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History
- Witnesses
- Events preceding the loss of consciousness,
premonitory symptoms
Duration of loss of consciousness
- Symptoms occurring after regaining consciousness :
Headache, diplopia, vertigo, or focal weakness : SAH
Chest pain : AMI, dissection, PE, AS
Palpitations : Arrhythmia
Shortness of breath : PE, CHF
Abdominal or back pain : AAA, ruptured ectopic pregnancy
Sudden event without warning and events associated with exertion
raise suspicion for a cardiac dysrhythmia or structural cardiopulmonary lesion
- Alcohol ingestion or substance abuse
- Family history is important in regard to history of prolonged QT syndrome,
dysrhythmias, sudden cardiac death, or other cardiac risks
San Francisco Syncope Rule
Rhythm other than sinus, including those on rhythm strips or monitoring,
conduction delays or new changes as minimal as first-degree AV block,
or any morphologic changes to the QRS complex or ST segment that could not be proven to be old by prior tracings
The presence of any one of the 5 high-risk criteria listed above has an
89% sensitivity and 52% specificity for death at 1 year.
Patients thought to be high risk by the examining physician and those with
active chest pain or dyspnea, exertional syncope,
sudden-onset palpitations prior to syncope,
ECG evidence of conduction abnormalities
or ongoing arrhythmia,
history of CHF or structural heart disease,
or family history of sudden cardiac death are recommended for admission !
原因不明的 Syncope 主要評估 Risk
除了 San Francisco Syncope Rule 外
Guideline 也有提到 :
- Syncope while supine, syncope during exercise
- Syncope without prodromal symptoms
- Palpations preceding syncope
- Specific age cut points of >60 or > 65 y/o
Elderly syncope 危險很多Aortic stenosis is the most
更要考量 AS, DM ANS dysfunction, Medication, volume depletion ...
Pregnancy 可能是子宮壓迫 IVC 減少回心血流
要小心 Ruptured ectopic pregnancy and Pulmonary embolism
San Francisco Syncope Rule (全部negative就可以回家！)
Congestive heart failure
Hct < 30%
EKG 不正常
SOB 有喘的問題出現
SBP < 90mmHg
外加 Age > 65 也要很小心
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