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Peter Ott, M.D.
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Peter Ott, M.D.
Clinico-Pathological Conference
6-22-05
Recurrent syncope in a yo= ung female
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope
 =
•Sudden (a) loss of consciousness with (b) loss of postural tone and (= c) = spontaneous recovery
•
•<= /span>1% of all admissions
•<= /span>3% of all ER visits
•<= /span>Incidence: 6%
•<= /span>Recurrence: 30%
•
•<= /span>$ 2,600/patient
•<= /span>$ 24,000/diagnosis
•<= /span>
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Peter Ott, M.D.
Syncope
- causes -
•C= ardiac
–= Arrhythmic
–= Non-arrhythmic
–=
–= Tachycardia
–= Bradycardia
•N= on-cardiac
–= CNS
•= Neurologic
•= psychiatric
–= Drug reaction
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope: prognosis
3D"
NEJM 2002, 347: 878
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Peter Ott, M.D.
Syncope
- other tests -
•Holter
•Signal averaged ECG
•EP study
•Event monitor
•Implantable loop = recorder
•Tilt table test
•<= /span>
US carotids
CT scan
MRI
EEG
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0022.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope:
<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•H&P&#= 13;
<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•EKG
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0005.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope
- neurologic tests -
<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Neurologi= c cause: < 10%
<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Yield of neurologic tests: < 10%
<= span style=3D'visibility:hidden'>•
• •Note: seizure activity often not primary but due to = CNS hypo-perfusion
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0023.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope:
&#= 8226;Provocative tests
= –EP study
= –Tilt table
= –Carotid massage
&= #8226;Monitoring strategies
= –24 hr Holter
= –Event Monitor
–Implantable loop monitor
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope:
who needs an EP evaluation
R= 26;Symptoms strongly suggestive of an arrhythmia
&#= 8226;Structural heart disease
&#= 8226;AV conduction disorders
&#= 8226;“Channelopathies”
&= #8211;Long QT
&= #8211;Brugada syndrome etc
------=_NextPart_01C577F3.F2C0FF60 Content-Location: file:///C:/257BCE74/MedGR2005_06_22Ottppt_files/slide0024.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Clinicopathological Conference 6-22-05
Peter Ott, M.D.
Syncope:
who needs an EP evaluation
&#= 8226;Diagnostic findings during EP study:
R= 26;
&= #8211;Inducible SVT with hemodynamic collapse
&= #8211;Abnormal sinus node recovery time
&= #8211;Abnormal His Purkinje System
&= #8226;Prolonged HV interval
&= #8226;Inducible infra His block
&= #8211;Inducible VT/VF
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Peter Ott, M.D.
•= EP study:
–Typical A= VNRT induced/ablated
Rec syncope in 87 y woman
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Peter Ott, M.D.
Syncope = in elderly Navajo  Male
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