https://www.wikidoc.org/api.php?action=feedcontributions&feedformat=atom&user=Karol+Gema+Hernandez 2026-04-11T14:11:50Z User contributions MediaWiki 1.45.1 https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933471 2014-01-17T20:28:59Z

<p>Karol Gema Hernandez: /* Causes */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Causes in Alphabetical Order===<br /> *[[Amyloidosis]]<br /> *[[Anticoagulant therapy]] &lt;ref&gt;Longmore, M., Wilkinson, I.B., Rajagopalan, S. (2004) (6th Ed.). Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press ISBN 9780198568377 &lt;/ref&gt;. <br /> *[[Aortic dissection]] &lt;ref&gt;Isselbacher, E.M., Cigarroa, J.E., Eagle, K.A. (1994). Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation. Vol 90, 2375-2378&lt;/ref&gt;<br /> *Bacterial [[pericarditis]]<br /> *[[Bronchogenic cyst]]<br /> *[[Cancer]]<br /> *[[Chest trauma]] (both blunt and penetrating) &lt;ref&gt;Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097 &lt;/ref&gt;<br /> *[[Constrictive pericarditis]]<br /> *[[Dilated cardiomyopathy]]<br /> *[[Dissecting aortic aneurysm]]<br /> *[[Dressler syndrome]]<br /> *During cardiac surgery &lt;ref&gt;Mattson Porth, C. (Ed.) (2005) (7th Ed.) Pathophysiology: Concepts of Altered Health States. Philadelphia : Lippincott Williams &amp; Wilkins ISBN 978-0781749886 &lt;/ref&gt;<br /> *[[Hypothyroidism]]<br /> *[[Malignancy]]<br /> *[[Mycobacterium tuberculosis]]<br /> *[[Myocardial rupture]]. Myocardial rupture typically happens in the subacute setting after a [[myocardial infarction]] (heart attack), in which the infarcted muscle of the heart thins out and tears. Myocardial rupture is more likely to happen in females, the elderly, patients with hypertension, and individuals without any previous[[heart|cardiac]] history who suffer from their first heart attack and are not revascularized with [[thrombolytic]] therapy, [[percutaneous coronary intervention]], or with[[coronary artery bypass graft surgery]].&lt;ref name=&quot;rupturelikeliness&quot;&gt;*{{cite journal<br /> | first=A<br /> | last=Meniconi<br /> | authorlink=<br /> | coauthors=C H ATTENHOFER JOST, R JENNI<br /> | year=2000<br /> | month=November<br /> | title=How to survive myocardial rupture after myocardial infarction<br /> | journal=Heart<br /> | volume=84<br /> | issue=5<br /> | pages =<br /> | id= PMID 11040020<br /> | url=http://heart.bmj.com/cgi/content/full/84/5/552<br /> }}&lt;/ref&gt; These patients often have single vessel disease without the development of [[collateral]]s.<br /> *Penetrating cardiac injury<br /> *[[Pericarditis]]<br /> *Physical trauma<br /> *[[Postpericardiotomy syndrome]]<br /> *Pyogenic [[pericarditis]]<br /> *Rheumatoid pericarditis<br /> *[[Scrub typhus]]<br /> *[[Tuberculous pericarditis]]<br /> *[[Uremia]]<br /> *[[Uremic pericarditis]]<br /> *[[Ventricular aneurysm]]<br /> *Viral [[pericarditis]]<br /> <br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]]: &lt;br&gt;❑ “water bottle” heart shadow}}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933468 2014-01-17T20:15:52Z

<p>Karol Gema Hernandez: </p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]]: &lt;br&gt;❑ “water bottle” heart shadow}}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933460 2014-01-17T19:49:36Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]]: &lt;br&gt;❑ “water bottle” heart shadow}}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933458 2014-01-17T19:49:00Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]]:“water bottle” heart shadow}}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933449 2014-01-17T19:36:27Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]] }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933448 2014-01-17T19:36:00Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform Chest X-Ray }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933447 2014-01-17T19:35:27Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | |!| | | | }}<br /> {{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform chest x- ray }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933445 2014-01-17T19:34:19Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | | }}<br /> {{familytree | G01 | | G02 | | | | | | | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933444 2014-01-17T19:33:27Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | | }}<br /> {{familytree | G01 | | G02 | | | | | | | | |G01=}}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933443 2014-01-17T19:32:51Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | | }}<br /> {{familytree | G01 | | G02 | | | | | | | | |G01=<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933438 2014-01-17T19:28:12Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= &lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)&lt;/div&gt;}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933436 2014-01-17T19:26:53Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]:&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933435 2014-01-17T19:26:10Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate ischemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933433 2014-01-17T19:25:23Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial [[chest pain]]&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933432 2014-01-17T19:24:35Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦[[Fever]] &lt;br&gt; ♦[[Malaise]] &lt;br&gt; ♦[[Myalgia]]&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933429 2014-01-17T19:22:18Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification: &lt;br&gt; ♦ Type A: No effusion &lt;br&gt; ♦ Type B: Separation of epicardium and pericardium (3–16 ml)&lt;br&gt; ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion &gt;16 ml)&lt;br&gt; ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion&lt;br&gt; ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space&lt;br&gt; ♦ Type E: Pericardial thickening (&gt;4 mm)}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933428 2014-01-17T19:20:27Z

