Transient loss of consciousness characterized by unresponsiveness and loss of postural tone with spontaneous recovery; usually brief and caused by cerebral hypoperfusion
System(s) aff...
Careful history, physical exam, and an ECG are more important than other investigations in determining the diagnosis (1).
Make sure that the patient or witness (if present) is not ref...
Initial therapy consists of maintaining good hydration status and normal salt intake. Educate patients of the premonitory signs of syncope (1)
Majority of pediatric patients improve with non...
Frequent follow-up visits for patients with cardiac causes of syncope, especially if on antiarrhythmics
Patients with an unknown cause of syncope...
Aortic Valvular Stenosis; Atrial Septal Defect; Carotid Sinus Hypersensitivity; Patent Ductus Arteriosus; Pulmonary Arterial Hypertension; Pulmonary Embolism; Seizure Disorders; Stokes-Adams ...
271594007 Syncope (disorder)
398665005 Vasovagal syncope (disorder)
58077008 Hypotensive syncope
234167006 Situational syncope
Careful history and physical exam are keys to a diagnosis.
Use the ECG/event-recorder to evaluate for arrhythmias.
Reflex-mediated vasovagal (neurally mediated syncope [NMS]/neurocardiog...
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Calcific aortic stenosis. Large deposits of calcium salts are evident in the cusps and the free margins of the thickened aortic valve, as viewed from above.
Calcific aortic stenosis. Large deposits of calcium salts are evident in the cusps and the free margins of the thickened aortic valve, as ...
Pathogenesis of ventricular and atrial septal defects. (A) The common atrial chamber is being separated into the right and left atria (RA and LA) by the septum primum. Because the septum primum has not yet joined the endocardial cushion material, there is an open ostium primum. The ventricular cavity is being divided by a muscular interventricular septum into right and left chambers (RV and LV). SVC, superior vena cava; IVC, inferior vena cava. (B) The septum primum has joined the endocardi...
Pathogenesis of ventricular and atrial septal defects. (A) The common atrial chamber is being separated into the right and left atria (RA ...
Calcific aortic stenosis of a congenitally bicuspid aortic semilunar valve.
<bold>Figure 21.18</bold> An atrial septal defect is an abnormal opening between the right and left atria. Basically, three types of abnormalities result from incorrect development of the atrial septum. An incompetent foramen ovale is the most common defect. The ostium secundum defect results from abnormal development of the septum secundum and causes an opening in the middle of the septum. Improper development of the septum primum produces an opening at the lower end of the septum known as an os...
<bold>Figure 21.18</bold> An atrial septal defect is an abnormal opening between the right and left atria. Basically, three ty...
FIGURE 1.3. Ventilation-perfusion imaging in diagnosis of pulmonary embolism. A:Ventilation image, obtained with 99mTc pentetate aerosol, shows homogenous ventilation on posterior view. B: Matched perfusion image shows large (segmental) perfusion defects in the left mid lung, and in the lateral segment of the left lower lobe. There is also decreased perfusion in the right upper lobe. The presence of unmatched segmental abnormalities indicates a high probability for pulmonary embolism.
FIGURE 1.3. Ventilation-perfusion imaging in diagnosis of pulmonary embolism. A:Ventilation image, obtained with 99mTc pentetate aerosol, ...
FIGURE 1.32. A 60-year-old man with pulmonary hypertension due to chronic liver disease. A: On the frontal chest radiograph, the main pulmonary artery is enlarged (arrow). The right interlobar pulmonary artery is enlarged, measuring 20 mm. The normal value is 17 mm (arrows). B: On the lateral view, the left pulmonary artery is enlarged, measuring 23 mm, compared with a normal value of 20 mm.
FIGURE 1.32. A 60-year-old man with pulmonary hypertension due to chronic liver disease. A: On the frontal chest radiograph, the main pulm...
FIGURE 36.2. Bilateral pulmonary embolism (arrows) demonstrated by contrast-enhanced spiral computed tomography scan.
<bold>Figure 33-37</bold> Diagram of the cardiac anatomy and physiology in a 1-month-old infant with valvar aortic stenosis had a systolic pressure gradient of 70 mmHg across the aortic valve. The blood passing from left to right through the ductus must return again through the aortic valve, with the excess flow compounding the obstruction. The large atrial shunt, whether a true anomaly or a sprung foramen ovale, elevates left atrial pressure. The numbers below the chamber name are pressure measu...
<bold>Figure 33-37</bold> Diagram of the cardiac anatomy and physiology in a 1-month-old infant with valvar aortic stenosis ha...
<bold>Figure 13.5</bold> Contrast enhanced multirow (16-slice) detector chest CT in a patient with acute pulmonary embolism. In the coronal reconstructed view, multiple segmental emboli can be visualized <italic>(arrows)</bold>. (Figure kindly provided by Joseph Schoepf, MD, Department of Radiology, Brigham and Womens Hospital, Boston, MA.)
<bold>Figure 13.5</bold> Contrast enhanced multirow (16-slice) detector chest CT in a patient with acute pulmonary embolism. I...
