Syncope

- Transient loss of consciousness and postural tone with spontaneous

recovery
- Complete recovery
-

Symptoms, not a disease

Decrease in the global perfusion to the brain, especially the brain
stem
- ARAS (ascending reticular activating system)
- Responsible for arousal
Key components for adequate perfusion of the brain
- Adequate blood volume
- Adequate perfusion pressure
- Adequate pump
o Adequate rate
o Too slow
o Too fast
o Adequate squeeze
o Pump must not be obstructed
- Vascular supply of the brain
o Circle of willis
o Obstruction of one of the arteries does not cause syncope
- Loss of postural tone
o Occur when patients are upright
o Seldom occurs when patients are lying down
o No residual focal neurological deficit
Causes of syncope
- Vascular
o Postural
Drug induced
GTN
Anti-hypertensives
Hypovolumia
Autonomic failure
Diabetes, parkinsons with lewy bodies
o Reflex mediated
Vasovagal
Situational (cough, micturition, defecation)
Carotid sinus hypersensitivity
- Cardiac
o Anatomical
Obstruction
Aortic stenosis
Hypertrophic cardiomyopathy
Atrial myoxma
o Arrhythmia
Bradyarrhythmia

Tachyarrhythmia
Neurogenic
Metabolic/miscellaneous

Approach to syncope
- History is very important
o When did it happen, what were you doing, were you well,
bowel motions
- Physical examination
o Signs of hypovolemia
o Blood pressure
o Postural drop
o Heart rate
o Heart sounds
o Murmurs
o Carotid sinus massage
Investigations
- ECG
o Arrhythmia
Not always present
Brady
Tachy
o Look for evidence that it happened
o Look for substrate for arrhythmias
o Look for consequences of underlying diseases
Arrhythmias
o Heart is too slow
SA node disease
AV node disease