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Cataplexy vs syncope1/16/2024 ![]() 17 Indications for hospitalization of patients with syncope are shown in Table 3. 2, 11 Patients with underlying cardiac disease, particularly older patients, also are more likely to require hospital admission. Compared with all other patients with syncope, patients with cardiac-induced syncope have almost double the risk of all-cause mortality and an increased risk of fatal and nonfatal cardiovascular events. 1 Medications that affect cardiac conduction are a potential cause of syncope, and arrhythmias may be induced despite nontoxic blood levels. 2, 9, 11 Patients with syncope are more likely to have coronary artery or cerebrovascular disease and to take cardiac or antihypertensive medications than patients without syncope. Patients with underlying cardiac disease are at greater risk for recurrent syncopal events than are other patients with syncope. Paroxysmal atrioventricular block or asystole of a least three seconds’ duration, or blood pressure decrease from baseline of 50 mm Hg systolic or 30 mm Hg diastolic, and occurrence of syncope or presyncope symptomsĬoronary artery disease, congestive heart failure, ventricular tachycardia, and myocarditis may be precursors to arrhythmia and syncope. Patient in the upright position by convention, begin with the right carotid artery massage to the superior border of the thyroid cartilage at the angle of the mandible use firm longitudinal massage with increasing pressure massage is continued for five seconds at no time should both arteries be massaged at once. Nurse or technician to monitor blood pressure and pulse, physician to perform the procedure Intravenous access, pulse oximeter, electrocardiograph Recent (within past three months) myocardial infarction, transient ischemic attack, or stroke presence of ventricular fibrillation, ventricular tachycardia, or carotid bruits History of syncope after head turning, shaving, or while wearing a tight collar older patients with unexplained presyncope or falls negative cardiovascular and neurologic investigations Volume depletion medications illegal drugs or alcohol diabetes or amyloid neuropathy Multiple system atrophy pure autonomic failure Parkinson’s disease Sinus node dysfunction second- or third-degree heart block ventricular tachycardia implanted device malfunction (e.g., pacemaker, implantable cardioverter-defibrillator) Valvular disease, particularly aortic or mitral stenosis acute cardiac syndromes or ischemia pulmonary embolism or hypertension acute aortic dissection hypertrophic cardiomyopathy pericardial disease or tamponade atrial myxoma Glossopharyngeal and trigeminal neuralgia Situational (e.g., coughing, sneezing, defecating, micturition, postmicturition) The use of tests such as head computed tomography, magnetic resonance imaging, carotid and transcranial ultrasonography, and electroencephalography to detect cerebrovascular causes of syncope should be reserved for those few patients with syncope whose history suggests a neurologic event or who have focal neurologic signs or symptoms. When structural heart disease is excluded, tests for neurogenic reflex-mediated syncope, such as head-up tilt-table testing and carotid sinus massage, should be performed. Older patients and those with underlying organic heart disease or abnormal electrocardiograms generally will need additional cardiac evaluation, which may include prolonged electrocardiographic monitoring, echocardiography, and exercise stress testing. Additional testing should be based on the initial clinical evaluation. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography. A cardiac cause of syncope is associated with significantly higher rates of morbidity and mortality than other causes. ![]() Syncope can be classified into four categories: reflex mediated, cardiac, orthostatic, and cerebrovascular. Syncope must be carefully differentiated from other conditions that may cause a loss of consciousness or falling. Though relatively common, syncope is a complex presenting symptom defined by a transient loss of consciousness, usually accompanied by falling, and with spontaneous recovery. ![]()
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