Definition of Syncope
Syncope is Transient Loss of Consciousness due to Cerebral Hypoperfusion.
Causes & Prognosis of Syncope
Reflex syncope (or vasovagal, or neurally mediated) is the most common cause. Cardiac syncope has the worst prognosis.
Initial Evaluation
Initial evaluation includes detailed history taking, physical examination, and ECG.
History taking, if properly performed, is in most cases the only ‘test’ necessary.
Diagnostic Evaluation
Choice of Diagnostic Testing(s) is driven by the initial evaluation. The use of broad-based investigations is ineffective and costly.
Bifascicular Block
1. Chronic bifascicular block increases risk of complete heart block.
2. Earlier non-randomized date favors the EPS or Implantable monitoring guided approach, rather than empirical pacemaker.
3. In a recent data from an RCT, permenent pacemaker compared to implantable monitoring is a preferred strategy.
Exercise-related Syncope
1. Syncope DURING exercise is most concerning for cardiac etiology.
2. Syncope AFTER exercise is usually from reflex syncope or orthostatic hypotension.
Post-prandial Hypotension/Syncope
1. Postprandial hypotension/syncope is not uncommon in elderly esp. with comorbodities.
2. The major mechanism is likely orthostatic hypotension due to autonomic failure.
3. Though the mechanism is benign, the underlying comorbidities are not.
The Issues of Recurrency
1. Many patients have more than 1 etiology of syncope.
2. Syncope and Recurrent Syncope increase morbiditiy and mortality.
3. Syncope may be the 1st manifestation of a more severe underlying cardiovascular disease.
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