SINCOPE Puesta al día de emergencia Dra. Noelia Gómez Dra. Patricia Arizmendi.
Sincope.
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SINCOPEJairo Andrés Castro PeñalozaEstudiante de Medicina Sexto SemestreUniversidad Icesi
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GENERALIDADESSon muy frecuentes y son importantes en cuanto a mortalidad, morbilidad, inconvenientes sociales, disminución de productividad laboral y consumo de recursos médicos.
Puede ser una simple molestia o ser grave.
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DEFINICIONEs una pérdida de conciencia transitoria debido a una hipoperfusión cerebral global transitoria caracterizada por ser de inicio rápido, corta duración y recuperación completa de forma espontanea.
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PRE-SÍNCOPEAlerta-PródromoNauseaSudoraciónTrastornos visuales
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EPIDEMIOLOGIAEntre 10 y 30 años, predominantemente en mujeres en la edad de 15 años
Pico por encima de los 65 años
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FISIOPATOLOGIA
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DETERMINANTES DE LA PRESION ARTERIAL
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FISIOPATOLOGIA
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SINCOPE REFLEJO
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SINCOPE REFLEJOReflejos cardiovasculares inapropiados en respuesta a un estimulo.
Vasodepresor.
Cardioinhibidor.
Mixto.
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SINCOPE REFLEJOVasovagal.
Situacional.
Del seno carotideo.
Forma atípica.
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TRATAMIENTOEvitar estímulos desencadenantes.
Expansión de volumen con fluidos y sal.
Maniobras de contrapresión isométrica.
Fludrocortisona, agentes vasoconstrictores y antagonistas B.
Marcapasos: Asistolia/ Bradicardia severa o inhibición cardiaca prominente.
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SINCOPE POR HIPOTENSION ORTOSTATICA
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SINCOPE POR HIPOTENSION ORTOSTATICAEs crónico y la vasoconstricción es deficiente.
Sistólica 20mmHg/Diastólica 10mmHg 3 minutos después de pararse.
Intolerancia ortostática: Síntomas y signos en posición vertical por anormalidad circulatoria.
También esta la OH inicial y retardada.
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HIPOTENSION ORTOSTATICA Hipotensión Ortostática Clásica
Hipotensión Ortostática Inicial
Hipotensión Ortostática Progresiva
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HTA en posición supina.
Tratamiento de HTA/ tratamiento de hipotensión ortostática.
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TRATAMIENTORemover causas reversibles.Educación del paciente.Aumentar dieta en líquidos y sal para
expandir volumen.Fludrocortisona, Midodrina y
Pseudoefedrina.Piridostigmina, Yohimbina, Acetato de
Desmopresina y EPO.
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SINCOPE CARDIACO
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ARRITMIASCausa más frecuente
Debe ser específicamente tratada
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ARRITMIASDaño en nodo SA: automatismo anormal o
anormalidades de conducción.
Bloqueos AV
Taquicardia paroxística
Drogas que alteran el EKG
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ENFERMEDAD ESTRUCTURAL
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TRATAMIENTOTratar la causa subyacente
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HISTORIA CLINICA
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PROCEDIMIENTOS DIAGNOSTICOS
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PRUEBAS DEL SISTEMA NERVIOSO AUTONOMOMesa basculante: falla autónoma/ sincope
reflejo.Masaje del seno carotideo: Asistolia
mayor a 3s o caída de TA sistólica mayor a 50mmHg.
Evitar el masaje de seno carotideo en pacientes con TIA previo, ECV en los últimos 3 meses, pacientes con soplo carotideo, aneurismas, placas o estenosis.
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EVALUACION CARDIACAEKG-Holter
ECO
Prueba de esfuerzos
Estudio electrofisiológico
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MONITOREO ELECTROCARDIOGRAFICO
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RECOMENDACIONES PARA ESTUDIOS POR ELECTROFISIOLOGÍA(EPS)
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EVALUACION NEUROLOGICASíntomas sin cambios hemodinámicos en la
mesa basculante.
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RECOMENDACIONES PARA LA EVALUACIÓN NEUROLÓGICA.
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RECOMENDACIONES PARA LA EVALUACIÓN NEUROLÓGICA.
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BIBLIOGRAFIALongo DL, Fauci AS, Kasper DL, Hauser
SL, Jameson JL, Loscaizo J: Harrisons Principles of Internal Medicine 18th Edition.
Guidelines for Diagnosis and management of syncope (version 2009) European Society of Cardiology.