1、晕厥的诊断与处理一一.晕厥的一般概念晕厥的一般概念什么是晕厥什么是晕厥?Definition of Syncope症状四大特点症状四大特点晕厥的原因晕厥的原因(晕厥门诊晕厥门诊)OrthostaticCardiacArrhythmiaStructuralCardio-Pulmonary*1 Vasovagal Carotid Sinus SituationalCoughPost-micturition2 Drug Induced ANS FailurePrimarySecondary3 BradySick sinusAV block TachyVTSVT Long QT Syndrome4 A
2、ortic Stenosis HOCM PulmonaryHypertension5Cerebro-vascularNeurally-MediatedUnknown Cause=18%56%2%20%3%1%Alboni P,et al.JACC 2001;37:1921-1928Steal SyndromeTIAEpilepsyClassification of transient loss of consciousnessCauses of SyncopeCauses of Syncope(cont.)Orthostatic SyncopeCauses of Syncope(cont.)C
3、auses of Syncope(cont.)Causes of Non-syncope Attacks(Commonly misdiagnosed as syncope)二二.晕厥的诊断晕厥的诊断Initial evaluationimportant historical featuresInitial evaluationimportant historical featuresInitial evaluationDiagnostic criterionInitial evaluationECG diagnostic criteriaInitial evaluationECG diagno
4、stic criteriaClinical and ECG features Suggesting Cardiac SyncopeClinical and ECG features Suggesting Neurally-mediated SyncopeLaboratory investigationsCertain or suspected heart diseaseyesnoCardiac evaluation-Echocardiogram-ECG monitoring-Exercise test-EP study-ILRNM evaluation-Carotid sinus massag
5、e-Tilt testing-ATP test-ILRLaborarory investigationsAlmost never usefulCarotid sinus massageTilt testingEchocardiogramHolter/loop monitoringElectrophysiological testExercise stress testingImplantable loop recorderEEGCT scan&MNRCarotid Doppler sonographyVentricular SAECGCoronary angiograhpyPulmonary
6、scintigraphy初步诊断病史、体检、ECG、BP实验室检查 Holter、Loop、HUT危险性评价诊断及评价诊断及评价晕厥晕厥症状症状真晕厥真晕厥诊断明确诊断明确病史病史+体检体检+心电图心电图除外诊断除外诊断治疗治疗诊断不明确诊断不明确详细病史、家族史详细病史、家族史查体查体心脏病诊断程序心脏病诊断程序晕厥诊断程序晕厥诊断程序?（1）诊断及鉴别诊断）诊断及鉴别诊断病史病史问什么问什么 12-导导 ECG诊断及鉴别诊断及鉴别 诊断诊断（2）Holter/ILR*Medtronic data on file21%因晕厥查Holter2%有心律失常+晕厥15%有晕厥但无心律失常用于间隔较
7、长的复发者常规检查不能确诊心脏电生理检查心脏电生理检查有意义的指标有意义的指标脑脑 电电 图图颈动脉窦按摩颈动脉窦按摩(CSM)3秒长间隙50mmHg收 缩压下降症状Carotid Sinus+DG Benditt,UM Cardiac Arrhythmia Center不明原因晕厥不明原因晕厥明确病因明确病因 53%to 62%不明原因不明原因 38%to 47%1-4（3）危险程度评估危险程度评估危险程度评估危险程度评估三三.晕厥的治疗晕厥的治疗晕厥的治疗晕厥的治疗器质性心脏病流出道梗阻泵衰竭心包压塞主动脉夹层电生理异常特殊类型神经系统病变小小 结结Flow Chat for syncop
8、e diagnosisSyncopeHistory,physical examination,ECGDiagnosis for orthostatic hypotension or neurocardiogenic syncopeUnexplained syncope:ECG,exercise test,ischemia evaluationPOSITIVE:1.Structure heart disease:Tx2.Ischemia:Tx3.Arrhythmia:EP examination Abalation,ICD4.MI:ICD5.EF0.3:ICDNormalContNormal(Cont)Single,benign episodeEvaluation completeFrequent episodeCorrelate symptoms with rhythm with Holtor or event monitor,or implantable loop recorder,as appropriateInfrequent episodesImplantable loop recorderSinus rhythm with symptomArrhythmia with symptomsCardiac evaluation completeTx
