Syncope

**TLOC d/t global loss of blood flow to brain with spontaneous recovery.

Cardiogenic vs Non Cardiogenic (Orthostatic / Vasovagal)

quick reference

Evaluate for:
High Risk Features
- palpitations preceding syncope
- syncope during exertion
- Hx of heart disease
- Suggested source of bleeding
- Syncope while supine
- Abscence of prodrome
- Age >60
- Trauma associated with syncopal event

DDx

• Cardiogenic
• Vasovagal
  -Prodrome! Sweat, flush, nausea, etc
• Orthostatic
  • Meds: a blockers, diuretics, antihypertensives
• Seizure
  • don’t wake up immediately normal (postictal)
• Stroke
• Intracranial Hemorrhage
• Metabolic Disorder

don’t miss

cardiogenic syncope

Ischemia/infarct
Dysrhythmias
HOCM
Brugada
WPW
Long QT

HOCM

• young syncope
• Genetic structural hypertrophy + lvoto
• “LVH” + lateral lead (1/AVL/V5/V6) Q waves (deep (1/3QRS) but narrow (<1box))
  -send for Doppler echo
  -beta blockers! (Diastolic dysfunction)

Brugada Syndrome

• young syncope (Asian?)
• Sodium channelopathy - tend to develop polymorphic vtach
• V1, V2 “shark fin” or “saddle”
  • shark: looks like down sloping st-elev terminating in inverted t-wave
  • saddle: rsr’ into u-shape ste terminating in upright t-wave
    -send to EP lab!
    -AICD stat! No med or surgical fix

WPW

• short PR (less than 120)
• Wide QRS
• delta waves
  -NEVER use av nodal blockers in WPW A-fib (will induce v-fib)
  • CCB, Amio, Digoxin, BB, adenosine
    -send to EP for ablation

Prolonged QT

• 500ms = high risk (torsades)

• Pop: psych, GI, 1st time seizures, alcoholic
  IV Mg, shock

workup

1. EKG
2. Head strike? CT head non-con