Syncope and Bradydysrhythmias

Possible Causes:

1.        HR

1.  Bradycardias

2.    Rhythm

1.  Heart blocks
2.  Pauses
3. Prolonged QTc
4. Pre-excitation i.e. WPW

3.        Perfusion

1. assess orthostatic changes, 5 min. between each position including correlating HR
2. RV dysplasia

4.        Neurogenic

1. Carotid hypersensitivity
2. Positive bedside vagal response or tilt table testing
3. Start Pindolol  at 5 mg po DID

Assess for S/S:

1.        Convulsions

2.        Murmur

3.        Pallor

Differentiating syncope based on history

1.         Dysrhythmia

1. sudden onset                                                       
2. no prodrome
3. palpitations
4. unrelated to posture

2.         Orthostatic causes

a.        sudden onset after standing

b.       brief warning of symptoms

3.         Reflex-mediated vasodepressor

a.        onset of varying duration when upright

b.       prodrome of warmth, light-headedness, nausea, headache

4.         Cardiac Obstruction, Subclavian steal, or Exercise dysrhythmia

a.        onset with exertion

5.         Hypoglycemia or Drug effects

a.        gradual onset

b.       gradual resolution

6.         Cerebrovascular disease

a.        onset varying

b.       associated with vertebrobasilar symptoms

7.         Seizure disorder

a.        postevent drowsiness or confusion

b.        postevent headache

8.         Situational stress

a.        onset with cough

b.        onset with micturition

Labs:

1.        CBC, BMP, TSH, sed rate, UA, consider VDRL

2.        Consider Holter Monitoring

3.        CT or MRI of head s contrast

4.        Tilt table testing

Tilt Table Testing

1.        Assess if physically able to be strapped to flat board

2.        NPO 3 hours prior test

3.        Hold beta blocker in am.  Patient may receive isuprel during test.