{"id":9058,"date":"2025-10-27T21:25:04","date_gmt":"2025-10-27T18:25:04","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9058"},"modified":"2025-10-27T21:25:44","modified_gmt":"2025-10-27T18:25:44","slug":"syncope-dr-islam-abusido-md-facc-ep-hf-taskforce","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/syncope-dr-islam-abusido-md-facc-ep-hf-taskforce\/","title":{"rendered":"Syncope \u2013 Dr. Islam Abusido, MD, FACC (EP HF Taskforce)"},"content":{"rendered":"
Syncope \u2013 Dr. Islam Abusido, MD, FACC (EP HF Taskforce )\u201d<\/div>\n
<\/div>\n
\u20071.\u2060 \u2060Definition & Overview<\/div>\n
\u2022 Syncope: transient loss of consciousness and postural tone, followed by spontaneous recovery.<\/span><\/div>\n
\u2022 Often preceded by dizziness, nausea, diaphoresis, visual changes.<\/span><\/div>\n
\u2022 Accounts for 1\u20133.5 % of ER visits and 6 % of hospital admissions.<\/span><\/div>\n
\u2022 Can range from benign to life-threatening causes.<\/span><\/div>\n
<\/div>\n
\u20072.\u2060 \u2060Epidemiology<\/div>\n
\u2022 Cardiac causes \u2192 more common in older adults.<\/span><\/div>\n
\u2022 Vasovagal (non-cardiac) \u2192 frequent in young people.<\/span><\/div>\n
\u2022 Gender: no significant difference between men and women.<\/span><\/div>\n
<\/div>\n
\u20073.\u2060 \u2060Main Causes:<\/div>\n
\u20031. Cardiovascular:<\/div>\n
\u2003\u2022 Arrhythmias (tachy- or brady-).<\/div>\n
\u2003\u2022 Structural: valvular disease, MI, HCM, pulmonary embolism:<\/div>\n
\u2003\u2003- PE (Pulmonary Embolism): (Syncope with sudden dyspnea, chest pain, hypoxia \u2014 due to acute right heart strain.)<\/div>\n
\u2003\u2003- MI (Myocardial Infarction): (Syncope from severe ischemia or arrhythmia during or after a chest pain episode.)<\/div>\n
\u2003\u2003- Valvular Disease (esp. Aortic Stenosis): (Syncope on exertion, due to fixed cardiac output obstruction.)<\/div>\n
\u2003\u2003- HCM (Hypertrophic Cardiomyopathy): (Syncope with exertion or sudden standing, from LVOT obstruction or arrhythmia.)<\/div>\n
<\/div>\n
2. Cerebrovascular:<\/span><\/div>\n
\u2003\u2022 Vertebrobasilar insufficiency.<\/div>\n
<\/div>\n
\u20033. Vascular Tone \/ Blood Flow Disorders:<\/div>\n
\u2003\u2022 Vasovagal (neurocardiogenic) syncope.<\/div>\n
\u2003\u2022 Orthostatic hypotension.<\/div>\n
\u2003\u2022 Carotid-sinus syncope.<\/div>\n
\u2003\u2022 Situational syncope (micturition, coughing, swallowing, postprandial).<\/div>\n
<\/div>\n
\u20034. Mimics:<\/div>\n
\u2003\u2022 Seizures.<\/div>\n
\u2003\u2022 Hypoglycemia.<\/div>\n
\u2003\u2022 Hypoxia.<\/div>\n
\u2003\u2022 Psychogenic disorders.<\/div>\n
<\/div>\n
\u20074.\u2060 \u2060Pathophysiology<\/div>\n
\u2022 Brain requires constant glucose and oxygen; interruption for seconds \u2192 LOC.<\/span><\/div>\n
\u2022 Maintained by cardiac output + vascular resistance + MAP + volume.<\/span><\/div>\n
\u2022 \u201cNear-syncope\u201d = feeling of imminent faint; shares same mechanism (hypoperfusion).<\/span><\/div>\n
\u2022 Episodes > a few minutes = not syncope, likely neurologic (e.g., seizure).<\/span><\/div>\n
<\/div>\n
\u20075.\u2060 \u2060Clinical Evaluation<\/div>\n
\u2022 History + physical identify cause in ~50 % of cases.<\/span><\/div>\n
\u2022 Focus: duration, triggers, prodrome, posture, medications.<\/span><\/div>\n
\u2022 Standing \u2192 vasovagal; supine or no warning \u2192 cardiac origin.<\/span><\/div>\n
\u2022 Examine vitals, cardiac & neuro findings.<\/span><\/div>\n
<\/div>\n
Vertebrobasilar Insufficiency (VBI) \u2013 Brief Evaluation:<\/div>\n
\u2022 Suspect VBI when dizziness or vertigo occurs with other brainstem symptoms such as diplopia, ataxia, dysarthria, dysphagia, or drop attacks \u2014 not with isolated vertigo alone.<\/span><\/div>\n
\ud83d\udccc Isolated dizziness rarely indicates vertebrobasilar insufficiency.<\/div>\n
\u2022 Check both arm BPs to exclude subclavian steal syndrome.<\/span><\/div>\n
<\/div>\n
\u20076.\u2060 \u2060Diagnostic Work-up<\/div>\n
\u2022 Baseline: ECG + blood glucose (mandatory).<\/span><\/div>\n
\u2022 Labs: CBC, electrolytes, cardiac enzymes as indicated.<\/span><\/div>\n
\u2022 Echocardiography: if heart disease suspected.<\/span><\/div>\n
\u2022 Continuous\/event monitoring for arrhythmias.<\/span><\/div>\n
\u2022 Neuro-imaging if cerebrovascular:<\/span><\/div>\n
\u2022 Best test: MRI\/MRA of brain and neck \u2192 evaluates vertebral & basilar arteries and detects posterior circulation ischemia.<\/span><\/div>\n
