Day #242 - Syncope

The approach to syncope involves an attempt to determine the etiology on the basis of the history, physical exam, and investigations. A guideline is available here.

Approximately 20% of the population, at any age, will have syncope.

• Cardiogenic Cause (Highest 1yr mortality)
  
  • Structural - AS, HOCM, Severe MS, Myxoma, Other
  • Arrythmogenic -
    
    • Tachyarrythmia: Atrial fibrillation, VT/VF, other
    • Bradyarrythmia: Sinus arrest, "Sick Sinus Syndrome", AV Block
  • Ischemia/Aortic Dissection
  • Tamponade
    
  • Pulmonary Embolism/Pulmonary Hypertension
    
• Neurogenic/Neurocardiogenic Cause
  
  • Vagally mediated - vasovagal, defication, micturition, cough/sneeze
  • Orthostasis/Hypovolemia
    
    • Drug induced (i.e. diuretics/vasodilators)
    • Disease mediated (i.e. autonomic dysfunction from DM, or Parkinson's)
    • Hypovolemia from any cause
      
  • Carotid Sinus Hypersensitivity
  • Choking on a pretzel...
    
• Not Syncope
  
  • Seizure
  • Pseudosyncope