<bold>Figure 13.7</bold> Primary evidence of acute pulmonary embolism. Selective cut-film angiogram of the right lower lobe pulmonary artery with multiple intraluminal radiolucencies, almost completely outlined by contrast <bold>(left)</bold>. Corresponding segmental perfusion defects of the right lower lobe <bold>(right)</bold>.
<bold>Figure 13.7</bold> Primary evidence of acute pulmonary embolism. Selective cut-film angiogram of the right lower lobe pu...
<bold>Figure 27.9</bold> Secundum atrial septal defect (ASD) denoted by <italic>arrow.</bold><bold>A.</bold> Transesophageal echo image. <bold>B.</bold> Intracardiac echo image. RA, right atrium; LA, left atrium; Ao, aorta.
<bold>Figure 27.9</bold> Secundum atrial septal defect (ASD) denoted by <italic>arrow.</bold><bold>A.</bo...
<bold>Fig C 1-22 Pulmonary infarction.</bold> (A) Chest film made 3 days after open-heart surgery demonstrates a very irregular opacity at the right base (pneumonia versus pulmonary embolization with infarction). (B) On a film made 5 days later, the consolidation is seen to have reduced in size yet to have retained the same general configuration as on the initial view. The diagnosis of pulmonary embolism was confirmed by a radionuclide lung scan.<sup>5</sup>
<bold>Fig C 1-22 Pulmonary infarction.</bold> (A) Chest film made 3 days after open-heart surgery demonstrates a very irregula...
<bold>Fig CA 5-10 Eisenmenger physiology</bold> in patent ductus arteriosus. There is an increased fullness of the central pulmonary arteries with an abrupt narrowing and paucity of peripheral vessels.
<bold>Fig CA 5-10 Eisenmenger physiology</bold> in patent ductus arteriosus. There is an increased fullness of the central pul...
<bold>Fig CA 8-2</bold> (A) <bold>Subvalvular aortic stenosis.</bold> Note the muscular ridge protruding from the upper portion of the ventricular septum (arrows). The ridge is approximately 2 cm below the aortic valve and encroaches on the outflow tract of the left ventricle. (B) <bold>Valvular aortic stenosis.</bold> Irregular thickening of aortic valve leaflets and relative rigidity of the left coronary cusp. (C) <bold>Supravalvular aortic stenosis.</bold> Narrowed segment (arrows) located just above the corona...
<bold>Fig CA 8-2</bold> (A) <bold>Subvalvular aortic stenosis.</bold> Note the muscular ridge protruding from the ...
<bold><italic>FIGURE 4.31.</bold></bold> Apical four-chamber view recorded in a patient with an atrial septal defect after intravenous injection of contrast agent. Note the opacification of the right atrium and the right ventricle and the significant amount of contrast appearing in the left atrium, consistent with a right-to-left shunt at the atrium level, subsequently confirmed to be a secundum atrial defect.
<bold><italic>FIGURE 4.31.</bold></bold> Apical four-chamber view recorded in a patient with an atrial septal defe...
<bold><i>FIGURE 8.19.</i></bold> Two patients with aortic stenosis are included. In both cases, different values for aortic stenosis jet velocity are obtained, yielding different measures of peak gradient. In patient A, the apical view underestimates the true velocity, which is optimally recorded from the right parasternal window. In patient B, the apical window again underestimates true velocity. In this case, the peak gradient was best recorded from the suprasternal notch.
<bold><i>FIGURE 8.19.</i></bold> Two patients with aortic stenosis are included. In both cases, different values f...
<bold><italic>FIGURE 8.21.</bold></bold> This schematic demonstrates the relationship between aortic (<italic>Ao</bold>) and left ventricular (<italic>LV</bold>) pressure in the setting of aortic stenosis. The differences between peak instantaneous, peak-to-peak, and mean gradients are demonstrated.
<bold><italic>FIGURE 8.21.</bold></bold> This schematic demonstrates the relationship between aortic (<italic...
<bold><italic>FIGURE 10.6.</bold></bold> A two-dimensional echocardiogram from a patient with severe aortic stenosis is shown. <bold>A:</bold> The long-axis view reveals an echogenic and very immobile aortic valve. <bold>B:</bold> The corresponding short-axis view suggests a high degree of calcification of the valve and minimal mobility during systole. LA, left atrium; LV, left ventricle; RV, right ventricle.
<bold><italic>FIGURE 10.6.</bold></bold> A two-dimensional echocardiogram from a patient with severe aortic steno...
<bold><i>FIGURE 20.11.</i></bold> Transthoracic parasternal long-axis view of the ascending aorta recorded in a patient with significant valvular aortic stenosis and proximal aortic dilation. Note the dilation of the aorta at the level of the sinuses, sinotubular junction, and proximal ascending aorta. This represents poststenotic dilation. In many instances, dilation to the degree seen here may be due to both disease of the aortic valve and concurrent aortic aneurysm. Ao,...
