20/07/2026
สรุปแนวทางการ Approach syncope แบบง่ายๆ 🤗 (รายละเอียดในรูปและใน reference)
1. Is it true syncope?: Acute, transient, loss of consciousness, spontaneous recovery, Ddx with seizure.
- Important History🧐:
3P (Posture, Provocation, Prodrome),
age, family history, medical history.
- Physical exam🩺:
“clue of cardiac syncope”
Vital sign, BP supine/upright, pulse
(brady, tachy, pulse deficit,
pulsus paradoxus), JVP, murmur,
edema, hypoxemia.
2. Three main causes of syncope:
2.1. Cardiac (arrhythmia, structural, vascular)
2.2. Neurocardiogenic (vagal, situational, carotid sinus syndrome)
2.3. Orthostatic (drug, volume depletion, autonomic failure).
3. Risk of cardiac syncope: 😯
Old, known structural heart,
FH of SCD, syncope during supine
position, syncope during exertion,
absent of prodrome, syncope with
chest pain or palpitation.
4. EKG ❤️ is essential and should be performed in all patients !!! Use HEARTS approach to interpret findings.
5. Use Canadian syncope risk score:
- Low risk (discharge and F/U)
- Intermediate risk (monitor, selective test)
- High risk (admit, further cardiac work up)
6. Treatment: 🤕
6.1 Reflex or neurocardiogenic
- Trigger avoidance
- Counterpressure maneuver
- Reassure, hydration.
6.2 Orthostatic
- Stop/decrease vasodilator
- Compression stocking
- Midodrine, fludrocortisone.
6.3 Cardiac: Base on underlying conditions.
- Pacemaker for SSS, high grade AV block
- Ablation for SVT, VT
- AICD for Brugada, VT
- BB for HOCM, long QT, ARVC
- Anticoagulant or lytic for PE, prosthetic valve malfunction
- Surgery for dissection, AS, atrial myxoma
- Pericardiocentesis for tamponade
Reference:
- Recognising cardiac syncope. BMJ 2026;393:e085720
- Fuster&Hurst’s the HEART, 15th edition. Diagnosis and management of Syncope. Zachary Goldberger, Mohammed Ruzieh, Blair Grubb.
