
Cerebrovascular – steal phenomenon
Cerebrovascular – steal phenomenon
Investigagtion of syncope
• History + physical examination
• ECG, OT test, Carrotic sinus massage, Holter, ECHO, EEG,
US carotic art.
• HUT test, EP study, prolonged monitoring, psychiatric
examination
• Single syncope of unknown etiology:
Stop further investigation in the right time and inform
patient
Recurrent syncope of unknown
etiology
• Indication for an ILR (Implantable Loop Recorder)
implantation