Syncope
Krongkarn Sutham, M.D., FTCEP, Department of Emergency Medicine, CMU
- Acute elevated of Blood pressure(Severe hypertension) + Rapid and progressive end-organ damage including
- Acute Kidney Injury
- Acute MI
- Acute Stroke
- Acute Heart failure (Pulmonary edema)
- If no end-organ damage = Hypertensive urgency
- Severe hypertension ≥ 180/120 mmHg
- Severe hypertension = Hypertensive crisis = Malignant Hypertension = Accelerated Hypertension
Differential diagnosis
- Structural cardiopulmonary disease
- Valvular heart disease: AS, TS, MS
- Cardiomyopathy
- Pulmonary hypertension
- Neural/Reflex-Mediated
- Vasovagal
- Congenital heart disease
- Aortic dissection
- Pulmonary embolism
- Myocardial ischemia / Myocardial infarction
- Pericardial disease
- Dysrhythmias
- Bradydysrhythmias
- Stokes-Adams attack
- 2nd or 3rd degree AV block
- Sinus node disease
- Pacemaker malfunction
- Tachydysrhythmias
- Ventricular tachycardia
- Torsades de pointes
- Supraventricular tachycardia
- Atrial fibrillation or flutter
- Situational
- Cough
- Micturition / Defecation
- Swallow Neuralgia
- Carotid sinus syndrome
- Orthostatic hypotension
- Neurologic
- Transient ischemic attacks
- Subclavian steal
- Migraine
- Psychiatric
- Medications
- Antihypertensives
- Beta Blockers
- Cardiac glycosides
- Diuretics
- Antipsychotics
- Antidysrhythmics
- Antiparkinsonism drugs
- Antidepressants
- Phenothiazines
- Nitrates
- Alcohol
- Cocaine