Sudden syncope, how to deal with it? These 7 points to master

(1) ECG ECG is of great significance to patients with cardiogenic syncope, such as pathological Q wave suggesting myocardial infarction, QT interval prolongation suggesting LQT syndrome, etc.
; Some patients may find arrhythmias such as second-degree type II AV block and third-degree AV block, and even malignant arrhythmias
such as ventricular tachycardia and ventricular fibrillation.

(2) Carotid sinus massage: if carotid sinus massage induces cardiac arrest for > 3s, or blood pressure drops by > 50mmHg, it means that the carotid sinus massage test is positive, indicating carotid sinus hypersensitivity syndrome
.

(3) Lying blood pressure: monitor changes in blood pressure within 3 minutes of recumbent position, such as systolic blood pressure drop ≥ 20mmHg or diastolic blood pressure drop ≥ 10mmHg, or systolic blood pressure drop below 90mmHg, with or without syncope, for the recumbent position blood pressure test is positive, indicating the diagnosis
of orthostatic hypotension.

(4) Upright tilt test: tilt position, if necessary, can be added nitroglycerin or epinephrine induced, positive results include heart rate suppression, blood pressure suppression and mixed, positive results suggest vasovagal syncope
.

(5) Echocardiography and other cardiac imaging examinations: such as cardiac CT and MRI, can provide objective information on heart structure and function, clarify whether there is myocardial hypertrophy, valve stenosis, and accurately assess cardiac functions
such as ejection fraction.

(6) ECG monitoring: For arrhythmias, especially syncope caused by infrequent arrhythmias, long-term Holter and even implantable Holter can provide more diagnostic information
.

(7) Exercise experiment: second-degree type II AV block or AV block during exercise often indicates a lesion of the conduction system, that is, bradyarrhythmia caused by conduction block is the cause
of syncope.

(8) Cardiac electrophysiological examination: through invasive electrophysiological examination, bradyarrhythmia and syncope caused by tachyarrhythmia can be diagnosed, and risk stratification and treatment
can be carried out.

(9) Cardiac catheterization: understand coronary artery lesions and perform ischemia-reperfusion therapy
.

How are syncope treated [2]?

(1) Neuromediated syncope: treatment methods include physical negative pressure training, tilt training, application of β receptor blockers, theophylline, SSRI and other drugs
.
Some patients with cardiosuppressive form may have pacemakers implanted to prevent syncope attacks
.

(2) Orthostatic hypotension: lifestyle adjustment is the key
to treatment.
The application of compression stockings, drinking more water, salt supplementation, etc.
can play a certain role
.
Midodrine can be used as a treatment for some patients with autonomic dysfunction
.

(3) Cardiogenic syncope:

(1) Bradyarrhythmia, such as sinus arrest, sinus bradycardia, atrioventricular block, etc.
: pacemaker implantation is required
.
Patients with malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation that cause syncope need to implant an implantable cardioverter defibrillator (ICD).

Some supraventricular tachycardia with fast ventricular rate leading to syncope, such as atrial fibrillation with pre-excitation, can be treated
with catheter radiofrequency ablation.

(2) Coronary disease: revascularization treatment can be performed through cardiac catheterization.

(3) Syncope caused by cardiac structural abnormalities such as cardiomyopathy and valvular disease: surgical treatment
for the cause.