<bold><i>FIGURE 20.11.</i></bold> Transthoracic parasternal long-axis view of the ascending aorta recorded in a pa...
A 60-year-old man with degenerative calcific aortic stenosis. A: Posteroanterior examination shows increased rounding of the left ventricular portion of the left heart border and dilatation of the ascending aorta (arrows). B: Lateral examination shows aortic valvular calcification (arrowheads) in the center of the cardiac silhouette and filling of the retrosternal air space by the dilated, calcified (arrows) ascending aorta. The left ventricle is not dilated.
A 60-year-old man with degenerative calcific aortic stenosis. A: Posteroanterior examination shows increased rounding of the left ventricu...
A 46-year-old woman with secundum atrial septal defect. Mean pulmonary artery pressure is 20 mm Hg. A: The heart lies in the left chest. The pulmonary artery segment (PA) is greater in caliber than the aortic arch (Ao). The pulmonary artery branches of both lungs are all dilated, sharp edged, and extend nearly to the pleura. The narrow superior mediastinum and decreased concavity in the middle of the left heart contour are caused by cardiac rotation secondary to right heart dilatation. Furt...
A 46-year-old woman with secundum atrial septal defect. Mean pulmonary artery pressure is 20 mm Hg. A: The heart lies in the left chest. T...
A 55-year-old woman with atrial septal defect and pulmonary hypertension. The pulmonary artery is dilated. The dramatic difference between the caliber of the hilar and lobar pulmonary arteries and the segmental branches is typical of pulmonary hypertension. However, these segmental arteries branch and extend toward the pleura, which is typical of shunt vessels.
A 55-year-old woman with atrial septal defect and pulmonary hypertension. The pulmonary artery is dilated. The dramatic difference between...
Aortic valve dilation in a newborn with critical aortic stenosis. An antegrade catheter is positioned in the left ventricle via the patent foramen ovale.
Aortic valve dilation in a newborn with critical aortic stenosis. An antegrade catheter is positioned in the left ventricle via the patent...
Echocardiography in a patient with massive pulmonary embolism. The right ventricle (RV) is markedly enlarged, flattening the intraventricular septum and compromising the left ventricle (LV).
Echocardiography in a patient with massive pulmonary embolism. The right ventricle (RV) is markedly enlarged, flattening the intraventricu...
<bold>Figure 1.25. Ventilation-perfusion scan in a patient with pulmonary emboli. A.</bold> Perfusion scan of the lungs shows many areas devoid of radioisotope (photopenia) bilaterally. <bold>B.</bold> The ventilation scan is normal. This combination of findings is diagnostic of pulmonary embolism.
<bold>Figure 1.25. Ventilation-perfusion scan in a patient with pulmonary emboli. A.</bold> Perfusion scan of the lungs shows ...
<bold><italic>Figure 13-16</bold> Calcific aortic stenosis.</bold> Congenital bicuspid aortic valve. Valve leaflets are thick and crusted with calcium and frozen in position. This valve is both stenotic and insufficient.
<bold><italic>Figure 13-16</bold> Calcific aortic stenosis.</bold> Congenital bicuspid aortic valve. Valve leaflet...
<bold>FIGURE 11-37. Calcific aortic stenosis of a congenitally bicuspid aortic valve.</bold> The two leaflets are heavily calcified, but there is no commissural fusion.
<bold>FIGURE 11-37. Calcific aortic stenosis of a congenitally bicuspid aortic valve.</bold> The two leaflets are heavily calc...
Auscultation, subvalvular membranous stenosis - Supravalvular aortic stenosis causes the jet to strike the aorta, producing an ejection murmur indistinguishable from that associated with valvular aortic stenosis except that there is no ejection click
Auscultation, subvalvular membranous stenosis - Supravalvular aortic stenosis causes the jet to strike the aorta, producing an ejection mu...
Atrial septal defect, isolated - Coronal view of heart with an isolated atrial septal defect allowing blood to flow between the atria
Defect, aortic - Heart demonstrating normal anatomic position of aorta (Ao) in an example of supravalvular aortic stenosis with bilateral superior caval veins. Pulmonary trunk (PT), r. sup. vena cava (RSCV), l. sup. vena cava (LSCV)
Defect, aortic - Heart demonstrating normal anatomic position of aorta (Ao) in an example of supravalvular aortic stenosis with bilateral ...
Defect, secundum atrial septal - A chest radiograph of a two-year-old patient with secundum atrial septal defect (ASD). Note cardiomegaly, right atrial prominence, upturned apex, and increased pulmonary vascular markings
Defect, secundum atrial septal - A chest radiograph of a two-year-old patient with secundum atrial septal defect (ASD). Note cardiomegaly...
Defect, secundum atrial septal - Chest radiograph of 21-year-old patient with secundum atrial septal defect (ASD). Note nearly normal heart size, prominence of left heart border with lifting of apex, prominence of the main pulmonary a., and increased pulmonary vascular markings
Defect, secundum atrial septal - Chest radiograph of 21-year-old patient with secundum atrial septal defect (ASD). Note nearly normal hea...