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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140ortostatica si <strong>s<strong>in</strong>copa</strong>.- S<strong>in</strong>copa ortostatica – exista o relatie <strong>in</strong>tre hipotensiune ortostatica si<strong>s<strong>in</strong>copa</strong>. Inci<strong>de</strong>nta hipotensiunii ortostatice este corelata <strong>cu</strong> efectele baroreceptorilorsi <strong>in</strong>suficientei efectelor cardio-acceleratorii compensatorii;la pacientii varstnici 45% d<strong>in</strong> cauze se datoreaza medicamentelor.Studiile au <strong>de</strong>monstrat ca polidipsia poate reduce re<strong>cu</strong>renta. Ortopneeaeste o cauza frecventa <strong>de</strong> <strong>s<strong>in</strong>copa</strong>.- S<strong>in</strong>copa situationala are <strong>in</strong> esenta un mecanism reproductibil vasovagal,fi<strong>in</strong>d precipitata <strong>de</strong> un factor <strong>cu</strong>nos<strong>cu</strong>t. Mictiunea, <strong>de</strong>fecatia, s<strong>in</strong>dromuls<strong>in</strong>usului carotidian, tusea, <strong>de</strong>glutitia, efortul fizic pot <strong>in</strong>duce <strong>s<strong>in</strong>copa</strong>.Acesti stimuli <strong>in</strong>duc un raspuns vaso<strong>de</strong>presor, care <strong>in</strong> f<strong>in</strong>al duce la hipoperfuziecerebrala tranzitorie. Aceste cauze nu sunt amen<strong>in</strong>tatoare<strong>de</strong> viata, dar pot <strong>in</strong>fluenta morbiditatea. Tratamentul consta <strong>in</strong> evitareaacestor stimuli atunci cand este posibil, si <strong>in</strong>itierea unor contramanevrecand <strong>s<strong>in</strong>copa</strong> este anticipata.- S<strong>in</strong>copa <strong>de</strong> etiologie neurologica poate fi precedata <strong>de</strong> simptome prodromale:vertij, dizartrie, diplopie, ataxie. S<strong>in</strong>copa apare datorita existenteiunei <strong>in</strong>suficiente vertebro- bazilare bilaterale. Cir<strong>cu</strong>latia estebrusc obstruata, apare hipoperfuzia sistemului reti<strong>cu</strong>lar <strong>de</strong> la nivel cerebralsi astfel se produce episodul <strong>de</strong> pier<strong>de</strong>re a constientei.- Afectiuni psihiatrice – vertijul si <strong>s<strong>in</strong>copa</strong> pot fi simptome ale <strong>de</strong>presiei,anxietatii, tulburarii <strong>de</strong> panica si abuzului <strong>de</strong> droguri.Diagnostic diferentialS<strong>in</strong>copa cardiacastenoza aorticaasistoliafibrilatia atrialas<strong>in</strong>drom Brugadacardiomiopatia obstructivadisectia <strong>de</strong> aortaBAV gr II /IIIs<strong>in</strong>drom QT prelungits<strong>in</strong>drom QT s<strong>cu</strong>rtstenoza mitralaS<strong>in</strong>copa cardiacaS<strong>in</strong>copa noncardiaca<strong>de</strong>shidratareatraumatismele cranienes<strong>in</strong>dromul <strong>de</strong> hiperventilatiefurt subclavi<strong>cu</strong>laranti<strong>de</strong>presive triciclice, ch<strong>in</strong>id<strong>in</strong>aβ-blocante, blocante <strong>de</strong> calciu, coca<strong>in</strong>atoxicitate amfetam<strong>in</strong>e, anti<strong>de</strong>presiveanevrismul <strong>de</strong> aortaneuropatia diabeticastimularea diurezeiS<strong>in</strong>copa noncardiacaActualitati <strong>in</strong> anestezie, terapie <strong>in</strong>tensiva si medic<strong>in</strong>a <strong>de</strong> <strong>urgenta</strong>
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