CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E015 - Syncope
Apr 1, 2016
A focused dive into syncope: what defines it and why it puzzles clinicians. High‑risk groups and mechanisms behind fainting are highlighted. Lists of critical cardiac, vascular, neurologic and metabolic causes are discussed. Medications that can provoke syncope are reviewed. The San Francisco risk rule and clear red flags that warrant admission are explained.
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Syncope Is Brain Hypoperfusion Not Just Fainting
- Syncope is a sudden transient loss of consciousness from bilateral hemispheric dysfunction or RAS impairment.
- Most episodes reflect acute cerebral hypoperfusion from cardiac output failure, low SVR, low preload, or local cerebral vasoconstriction.
Coronary Disease Greatly Raises Syncope Risk
- Patients with known coronary artery disease who present with syncope carry the highest mortality risk.
- Vasovagal, orthostatic, or medication-induced syncope do not increase mortality unless complications like head injury occur.
Recent CCU Discharge Often Precipitates Syncope
- Tristan and Adam note many post-CCU discharges present with syncope after being started on multiple cardiac drugs.
- Recent CCU discharge with new beta blockers/CCBs commonly leads to orthostatic or hypotensive syncope visits.