Syncope: An Evidence-Based Approach

Description

Syncope has many possible causes, but the underlying mechanism of loss of consciousness is transient insufficiency of blood-flow to the brain. The result is a temporary disturbance of brain function causing loss of consciousness and collapse. By virtue of its being due to a self-limited hemodynamic problem resulting for example from a heart rhythm problem, or a drop in blood pressure of other cause, syncope differs from other conditions that cause loss of consciousness. A multidisciplinary approach is likely to be most effective for the evaluation and treatment of syncope; often the expertise of cardiologists, neurologists, emergency medicine specialists, general practitioners, geriatricians and other clinicians is needed. However, unfortunately, each of these sub-specialties have tended to develop and use different terminology, methodology and management guidelines; this has complicated effective interaction among these various care-givers, and has made evaluation and treatment of affected patients more complex. This volume, represents a thorough multidisciplinary review of the subject, offering recommendations based on the guidelines as well as experience derived from the various sub-specialties. It begins by discussing the scientific basis behind the diverse pathophysiology of conditions that may cause syncope, and reviews the optimal clinical management pathways. Later sections of the book then take a more practical approach, defining recommendations for the practice of syncope management through case examples. The most common procedures and tests are discussed along with their indications, methodology, interpretation, and limitations. This book has been designed to fulfill the needs of the wide range of medical practitioners involved in the care of syncope patients. All specialties will benefit from the concentration on the importance of medical history taking. Emergency room physicians and internists will be aided by the focus on risk stratification. Cardiologists and cardiac electrophysiologists will find up-to-date recommendations regarding the indications for and appropriate interpretation of noninvasive and invasive cardiac testing. Neurologists and psychiatrists will find useful the sections exploring the often difficult topic of distinguishing true syncope from other important conditions that may present as transient loss of consciousness. Front Matter....Pages i-xvii Front Matter....Pages 1-1 Syncope: Definition, Terminology, and Classification....Pages 3-13 Pathophysiology of Syncope....Pages 15-25 Epidemiology of Syncope (Fainting)....Pages 27-36 Syncope Burden: Economic Impact of Syncope on Health-Care Resources and Personal Well-Being....Pages 37-45 Front Matter....Pages 47-47 The Initial Evaluation of T-LOC: Diagnostic Strategy Based on the Initial Findings....Pages 49-63 Transient Loss of Consciousness (T-LOC) Risk Stratification....Pages 65-77 Indications for and Interpretation of Laboratory Diagnostic Tests....Pages 79-105 Prolonged Ambulatory ECG Diagnostic Monitoring … Current and Evolving Indications....Pages 107-125 Syncope Facilities: Background and Current Standards....Pages 127-138 Syncope (T-LOC) Management Units: The Italian Model....Pages 139-150 Front Matter....Pages 151-151 Reflex Syncope (Neurally Mediated Syncope)....Pages 153-177 Orthostatic Intolerance: Orthostatic Hypotension and Postural Orthostatic Tachycardia Syndrome....Pages 179-197 Cardiac Syncope....Pages 199-224 Conditions that Mimic Syncope....Pages 225-236 Unexplained Syncope in Patients with High Risk of Sudden Cardiac Death....Pages 237-250 Front Matter....Pages 251-251 How to : Role of Questionnaires and Risk Stratification at the Initial Evaluation in the Clinic and in the Emergency Department....Pages 253-265 How to : Carotid Sinus Massage....Pages 267-277 How to : Tilt-Table Testing....Pages 279-289 How to : Prolonged Ambulatory ECG Monitoring....Pages 291-308 When and How: Electrophysiological Study (EPS)....Pages 309-327 Front Matter....Pages 251-251 How to : Physical Maneuvers for Reflex and Orthostatic Syncope....Pages 329-338 Back Matter....Pages 339-344