Syncope

Question 1

What is syncope?

Answer 1

Sudden, completely reversible loss of consciousness secondary to an acute reduction of cerebral perfusion

Question 2

What are the causes of syncope?

Answer 2

(Cardiac) Arrythmogenic from brady-/tachycardia (i.e. Sick sinus syndrome, Atrioventricular block
Supraventricular arrhythmias
Cardiovascular from outflow obstruction (i.e. Aortic stenosis, pulmonary embolism, pulmonary hypertension, hypertrophic cardiomyopathy, cardiac tamponade)
(Reflex) Vasovagal syncope, Emotional syncope, Carotid sinus syndrome (increased carotid sinus sensitivity)
(Orthostatic) Hypotension when standing (i.e. hypovolemia, medications)

Question 3

What are the clinical features of syncope?

Answer 3

Presyncope symptoms:
(Vasovagal) Impaired senses, nausea, pallor, warmth, diaphoresis (sweating), lightheadedness, hyperventilation
(Cardiac) Sudden
(Orthostatic) Lightheadedness, nausea, dizziness
Rapid onset consciousness

Question 4

How is syncope diagnosed?

Answer 4

Patient history
ECG
(Cardiac origin) Cardiac monitoring, Echocardiography, Cardiac enzymes, Carotid ultrasound with doppler
(Pulmonary origin) Chest x-ray
(Neurological origin) head imaging, Electroencephalography (EEG, for seizures)
Tilt table test (for vaso-vagal + orthostatic syncope)

Question 5

What is the treatment for syncope?

Answer 5

(Vasovagal syncope) Crossing the legs, tensing muscles, lying down, and elevating the legs
(Orthostatic syncope) Sufficient intake of sodium and fluids, compression stockings