Syncope: Difference between revisions
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==Disposition ==
==Disposition ==
#Admit (ACEP Clinical Policy 2007)* Abnormal ECG
Admit
##Ischemia, dysrhythmias, conduction abnormalities
#Abnormal ECG
##History, or presence of heart failure, CAD, or structural heart disease
#CHF
##Older age and associated comorbidities
#Suspicion of structural heart disease
##Hematocrit <30 (if obtained)
#HCT <30
#Consider Admitting (Hockberger 2003)
#Shortness of breath
##Age>60
#SBP <90
##H/O cardiovasc dz
#Family history of sudden cardiac death
##Frequent syncope
#Advanced age
##Meds that cause vent arrythmia
##FHx of sudden death or arrythmia
##Injuries d/t fall
##Mod-severe orthostatics
##Social situation


==F/U==
*Holter (heart dz suspected
*Tilt-test (heart dz not suspected)


-even if pacer looks nl could be loose
===Source===
 
Tintinalli
==San Francisco Syncope Rule (Annals 5/06)==
#SBP <90 ever
#C/O SOB
#H/O CHF
#Non-sinus EKG
#New change on EKG
#HCT < 30
7d serious outcome
 
==Syncope Rule: Pts > 60yo (Annals 12/09)==
#Age > 90
#Male
#Hx of arrhythmia
#Triage Sys BP >160
#Abnl EKG
#Abnl TnI
#Near-Syncope


Add 1 point for each, subtract 1 for near-syncope
UpToDate


Statification (30 day serious event rate):
ACEP Clinical Policy 2007
 
Low Risk: -1, 0 (2.5%)
 
Medium: 1, 2 (6.3%)
 
High: >3 (20%)
 
==F/U==
Holter (heart disease suspected) vs tilt-test (heart disease not suspected)
 
===Source===
UpToDate, ACEP Clinical Policy


[[Category:Cards]]
[[Category:Cards]]

Revision as of 18:45, 15 May 2011

Pearls

  • 3 Questions
  1. Is this true syncope or something else (eg, stroke, seizure, head injury)?
  2. If this is true syncope, is there a clear life-threatening cause?
  3. If this is true syncope and the cause is not clear, is the pt at high risk?
  • Cardiac syncope usually occurs w/o warning
  • TIA unlikely if no other s/s before or after
  • In elderly think MI until proven otherwise

Work-Up

  1. ECG
  2. Urine pregnancy
  3. Consider:
    1. Hemoglobin
    2. Chemistry
    3. Orthostatics (symptomatic)
    4. CXR (dissection)
    5. Troponin
    6. Guaiac

DDX

Syncope (DDx)

Disposition

Admit

  1. Abnormal ECG
  2. CHF
  3. Suspicion of structural heart disease
  4. HCT <30
  5. Shortness of breath
  6. SBP <90
  7. Family history of sudden cardiac death
  8. Advanced age

F/U

  • Holter (heart dz suspected
  • Tilt-test (heart dz not suspected)

Source

Tintinalli

UpToDate

ACEP Clinical Policy 2007

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