Mrs.

Rekha Anna Jacob, Lecturer, MOSC CON

SYNCOPE
INTRODUCTION
Syncope is a symptom not a disease
Syncope is the abrupt and transient loss of consciousness associated with absence of postural
tone, followed by complete and usually rapid spontaneous recovery. The underlying mechanism
is global hypoperfusion of both the cerebral cortices or focal hypoperfusion of the reticular
activating system.
DEFINITION
Syncope is defined as sudden and transient loss of consciousness which is secondary to period
of cerebral ischemia
CAUSES

Migraine*

Acute hypoxemia*

Hyperventilation*

Somatization disorder (psychogenic syncope)

Acute Intoxication (e.g., alcohol)

Seizures

Hypoglycemia

Sleep disorders

CLINICAL MANIFESTATIONS
Presyncope : feeling of warmth, pupillary dilatation, loss of colour:pale or ashen, yawning, grey
skin tone, hyperpnea, heavy perspiration, coldness in hands and feet, complaint of feeling bad or
hypotension, fainting, bradycardia, nausea, visual disturbances, at dizziness baseline loss of
consciousness, tachycardia

Mrs.
Rekha Anna Jacob, Lecturer, MOSC CON

Syncope: breathing irregular, jerky,gasping, pupil dilate,death like appears, bradycardiya, pulse
weak , decreased blood pressure.
Postsyncope: Pallor,nausea,weakness.sweating from few min to many hrs.
Short period of mental confusion
Disorientation
Blood pressure and heart rate- normal
Tendency of second attack if allowed to stand or sit too soon
PATHOPHYSIOLOGY
Stress
Release of catecholamine
Change of tissue perfusion
Decrease peripheral vascular resistance
Increaseblood flow
Pooling of blood
Decrease in circulatory volume
Decrease in cerebral blood flow
Syncope
Decrease in blood pressure
Compensatory mechanism are activated

Mrs.
Rekha Anna Jacob, Lecturer, MOSC CON

DIAGNOSIS

Detailed history

Physical examination

12-lead ECG

Echocardiogram (as available)

Ambulatory ECG

Head-up Tilt Test (HUT)

HISTORY COLLECTION
Time and day
Activities preceding (recurrent/at rest, exercise associated, on standing)
Prodromes, associated symptoms
Duration of LOC
Injuries
Medications, ingestions
Cardiac History
MA N A G E ME N T
PRESYNCOPE
Procedure should be stopped
P-Patient placed into the supine position with the legs slightly elevated
ABCD-

airway
B- breathing
C- circulation
D- drugs

SYNCOPE
Step 1:- Assess consciousness
Step 2:-Call for assistance
Step 3:-Position the patient:- placing the patient in supine position

Mrs.
Rekha Anna Jacob, Lecturer, MOSC CON

Step 4:-Assess and open airway

Step 5:-Assess airway potency and breathing
Step 6:-Assess circulation
Step 7:- if the patient continues to remain unconscious summon medical assistance immediately
Step 8:-Administer oxygen
Step 9:-Monitor vital signs
Step 10:-provide definitive management

DEFINITIVE MANAGEMENT
Loosening of clothes
Respiratory stimulant:-aromatic ammonia
Cold towel on patients forehead.
Blanket placed
If bradycardia persist:- anticholinergics atropine-0.5mg or max 3 mg
PHARMACOLOGICAL MANAGEMENT

Salt tablets, fludrocortisone

Beta-adrenergic blockers: atenolol

Disopyramide

SSRIs

Vasoconstrictors (e.g., midodrine)

POSTSYNCOPE
Patient should not be subjected to additional dental care. The possibilities of second episode of
syncope during this period of time. Prior to dismissal ,the doctor should determine from the
patient what the primary precipitating event was and what other factors may have been present
such as hunger or fear.
TREATMENT

Mrs.
Rekha Anna Jacob, Lecturer, MOSC CON

Immediately stop any dental treatment going on

Loosen tight clothing
Place the patient in head low position with lower limb elevated (trendelenburg position)
Monitor pulse If pulse is normal Sprinkle cold water Carry a gauge dipped in

aromatic spirit of ammonia close to patients nostrils

If bradycardia Injection of atropine 6mg i.v. Injection of mephentramine 10-30 mg
i.m.
If patient is still not responding support respiration (start oxygen)
CONCLUSION
Syncope is a common symptom, often with dramatic consequences, which deserves thorough
investigation and appropriate treatment of its cause.

Be vigilant in ruling out the life-threatening ones!

Use the ultrasound machine
Take into account the risks of hospitalization