Lets kick it with Dr. Bill Kormos and try not to pass out with excitement as we talk syncope
4 questions to ask:
1) Did this person have a LOC
2) Was it from syncope or non-syncope (rule out mimics such as metabolic, seizure, pseudo-syncope etc.)
3) Is the etiology of syncope clear (consider meds)
4) What is the underlying risk of cardiac syncope
4 main etiologies of syncope: 👍👉
1) Reflex (60%); vasovagal, situational
2) Orthostatic (15%); hypovolemia, ANS-failure drug induced
3) Cardiac arrhythmia (10%) (SSS, AB block, tachycardia, Long-QT, brugada)
4) Cardiac structural (5%)
What are some high risk features that point to a cardiac cause? ♥️
-Hx of heart disease
-Dyspnea
-CP
-Exertional
-Positional (supine)
-Abnormal ECG
Consider using EGSY score; A score >3 makes cardiac syncope likely and increased 2 yr mortality 😲
PE in syncope may not be as common as suggested by the PESIT trial (17%)
In fact it may be closer to 1-2%
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