<p>Karol Gema Hernandez: </p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933427 2014-01-17T19:19:41Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦ Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==EKG Staging==<br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933425 2014-01-17T19:14:16Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine ECK staging:&lt;br&gt; ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity &lt;br&gt; ♦Early stage II: ST junctions return to the baseline, PR deviated &lt;br&gt; ♦ Late stage II: T waves progressively flatten and invert &lt;br&gt; ♦ Stage III: generalised T wave inversions &lt;br&gt; ♦ Stage IV: ECG returns to prepericarditis state <br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==EKG Staging==<br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933415 2014-01-17T18:52:54Z

<p>Karol Gema Hernandez: </p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine [[Cardiac tamponade resident survival guide#ECK staging|ECK staging]]&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> ==EKG Staging==<br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933413 2014-01-17T18:52:25Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine [[Cardiac tamponade resident survival guide#ECK staging|ECK staging]]&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933412 2014-01-17T18:51:10Z

<p>Karol Gema Hernandez: </p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> ==Horowitz Classification==<br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933410 2014-01-17T18:50:17Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to[[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]] }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933407 2014-01-17T18:45:09Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''&lt;br&gt; ❑ Effusion types B- D according to Horowitz classification }}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933404 2014-01-17T18:41:57Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography'''}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion:&lt;br&gt; ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933403 2014-01-17T18:41:17Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography'''}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion: ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | |!| | | | | | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933402 2014-01-17T18:40:41Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography'''}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion: ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933401 2014-01-17T18:39:24Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography'''}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers: &lt;br&gt;♦[[ESR]] &lt;br&gt; ♦[[CRP]] &lt;br&gt; ♦[[LDH]] &lt;br&gt; ❑ Markers of myocardial lesion: ♦[[Troponin I]] &lt;br&gt; ♦[[CK MB]]&lt;/div&gt; }}<br /> <br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933396 2014-01-17T18:32:12Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> ♦Fever &lt;br&gt; ♦Malaise &lt;br&gt; ♦Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> ♦Radiates to trapezius ridge&lt;br&gt; ♦Can be pleuritic &lt;br&gt; ♦Can simulate isquemia &lt;br&gt; ♦Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> ♦Monophasic&lt;br&gt; ♦Biphasic&lt;br&gt; ♦Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography'''}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers &lt;br&gt; ❑ Markers of myocardial lesion&lt;/div&gt; }}<br /> <br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=933395 2014-01-17T18:30:39Z

<p>Karol Gema Hernandez: /* Treatment of Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC|loss of consciousness]] due to cerebral hypoperfusion, characterized by a rapid onset, a short duration and a spontaneous complete recovery.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;'''Initial assessment:'''&lt;br&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -Syncope during exertion or supine &lt;br&gt; -Palpitations at the time of syncope &lt;br&gt; -Family history of[[SCD]] &lt;br&gt; -Non-sustained [[VT]] &lt;br&gt; -Conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[Sinus bradycardia]] &lt;br&gt; -Pre-exited QRS complex &lt;br&gt; -Prolonged or short QR interval &lt;br&gt; -Brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated tests as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}}<br /> <br /> ===Treatment of Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | A01 | | | | | | A02 | | | | A03 | | | | A01=Reflex and orthostatic intolerance | A02= Cardiac | A03= Unexplained and high risk [[SCD]] }}<br /> {{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| | | | | | | | | }}<br /> {{familytree | | B01 | | B02 | | B03 | | B04 | | B05 | B01=Unpredictable or high- frequency | B02= Predictable or low frequency | B03= Cardiac arrythmias [[SCD]]| B04=Structural (cardiac or pulmonary) | B05= i.e. [[CAD]], [[HOCM]], [[ARV]], channelopathies}}<br /> {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| }}<br /> <br /> {{familytree | | C01 | | C02 | | C03 | | C04 | | C05 | C01=Consider specific therapy or delayed treatment based by [[ECG]] documentation | C02= Education, reassurance, avoidance of triggers | C03= Specfic therapy of the culprit arrythmia| C04=Treatment of underlying disease | C05= Consider [[ICD]] therapy}}<br /> {{familytree/end}}<br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform carotid sinus massage (CSM) in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933379 2014-01-17T17:12:12Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> {{familytree/start |summary=PE diagnosis Algorithm.}}<br /> {{familytree | | | | | | | A01 | |A01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Characterize the symptoms:'''&lt;br&gt;<br /> ❑ Prodrome:&lt;br&gt;<br /> -Fever &lt;br&gt; -Malaise &lt;br&gt; -Myalgia&lt;br&gt;<br /> ❑ Retrosternal or left precordial chest pain&lt;br&gt;<br /> - Radiates to trapezius ridge&lt;br&gt; -Can be pleuritic &lt;br&gt; -Can simulate isquemia &lt;br&gt; -Varies with posture &lt;br&gt;<br /> &lt;/div&gt; }}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | C01 | | | | | | |C01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Auscultation:'''&lt;br&gt;<br /> ❑ [[Pericardial rub]]&lt;br&gt;<br /> -Monophasic&lt;br&gt; -Biphasic&lt;br&gt; -Triphasic &lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | D01 | | | | | | |D01=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Perform ECG:'''&lt;br&gt;<br /> ❑ Convexly elevated J-ST segment&lt;br&gt;<br /> ❑ Determine stage&lt;br&gt;<br /> &lt;/div&gt;}}<br /> {{familytree | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography'''}}<br /> {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}<br /> {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=&lt;div style=&quot;float: left; text-align: left; line-height: 150% &quot;&gt;'''Order lab tests:''' &lt;br&gt; ❑ Inflammation markers &lt;br&gt; ❑ Markers of myocardial lesion&lt;/div&gt; }}<br /> <br /> {{familytree/end}}<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Cardiac_tamponade_resident_survival_guide&diff=933374 2014-01-17T17:01:46Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>__NOTOC__<br /> {{CMG}}; {{AE}} {{AO}}<br /> ==Definitions==<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> ===Common Causes===<br /> <br /> ==Management==<br /> Shown below is an algorithm showing acute pericarditis management.&lt;ref name=&quot;pmid15120056&quot;&gt;{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=15120056 }} &lt;/ref&gt;<br /> <br /> ==Dos==<br /> <br /> ==Don'ts==<br /> ==References==<br /> {{Reflist|2}}<br /> <br /> [[Category:Medicine]]<br /> [[Category:Resident survival guide]]<br /> <br /> {{WH}}<br /> {{WS}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=932251 2014-01-13T14:02:44Z

