Syncope
A. H&P
Try to find a witness who can describe the event.
1. Precipitants: Exertion, stress, meals, alcohol, drug, cough, swallowing, urination, postural change, head movements, poor POs.
2. Sequelae: Tonic/clonic movements, drowsiness, confusion, neuro changes, nausea, sweating, cold, incontinence, tongue biting, injury from fall, amnesia.
3. Exam: Orthostatic BP and HR (immediate and delayed), BP in both arms, bruits (carotid, subclavian, supraorbital, temporal), heart exam. Look for trauma from fall. Stool guaiac.
B. Causes
1. Cardiac:
a. Arrhythmic: AV block, sick sinus syndrome, long QT interval, pacer malfunction.
b. Obstructive: MI, global ischemia, valve stenosis or dysfunction, PE, pulmonary HTN, aortic dissection, tamponade, left atrial myxoma….
2. Vascular reflex:
a. Vasovagal: From fear, urination, Valsalva maneuver.
b. Orthostatic:Related posts:
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