Dr. Seana Nelson PGY 5
Cardiology
Brignole, M., Moya, A., de Lange, F.J., Deharo, J.C., Elliott, P.M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R.A., Martín, A. and Probst, V., 2018. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. European heart journal, 39(21), pp.e43-e80.
Total loss of consciousness due to cerebral hypoperfusion.
Onset is rapid.
Duration is short.
Recovery is spontaneous and complete.
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Loss of awareness =
amnesia for the period of loss of consciousness
+ unresponsive
Associated with abnormal motor control
Duration is short
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Reduced blood flow for 6-8 seconds.
Reduced SBP 50-60 mmHg at the level of the heart or
SBP 30-45 mmHg at the level of the brain
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Reflex Mediated
Orthostatic hypotension
Cardiac
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Reflex Syncope
Orthostatic hoTN
Cardiac
N/V = nausea and or vomiting; HD = heart disease;
PD = Parkinson's disease; FHx = family history
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Low Risk | High Risk | |
---|---|---|
History | Prodrome typical of reflex Triggers/specific situations Positional syncope Absense of CVD |
Symptoms suggestive of CVD Syncope with exertion or supine without prodrome History of CVD: ischemic, arrhythmic, obstructive, valvular Trauma Family Hx of sudden death (age <50) |
Physical exam | Normal | Abnormal vitals Abnormal cardiac exam |
12- Lead ECG | Normal | Any bradyarrhythmia, tachyarrhythmia or conduction disease |
Lab values | Normal | Elevated TnT, BNP |
Sandhu et al. 2020 CCS Syncope Guidelines Clinical Practice Update
High Risk | |
---|---|
Bradycardia | Asymptomatic inappropriate sinus rate < 50 bpm or slow AF (40-50 bpm), Sinus block Sinus pause > 3 seconds without negatively chronotropic medications |
Conduction disease | Bifascicular block Intraventricular conduction delay (QRS 120 ms) Second-degree AV block type 1 with prolonged PR interval Second-degree AV block type 2 Third-degree AV block |
Tachyarrhythmia | |
Supraventricular tachycardia | Ventricular pre-excitation Supraventricular tachycardia or AF |
Ventricular tachycardia | Nonsustained ventricular tachycardia Evidence of acute ischemia or previous myocardial infarction Long (> 460 ms) QT on repetitive ECGs or short (< 340 ms) QT interval Type 1 Brugada Brugada pattern (RBBB with ST elevation V1-V3) Arrhythmogenic right ventricular cardiomyopathy features (negative T waves in right precordial leads, epsilon wave, ventricular late potentials) Ventricular hypertrophy |
Sandhu et al. 2020 CCS Syncope Guidelines Clinical Practice Update
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Sandhu et al. 2020 CCS Syncope Guidelines Clinical Practice Update
**Persued based on clinical suspicion**
Sandhu et al. 2020 CCS Syncope Guidelines Clinical Practice Update
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
2018 ACC/AHA/HRS bradycardia and conduction guidelines
2018 ACC/AHA/HRS Bradycardia and conduction delay guidelines
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope
LQTS: Long QT Syndrome
CMAJ 2017 Driver's guide 9th Ed.