Syncope (Assessment and Plan)

#Syncope

Patient presents after (witnessed/unwitnessed) episode concerning for syncope. There was loss of consciousness. After the event the patient took XX minutes to recover. There XXX headstrike. The patient reports a prodrome consisting of XX (nausea, diaphoresis, lightheadedness, blurry vision). The patient XX chest pain, palpitations, SOB, numbness, visual changes. Patient also denies incontinence, tongue biting. If no loss of consciousness, but positive prodrome then patient had presyncope. The etiologies of syncope include unknown (36%), neurocardiogenic (21%), orthostasis (9%), cardiogenic (10%), stroke/TIA (4%), seizure (5%), and other miscellaneous (micturition, cough, situational; NEJM 2002).

San Francisco Syncope Rule to Predict Serious Outcomes

(http://www.mdcalc.com/san-francisco-syncope-rule-to-predict-serious-outcomes/)

Dx:

- telemetry

- TTE (if high concern for structural cause or first presentation)

- No indication for tilt table testing

Tx:

- Suspect: neurocardiogenic: Reassurance + avoidance of provocative stimuli, educate patient on isometric counterpressure maneuvers (eg leg cross, hand grip). Several negative trials for Rx intervention (Fludrocort(POST-II), metoprolol (POST), PPM (VPS-II)

- Suspect orthostatic: consider midodrine [5-10mg] if history highly consistent with orthostatic hypotension (or repeated episodes).

- Suspect

References