Mechanism

• Arrhythmia as primary cause resulting in decrease in CO
  • Bradycardia
    • Sinus node dysfunction (often due to degenerative changes = fibrosis)
    • AV conduction system disease
    • Implanted device malfunction
  • Tachycardia
    • Supraventricular
    • Ventricular
    • Drug induced bradycardia and tachyarrhythmias
• Structural heart disease: demands > ability to increase output
  • Cardiac: valve disease, AMI, ischaemia, hypertrophic cardiomyopathy,, congenital anomalies of coronary arteries
  • Others: pulmonary embolus, acute aortic dissection, pulmonary hypertension

Helpful hints in diagnosis of cardiac syncope

• Risk factors:
  • Personal History of cardiac disease
  • Family history of sudden cardiac arrest/death
  • Symptoms like:
    • Chest pain
    • Palpitations
    • Shortness of breath
• During exertion or while at rest (supine position)
• Sudden onset palpitations immediately followed by syncope (prodrome uncommon)
• Duration of consciousness: variable
• Recovery: quickly orientated/NO fatigue
• Colour: very pale/cold skin
• Abnormal ECG
• Abnormal structural exam
  • AS murmur
  • Murmur with valsalva

Risk Stratification at initial evaluation