Syncope evaluation : Clinical cardiology at it’s new low !
Recently , I came across a young women who underwent the following three tests for one episode of syncope after witnessing her pet dog bleeding with an Injury !
Carotid doppler
Holter monitoring and event monitors
Brain MRI /MR angiogram
This was followed up by Head up tilt(HUT) in a premier hospital
After 1 week of investigation ,a diagnosis of Neurocardiogenic syncope was made and she was reassured and no drugs were prescribed.
(The collective yield of the above three investigation in fixing a specific diagnosis is less than 10 % of all known causes of syncope )
To diagnose common syncope . . . we need common sense !
Syncope is a dramatic symptom.It is one of the commonest symptom in ER as well . Life time incidence of syncope is at least one episode in 50% all human life ! The definition of syncope until recently , was liberal .Any transient loss of consciousness with spontaneous recovery was termed syncope.
This includes
Hypoglycemia
Anemia
Siezure disorders
Structural neurogenic (Including , brain tumors , Dural hematomas etc )
Panic attacks (psychogenic)
Cardiologists wanted to fix syncope as an exclusive disorder of circulatory insufficiency.By bringing in a modification in the definition , ie syncope is now defined as a transient loss of consciousness due to reduction in cerebral perfusion .
This definition helped cardiologists to exclude the above entities . Still many would include all in single basket as patient s...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: cardaic physiology Cardiology - Clinical Cardiology -guidelines Cardiology -Mechnisms of disease Cardiology -unresolved questions Clinical cardiology general medicine Syncope Tutorial in clinical cardiology event monitors in syncope he Source Type: blogs
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