| ID | 109 |
|---|---|
| Name | SYNCOPE |
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| Introduction | Syncope is a common clinical problem, that occurs mostly in the elderly persons, characterized by a transient loss of consciousness and postutone due to inadequate cerebral blood flow and followed by prompt recovery or full consciousness, usually without resuscitative measures. |
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| Etiology | On aetiological basis syncope may be classified as below: 1. Vasovagal syncope- this is the common form of syncope, that occurs due to a reflex bradycardia by excessive vagal activation & a sudden withdrawal of peripheral sympathetic tone, leading to peripheral vasodilatation. For detail, see below 2. Cardiogenic syncope- this is caused by a sudden decline in cardiac output and hence cerebral perfusion; commonly results from cardiac arrhythmia (such as sinus node arrest or exit block, atrioventricular conduction block, or ventricular tachycardia or fibrillation), or mechanical cause (such as aortic stenosis, pulmonary stenosis, hypertrophic obstructive cardiomyopathy, congenital lesions associated with pulmonary hypertension or right-to-left shunting etc). In cardiogenic syncope, there may be some premonitory symptoms, such as lightheadedness, palpitation, breathlessness & chest pain. The loss of consciousness is usually brief & recovery is rapid with flushing. 3. Neurogenic syncope- in this, the loss of consciousness is due to transient cerebral ischaemia; epileptic attacks also lead to this type of syncope. In neurogenic syncope, there is usually a prodromal phase of premonitory symptoms, such as headache, confusion, hyperexcitability, olfactory hallucinations etc. During unconscious period, there may be seizure like activity, tongue-biting, & urinary incontinence. Recovery usually takes more than 5 minutes & there may be headache with focal neurological signs. 4. Metabolic syncope- such as syncope in hypoglycaemia. |
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