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Information ⬇

Apparent loss of consciousness can be present in generalized anxiety, panic disorders, major depression, and somatization disorder. Frequently resembles presyncope, although the symptoms are not accompanied by prodromal symptoms and are not relieved by recumbency. Attacks can often be reproduced by hyperventilation and have associated symptoms of panic attacks such as a feeling of impending doom, air hunger, palpitations, and tingling of the fingers and perioral region. Such pts are rarely injured despite numerous falls. There are no clinically significant hemodynamic changes.

Treatment: Syncope

Therapy is determined by the underlying cause.

  • Pts with neurally mediated syncope should be reassured and instructed to avoid situations or stimuli that provoke attacks. Plasma volume expansion should occur with fluid and salt.
  • Drug therapy may be necessary for resistant neurally medicated syncope. Fludrocortisone, vasoconstricting agents, and β-adrenergic antagonists are widely used although there is no consistent evidence from randomized trials.
  • Pts with orthostatic hypotension should first be treated with removal of vasoactive medications. Then consider nonpharmacologic (pt education regarding moves from supine to upright, increasing fluids and salt in diet) and finally pharmacologic methods such as fludrocortisone and vasoconstricting agents such as midodrine, l-dihydroxyphenylserine, and pseudoephedrine.
  • Management of cardiac causes depends in the underlying disorder. Cardiac pacing or cardioverter-defibrillator implantation is sometimes necessary.

    Management of refractory orthostatic hypotension is discussed in Chap. 186. Autonomic Nervous System Disorders.

For a more detailed discussion, see Freeman R: Syncope, Chap. 27, p. 142, in HPIM-19.

Outline ⬆

Section 3. Common Patient Presentations