- SYNCOPE: Cardiogenic / Orthostatics / Neurocardiogenic / Psychogenic / rule out Seizure - Perform and document orthostatics BP your self -
- Cardiogenic
- Arrythmia as a primary cause
- Bradycardia
- Tachycardia
- Drug Induced
- Structural Heart Disease
- Cardiac
- Valvular Disease
- Ischemic
- Myocardial
- Pericardial
- Other
- PE
- Aortic Dissection
- Pulmonary HTN
 - Alarming features
- Syncope due to exertion
- while lying down
- SOB
- CHF
- Low Hgb
- Low BP
- Orthostatics Hypotension
- Definition: HR 2015
- Vasovagal syncope is defined as a syncope syndrome that usually
- (1) occurs with upright posture held for more than 30 seconds or with
exposure to emotional stress, pain, or medical settings;
- (2) features diaphoresis, warmth, nausea, and pallor;
- (3) is associated with
hypotension and relative bradycardia, when known; and
- (4) is followed by fatigue.
- Primary Autonomic Failure
- Secondary Autonomic Failure
- Drug-Induced OH
- Volume Depletion
- Postural Tachycardia Syndrome (POTS)
- HR > 30 bpm after > 30 sec of standing ( > 40 sec form age 12 -19)
- Pure POTS has no orthostasis
- Mnt:
- Clonidine or alpha-methyldopa in patients with prominent hyperadrenergic features
- Mechanism
- autonomic denervation,
- hypovolemia,
- hyperadrenergic stimulation,
- reconditioning, and
- hypervigilance,
- Progressive OH
- Classic vs Initial OH
- Initial > 40 mmhg fall < 30 sec,
- Seen in younger patients
 - Neurocardiogenic or Reflexly mediated Syncope
- Definition:
- Upright posture > 30 sec, or emotional stress ordain. Related boradycardio, hypotension, and is followed by fatigue
- Mechanism
- Not fully understood
- Bezold-Jarish Reflex
- Workup
- When to use ILR
- Unexplained syncope
- Esp in older patients
References on Orthostatic Hypotension
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