Senkop
Özet
Senkop, serebral hipoperfüzyona bağlı gelişen ani, kısa süreli ve kendiliğinden düzelen bilinç kaybı olarak tanımlanabilir. Her yıl acil başvurularının yaklaşık %1-2’si senkop nedeniyle olmaktadır. Tüm senkopların yaklaşık %60’ı refleks (nöral aracılı), %15’i ortostatik, %15’i kardiyak senkoptur. Senkop prognozunda en önemli belirleyici etken etyolojidir. Kardiyak senkoplar kötü prognozluyken, diğer senkoplar daha iyi prognozludur. Detaylı muayene ve aydınlatıcı anamnez ile hastaların en azından yarısına (%32-74) tanı konulabilmektedir. Risk sınıflandırmaları, senkopla getirilen hastaların yönetiminde yönlendirici olmaktadır. Senkop geçiren hastaların tedavisinde spesifik tedaviler yoktur. Refleks senkoplarda otonomik regülasyon veya hidrasyon gibi tedaviler verilebilirken, kardiyak senkopta ablasyon tedavi olabilir.
Referanslar
Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al.Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009 Nov;30(21):2631-71.
Sarasin FP, Louis-Simonet M, Carballo D, Slama S, Rajeswaran A, Metzger JT, et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med. 2001 Aug 15;111(3):177-84.
Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85.
Colman N, Nahm K, Ganzeboom KS, Shen WK, Reitsma J, Linzer M, et al. Epidemiology of reflex syncope. Clin Auton Res. 2004 Oct;14 Suppl 1:9-17.
Gibbons CH, Freeman R. Delayed orthostatic hypotension. Auton Neurosci. 2020 Dec;229:102724.
Sutton R. Clinical classification of syncope. Prog Cardiovasc Dis. 2013 Jan-Feb;55(4):339-44.
Chen L, Chen MH, Larson MG, Evans J, Benjamin EJ, Levy D. Risk factors for syncope in a community-based sample (the Framingham Heart Study). Am J Cardiol. 2000 May 15;85(10):1189-93.
Goyal N, Donnino MW, Vachhani R, Bajwa R, Ahmad T, Otero R. The utility of head computed tomography in the emergency department evaluation of syncope. Intern Emerg Med. 2006;1(2):148-50.
Maisel WH, Stevenson WG. Syncope--getting to the heart of the matter. N Engl J Med. 2002 Sep 19;347(12):931-3.
McDermott D, Quinn J. Response to ‘failure to validate the San Francisco Syncope Rule in an independent emergency department population’. Ann Emerg Med. 2009 May;53(5):693; author reply 693-4.
Ungar A, Del Rosso A, Giada F, Bartoletti A, Furlan R, Quartieri F, et al; Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. Eur Heart J. 2010 Aug;31(16):2021-6.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Ann Intern Med. 1997 Jun 15;126(12):989-96.
Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M, et al; Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001 Jun 1;37(7):1921-8.
Puppala VK, Dickinson O, Benditt DG. Syncope: classification and risk stratification. J Cardiol. 2014 Mar;63(3):171-7.
Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W. Prevalence and triggers of syncope in medical students. Am J Cardiol. 2003 Apr 15;91(8):1006-8, A8.
van Dijk JG, Wieling W. Pathophysiological basis of syncope and neurological conditions that mimic syncope. Prog Cardiovasc Dis. 2013 Jan-Feb;55(4):345-56.
Thijs RD, Kruit MC, van Buchem MA, Ferrari MD, Launer LJ, van Dijk JG. Syncope in migraine: the population-based CAMERA study. Neurology. 2006 Apr 11;66(7):1034-7.
Kułakowski P. Syncope update 2013: diagnosis and treatment. Kardiol Pol. 2013;71(3):215-23.
Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, et al; Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008 Dec;94(12):1620-6.
Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al; Task force on syncope, Part 2. Diagnostic tests and treatment: summary of recommendations. Europace. 2001 Oct;3(4):261-8.
Referanslar
Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al.Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009 Nov;30(21):2631-71.
Sarasin FP, Louis-Simonet M, Carballo D, Slama S, Rajeswaran A, Metzger JT, et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med. 2001 Aug 15;111(3):177-84.
Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85.
Colman N, Nahm K, Ganzeboom KS, Shen WK, Reitsma J, Linzer M, et al. Epidemiology of reflex syncope. Clin Auton Res. 2004 Oct;14 Suppl 1:9-17.
Gibbons CH, Freeman R. Delayed orthostatic hypotension. Auton Neurosci. 2020 Dec;229:102724.
Sutton R. Clinical classification of syncope. Prog Cardiovasc Dis. 2013 Jan-Feb;55(4):339-44.
Chen L, Chen MH, Larson MG, Evans J, Benjamin EJ, Levy D. Risk factors for syncope in a community-based sample (the Framingham Heart Study). Am J Cardiol. 2000 May 15;85(10):1189-93.
Goyal N, Donnino MW, Vachhani R, Bajwa R, Ahmad T, Otero R. The utility of head computed tomography in the emergency department evaluation of syncope. Intern Emerg Med. 2006;1(2):148-50.
Maisel WH, Stevenson WG. Syncope--getting to the heart of the matter. N Engl J Med. 2002 Sep 19;347(12):931-3.
McDermott D, Quinn J. Response to ‘failure to validate the San Francisco Syncope Rule in an independent emergency department population’. Ann Emerg Med. 2009 May;53(5):693; author reply 693-4.
Ungar A, Del Rosso A, Giada F, Bartoletti A, Furlan R, Quartieri F, et al; Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. Eur Heart J. 2010 Aug;31(16):2021-6.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Ann Intern Med. 1997 Jun 15;126(12):989-96.
Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M, et al; Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001 Jun 1;37(7):1921-8.
Puppala VK, Dickinson O, Benditt DG. Syncope: classification and risk stratification. J Cardiol. 2014 Mar;63(3):171-7.
Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W. Prevalence and triggers of syncope in medical students. Am J Cardiol. 2003 Apr 15;91(8):1006-8, A8.
van Dijk JG, Wieling W. Pathophysiological basis of syncope and neurological conditions that mimic syncope. Prog Cardiovasc Dis. 2013 Jan-Feb;55(4):345-56.
Thijs RD, Kruit MC, van Buchem MA, Ferrari MD, Launer LJ, van Dijk JG. Syncope in migraine: the population-based CAMERA study. Neurology. 2006 Apr 11;66(7):1034-7.
Kułakowski P. Syncope update 2013: diagnosis and treatment. Kardiol Pol. 2013;71(3):215-23.
Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, et al; Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008 Dec;94(12):1620-6.
Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al; Task force on syncope, Part 2. Diagnostic tests and treatment: summary of recommendations. Europace. 2001 Oct;3(4):261-8.