\u2022 Alternative: CT angiography (CTA) if MRI not possible.<\/span><\/div>\n
\u2022 Carotid Doppler not useful \u2014 does not assess posterior circulation.<\/span><\/div>\n
\u2022 EEG if seizures possible.<\/span><\/div>\n
\u2022 Exercise test: to reveal ischemia, HOCM, or channelopathies.<\/span><\/div>\n
\u2022 Tilt-table test:<\/span><\/div>\n
\u2022 For recurrent unexplained syncope or to confirm vasovagal cause.<\/span><\/div>\n
\u2022 Contraindicated in IHD, severe HTN, AS, or LVOT obstruction.<\/span><\/div>\n
\u2022 Electrophysiology study (EPS):<\/span><\/div>\n
\u2022 For high-risk or recurrent unexplained syncope, esp. with structural heart disease, BBB, Brugada, ARVC.<\/span><\/div>\n
<\/div>\n
\u20077.\u2060 \u2060Management<\/div>\n
\u2022 General: treat underlying cause; keep patient supine with legs elevated during event.<\/span><\/div>\n
\u2022 Vasovagal syncope:<\/span><\/div>\n
\u2022 Avoid triggers, increase fluids & salt, tilt training.<\/span><\/div>\n
\u2022 Medications: \u03b2-blockers, SSRIs, fludrocortisone, midodrine.<\/span><\/div>\n
\u2022 DDD pacemaker reduces recurrent falls.<\/span><\/div>\n
\u2022 Orthostatic hypotension:<\/span><\/div>\n
\u2022 Rise slowly; avoid diuretics\/vasodilators; use compression stockings; give IV fluids if depleted; midodrine for refractory cases.<\/span><\/div>\n
\u2022 Cardiac syncope:<\/span><\/div>\n
\u2022 Manage per etiology\u2014antiarrhythmics, pacing, ablation, ICD if indicated.<\/span><\/div>\n
<\/div>\n
\u20078.\u2060 \u2060Risk Stratification<\/div>\n
\u2022 Boston Syncope Criteria:<\/span><\/div>\n
\u2022 Admission if cardiac disease, chest pain, dyspnea, palpitations, or abnormal ECG.<\/span><\/div>\n
\u2022 Low-risk patients (no heart disease, age < 50, normal ECG) \u2192 safe for outpatient follow-up.<\/span><\/div>\n
\u2022 High-risk factors: arrhythmic features, hypotension, CHF, CAD, family history of sudden death.<\/span><\/div>\n
\u2022 Low-risk: young, normal ECG, typical vasovagal or orthostatic pattern.<\/span><\/div>\n
<\/div>\n
\u20079.\u2060 \u2060Differential Diagnosis<\/div>\n
\u2022 Seizures: aura, tonic-clonic movements, incontinence, postictal confusion.<\/span><\/div>\n
\u2022 Hypoglycemia: sweating, tremor, irritability.<\/span><\/div>\n
\u2022 Panic attacks: impending doom, palpitations, air hunger, perioral tingling.<\/span><\/div>\n
\u2022 Distinguishing these is crucial for accurate management.<\/span><\/div>\n
<\/div>\n
10.\u2060 \u2060Key Takeaways \/ Pearls<\/div>\n
\u2022 Most cases are benign vasovagal.<\/span><\/div>\n
\u2022 Cardiac syncope can be fatal \u2192 must exclude.<\/span><\/div>\n
\u2022 ECG diagnostic yield \u2248 5 %, but still essential.<\/span><\/div>\n
\u2022 History + exam remain most valuable tools.<\/span><\/div>\n
\u2022 Advise patients not to drive until evaluation complete.<\/span><\/div>\n
\u2022 Consider mental health \/ substance abuse if etiology unclear.<\/span><\/div>\n
<\/div>\n
11.\u2060 \u2060Case Highlights<\/div>\n
\u2022 Young athlete fainting during exertion: rule out HOCM with echocardiogram before returning to sports.<\/span><\/div>\n
\u2022 Older woman with normal tests: external event monitor (1\u20132 weeks) is best next step.<\/span><\/div>\n
\u2022 Carotid disease or emboli do not cause syncope.<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

Syncope \u2013 Dr. Islam Abusido, MD, FACC (EP HF Taskforce )\u201d \u20071.\u2060 \u2060Definition & Overview \u2022 Syncope: transient loss of consciousness and postural tone, followed by spontaneous recovery. \u2022 Often preceded by dizziness, nausea, diaphoresis, visual changes. \u2022 Accounts for 1\u20133.5 % of ER visits and 6 % of hospital admissions. \u2022 Can range from […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9058","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9058","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9058"}],"version-history":[{"count":2,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9058\/revisions"}],"predecessor-version":[{"id":9060,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9058\/revisions\/9060"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9058"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9058"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9058"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}