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Cardio Diabetes Medicine 2017 339

Evaluvation of Cardiac Syncope And ECG

Markers of Sudden Cardiac Arrest.

Dr. Ameya Udyavar, Dr. Vinayaga Pandian,
MD(Medicine),DM,DNB (Cardiology), MD (Medicine), DNB (Cardiology),

Consultant Cardiac Electrophysiologist. Consultant Cardiologist.
Affiliation: P. D. Hinduja National Hospital,
Veer Savarkar Marg,Mahim, Mumbai 400016.

ABSTRACT Causes of Syncope:
Syncope is a common symptom presenting Causes of syncope are broadly classified as:
in emergency departments. The common causes of Neurally Mediated: vasovagal syncope, situational
syncope are vasovagal syncope, orthostatic hypo- syncope.
tension and cardiac causes. Cardiac causes tend to
be arrhythmic like bradycardias or tachycardias and Orthostatic Induced: autonomic nervous system fail-
structural disorders like aortic stenosis and hyper- ure (primary/secondary), drug induced.
trophic cardiomyopathy. Its important to identify pa- Cardiac Arrythmia: tachyarrythmia, bradyarrythmia
tients with cardiac syncope as they are associated and channelopathies.
with higher mortality. A detailed history, a meticulous
physical examination and a precise interpretation of Structural cardio-pulmonary diseases: severe aortic
the ECG is important to identify cardiac etiology of stenosis, hypertrophic obstructive cardiomyopathy
syncope. (HOCM), acute large pulmonary embolism, myocar-
dial infarction, severe pulmonary hypertension, aortic
Evaluation of Cardiac Syncope and ECG markers of dissection.
Sudden Cardiac Arrest.
Others like volume depletion, anemia, metabolic
Definition of Syncope: causes like dyselectrolytemia, acidosis or alkalosis.
Syncope is defined as transient loss of conscious- Common cause of syncope in diabetics are due to
nesss and postural tone due to transient reduced autonomic nervous dysfunction causing othostatic
cerebral hypoperfusion. It is hypotension or cardiac causes (7, 8). Cardiac causes
include arrhythmias, coronary artery disease or struc-
characterised by rapid onset, short duration and tural heart disase.
spontaneous recovery (1, 2).
Presyncopal symptoms like faintness, light headed- Risk stratification
ness precede syncope and may increase in severity Patients suffering from syncope should be risk-strat-
until loss of consciousness occurs, or they may re- ified as per the presenting complaints/ history, phys-
solve prior to loss of consciousness if the cerebral ical examination and ECG features. This is extremely
ischemia is corrected.
important as patients with cardiac syncope have a
higher chance of mortality in the mid and long term.
Prevalence of Syncope:

Syncope causes 1-6% of hospital admissions(3)and 1% Risk stratification as per History:
of emergency room visits per year (4, 5). Ten percent Youger patients tend to have syncope due to benign
of falls in the elderly are due to syncope. Syncope causes like vasovagal syncope while elderly patients
affects the quality of life similar to any other chronic tend to have cardiac/organic causes. Longer dura-
diseases causing anxiety, depression, restricted out- tion of syncope suggests that the underlying cause
door activities, change of employment etc. (6).
is likely to be benign. Syncope which occurs most-

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