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    Syncope and Palpitations

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    Tom Mallinson
    Uther discusses evaluating patients presenting with syncope or palpitations. Key factors to determine are if the cause is cardiac in origin and the site of any sensations. If assumed to be cardiac, the main causes of cardiogenic syncope are acute obstruction and arrhythmia. Arrhythmia is the most common cause and can be diagnosed by exam and ECG, with management focusing on controlling ventricular rate and restoring normal rhythm and conduction. Obstruction is less common and diagnosed by exam and echo, involving issues like valve stenosis, regurgitation, or main vessel blockage.

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    Syncope and Palpitations

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    Tom Mallinson
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    Uther discusses evaluating patients presenting with syncope or palpitations. Key factors to determine are if the cause is cardiac in origin and the site of any sensations. If assumed to be cardiac, the main causes of cardiogenic syncope are acute obstruction and arrhythmia. Arrhythmia is the most common cause and can be diagnosed by exam and ECG, with management focusing on controlling ventricular rate and restoring normal rhythm and conduction. Obstruction is less common and diagnosed by exam and echo, involving issues like valve stenosis, regurgitation, or main vessel blockage.

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    Uther discusses evaluating patients presenting with syncope or palpitations. Key factors to determine are if the cause is cardiac in origin and the site of any sensations. If assumed to be cardiac, the main causes of cardiogenic syncope are acute obstruction and arrhythmia. Arrhythmia is the most common cause and can be diagnosed by exam and ECG, with management focusing on controlling ventricular rate and restoring normal rhythm and conduction. Obstruction is less common and diagnosed by exam and echo, involving issues like valve stenosis, regurgitation, or main vessel blockage.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    127 views1 page

    Syncope and Palpitations

    Uploaded by

    Tom Mallinson
    Uther discusses evaluating patients presenting with syncope or palpitations. Key factors to determine are if the cause is cardiac in origin and the site of any sensations. If assumed to be cardiac, the main causes of cardiogenic syncope are acute obstruction and arrhythmia. Arrhythmia is the most common cause and can be diagnosed by exam and ECG, with management focusing on controlling ventricular rate and restoring normal rhythm and conduction. Obstruction is less common and diagnosed by exam and echo, involving issues like valve stenosis, regurgitation, or main vessel blockage.

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    Uther lecture: Evaluating Syncope and Palpitations

    SYNCOPE just means a blackout. PALPITATIONS mean an unpleasant


    Got to ask yourself: awareness of heartbeat- and not just
    IS IT OF CARDIAC ORIGIN?? the thumping rhythm after exercise.
    Could it be epileptic, hypoglycaemic, Must find out:
    vasovagal? Were there any witnesses SITE OF SENSATION
    whose account may help you? = chest or neck?
    Precipitating and relieving factors?
    Typical Historical Picture: Associated sweating, angina,
    Retrograde amnesia, presyncope or syncope?
    previous lesser “pre-syncope” events Young people can still get “functional” angina in
    No warning of attack absence of coronary artery disease.
    Short term of attack (few minutes)
    Change in colour (turning blue-grey)
    Typical Physical Exam Picture:
    Is there a family history of
    Heart disease signs SUDDEN CARDIAC DEATH?
    Postural hypotension
    ASK about oddities in family:
    Absent reflexes of autonomic neuropathy
    Murmurs and obstructive signs Excessive avoidance of bizarre self-
    identified triggers leads to a
    STRANGE LIFESTYLE of a person who’s
    So lets assume its cardiac. afraid of arrhythmias.
    2 major causes of cardiogenic syncope are
    ACUTE OBSTRUCTION and ARRHYTHMIA

    ARRHYTHMIA: most common; diagnose by exam + ECG


    BRADY or TACHY?
    Management:
    key goals are to CONTROL VENTRICULAR RATE
    (using beta blockers to slow it down or isoprenaline to speed it up)
    MAINTAIN NORMAL ATRIO-VENTRICULAR SYNCHRONY
    i.e cardiovert
    RESTORE NORMAL VENTRICULAR ACTIVATION
    i.e cardiovert and or pace the heart (pacemaker needed), and/or ablate the
    abnormal activation pathway
    RESTORE REGULARITY
    This may mean pacemaker, external pacing, or regular anyarrhythmic meds.
    Basically, keep em out of asystole until you can put a pacemaker in.

    OBSTRUCTION: not as common, diagnose by exam and ECHO


     Valve obstruction eg. stenosis
     Valve malfunction eg. sudden papillary tendon rupture and regurg.
     Main vessel obstruction eg. atrial myxoma blocking valve, or massive PE

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