A Practical Approach to Syncope

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UncertaindiagnosisHigh riskLow risk – 1-2 episodesLow risk -frequentEarly Ix/RxNo further IxRe-analyse HxTargeted IxsImplantable loop recorder
High Risk Patients who may need admissionand early electrophysiological evaluationThose with possible tachy-arrhythmias• <strong>Syncope</strong> during exertion or supine• Palpitations during syncope• Frequent VEs or NSVT• Pre-excited QRS complexes• Short or long QT intervals, Brugada pattern ECG• Family Hx of SCDThose with possible brady-arrhythmias• PR prolongation, Bi fascicular block, Intraventricular conduction defects(QRS>120ms)• Sinus bradycardia (< 50bpm) or sinoatrial blockEvidence of Coronary artery Dis, or Severe sructural Ht. Dis.• Hx of MI, Angina• Clinical evidence of Ht. failure or low EF on echo
Page 1 and 2: A Practical Approach to SyncopeDr.
Page 3 and 4: Exclusions• Conditions with LOC b
Page 6 and 7: Pre-syncope ↔ Syncope?
Page 8 and 9: Hx of syncope episodeLatest episode
Page 10 and 11: • Time of episode- Early morning
Page 12 and 13: Posture and situation cont.• Emot
Page 14 and 15: Preceding symptoms• Palpitations-
Page 16 and 17: During syncope• Tonic clonic move
Page 18 and 19: Recovery• Spontaneous and complet
Page 20 and 21: VVSStructural HDAutonomic failureDr
Page 22 and 23: Case Hx 5Episode of Syncopeyoung•
Page 24 and 25: After Hx & ExDefinite Syncope• Ve
Page 26 and 27: InvestigationsEchocardiogram• AS/
Page 28 and 29: InvestigationsTruesyncopeAppropriat
Page 31 and 32: Carotid massage
Page 33 and 34: InvestigationsTruesyncopeAppropriat
Page 35 and 36: Bradycardiastudy
Page 37: InvestigationsTruesyncopeAppropriat
Page 41: Case Hx 6• 68 year old women• H

A Practical Approach to Syncope

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