Definition

Syncope DefinitionSudden transient complete loss of consciousnessRapid onsetShort durationSpontaneous recoveryGlobal Cerebral hypoperfusionDiffrential diagnosis LOSS OF CONSCIOUSNESSEpilepsyStrokeTIA

METABOLIC hypoglycemia,hypoxia, hyperventilation, hypocapniaLOSS of consciousnesssyncopeReflex-VasovagalOrthostatic hypotensionCardiac syncopeReflex syncopeMost common Vasovagal (emotional stress, orthostatic stress) prodromeSituational (cough, micturation, excercise, sneezing)Carotid sinus syncope 5Orthostatic hypotensionPrimary autonomic failureSecondary autonomic failure (DM, amyloidosis)Drug- induced (vasodilators as alpha blockers, ACEI)Volume depletion (bleeding, diuretics)cardiacBradyarrythmias HB, Sinus bradycardia)

Tachyarrythmias VT,SVT, LONG QT

Mechanical AS, MS, MYXOMA, tamponade, pulmonary embolism, pulmonary hypertension

HOCMHistory takingTrue syncopeRecurrentProdromalExercise, sneezing , coughCardiac diseaseDrugsSystemic diseaseExaminationHeart rate Blood pressurePallorLocal cardiac examination

Diagnostic TestsECG prexcitation, long or short QT, BBB, LVHCarotid sinus massage No stroke ,no bruit unilateral syncope+ asystole>3 sec or fall in blood pressure >50 mmHg

Active standingWithin 3 minutes of standingSymptomatic fall in systolic blood pressure >20 mmHg or diastolic >10mmHg, or SBP