Managementul pacientului cu sincopa in departamentul de urgenta ...
Managementul pacientului cu sincopa in departamentul de urgenta ...
Managementul pacientului cu sincopa in departamentul de urgenta ...
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Constant<strong>in</strong>o si colab. au <strong>de</strong>scoperit ca 6,1 % d<strong>in</strong> pacientii <strong>cu</strong> disfunctii severeau necesitat 10 zile <strong>de</strong> evaluare <strong>de</strong> la <strong>s<strong>in</strong>copa</strong>. Mortalitatea a fost <strong>in</strong>tre0.7-5.4 % pentru pacientii care au fost re<strong>in</strong>ternati sau au suferit o <strong>in</strong>terventieterapeutica majora. Factorii <strong>de</strong> risc asociati <strong>cu</strong> disfunctii severe <strong>in</strong>clud:anormalitatile ECG, varsta peste 65 ani, sexul mas<strong>cu</strong>l<strong>in</strong>, antece<strong>de</strong>ntele <strong>de</strong>BPOC, trauma, lipsa simptomelor prodromale (10).RasaNu exista diferente semnificative <strong>in</strong> ceea ce priveste rasa pentru ris<strong>cu</strong>l <strong>de</strong>s<strong>in</strong>copei (1).SexulStudiile nu au evi<strong>de</strong>ntiat diferente semnificative <strong>in</strong>tre barbati si femei. Unstudiu <strong>de</strong> cohorta efectuat <strong>in</strong> SUA <strong>de</strong> Fram<strong>in</strong>gham a semnalat o <strong>in</strong>ci<strong>de</strong>ntaaproximativ egala <strong>de</strong> 72 /1000 la ambele sexe. S<strong>in</strong>copa neuroreglatorie (lipotimia)este mai frecventa la femei (11).135VarstaStudiile au <strong>de</strong>monstrate ca <strong>s<strong>in</strong>copa</strong> poate apare la toate grupele <strong>de</strong> varstala populatia adulta. Cauzele noncardiace sunt mai frecvente la populatiatanara, iar <strong>s<strong>in</strong>copa</strong> cardiaca apare mai frecvent la varste <strong>in</strong>a<strong>in</strong>tate (1).S<strong>in</strong>copa este extrem <strong>de</strong> rara <strong>in</strong> populatia pediatrica si are un varf <strong>de</strong> <strong>in</strong>ci<strong>de</strong>nta<strong>in</strong>tre 15 si 19 ani. Un studiu retrospectiv comunicat <strong>de</strong> Pratt si Fleisherraporteaza o prevalenta <strong>de</strong> sub 0.1% la copii. S<strong>in</strong>copa <strong>in</strong> pediatrie justificao evaluare <strong>de</strong>taliata (12).Varsta <strong>in</strong>a<strong>in</strong>tata este un factor <strong>de</strong> risc atat pentru <strong>s<strong>in</strong>copa</strong> cat si pentru<strong>de</strong>ces. Numeroase studii stratifica ris<strong>cu</strong>l <strong>in</strong> functie <strong>de</strong> varsta si sugereazaca pacienti <strong>cu</strong> varsta > 45ani, varsta > 65 ani, varsta > 85 ani au un riscproportional cres<strong>cu</strong>t. Varsta <strong>in</strong>a<strong>in</strong>tata este corelata <strong>cu</strong> cresterea frecventeiafectiunilor coronariene, bolilor miocardice, aritmiilor, <strong>in</strong>stabilitatii vasomotorii,pol<strong>in</strong>europatiilor, polipragmaziei (1).Tablou cl<strong>in</strong>icAnamneza si examenul fizic sunt cele mai specifice si sensibile cai <strong>de</strong> aevalua o <strong>s<strong>in</strong>copa</strong>. Pr<strong>in</strong> aceste meto<strong>de</strong>, diagnosti<strong>cu</strong>l este stabilit la 50-85%d<strong>in</strong> pacienti. Nici un alt test <strong>de</strong> laborator nu este mai eficace (1).De la pacient trebuie sa aflam <strong>in</strong> <strong>de</strong>taliu <strong>cu</strong>m s-a petre<strong>cu</strong>t evenimentul.Ne <strong>in</strong>tereseaza cir<strong>cu</strong>mstantele <strong>in</strong> care a aparut episodul, factorii precipitanti,activitatea pe care a <strong>de</strong>sfasurat-o pacientul <strong>in</strong>a<strong>in</strong>te <strong>de</strong> episod, pozitia <strong>in</strong> carese afla pacientul cand a avut loc episodul.Timisoara 2008
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