<p>Karol Gema Hernandez: /* Don&#039;ts */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -Syncope during exertion or supine &lt;br&gt; -Palpitations at the time of syncope &lt;br&gt; -Family history of[[SCD]] &lt;br&gt; -Non-sustained [[VT]] &lt;br&gt; -Conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[Sinus bradycardia]] &lt;br&gt; -Pre-exited QRS complex &lt;br&gt; -Prolonged or short QR interval &lt;br&gt; -Brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated tests as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}}<br /> <br /> ===Treatment of Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | A01 | | | | | | A02 | | | | A03 | | | | A01=Reflex and orthostatic intolerance | A02= Cardiac | A03= Unexplained and high risk [[SCD]] }}<br /> {{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| | | | | | | | | }}<br /> {{familytree | | B01 | | B02 | | B03 | | B04 | | B05 | B01=Unpredictable or high- frequency | B02= Preictable or low frequency | B03= Cardiac arrythmias [[SCD]]| B04=Structural (cardiac or pulmonary) | B05= i.e. [[CAD]], [[HOCM]], [[ARV]], channelopathies}}<br /> {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| }}<br /> <br /> {{familytree | | C01 | | C02 | | C03 | | C04 | | C05 | C01=Consider specific therapy or delayed treatment based by [[ECG]] documentation | C02= Education, reassurance, avoidance of triggers | C03= Specfic therapy of the culprit arrythmia| C04=Treatment of underlying disease | C05= Consider [[ICD]] therapy}}<br /> {{familytree/end}}<br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform carotid sinus massage (CSM) in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931857 2014-01-10T23:30:30Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -Syncope during exertion or supine &lt;br&gt; -Palpitations at the time of syncope &lt;br&gt; -Family history of[[SCD]] &lt;br&gt; -Non-sustained [[VT]] &lt;br&gt; -Conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[Sinus bradycardia]] &lt;br&gt; -Pre-exited QRS complex &lt;br&gt; -Prolonged or short QR interval &lt;br&gt; -Brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated tests as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}}<br /> <br /> ===Treatment of Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | A01 | | | | | | A02 | | | | A03 | | | | A01=Reflex and orthostatic intolerance | A02= Cardiac | A03= Unexplained and high risk [[SCD]] }}<br /> {{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| | | | | | | | | }}<br /> {{familytree | | B01 | | B02 | | B03 | | B04 | | B05 | B01=Unpredictable or high- frequency | B02= Preictable or low frequency | B03= Cardiac arrythmias [[SCD]]| B04=Structural (cardiac or pulmonary) | B05= i.e. [[CAD]], [[HOCM]], [[ARV]], channelopathies}}<br /> {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| }}<br /> <br /> {{familytree | | C01 | | C02 | | C03 | | C04 | | C05 | C01=Consider specific therapy or delayed treatment based by [[ECG]] documentation | C02= Education, reassurance, avoidance of triggers | C03= Specfic therapy of the culprit arrythmia| C04=Treatment of underlying disease | C05= Consider [[ICD]] therapy}}<br /> {{familytree/end}}<br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931856 2014-01-10T23:29:40Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -Syncope during exertion or supine &lt;br&gt; -Palpitations at the time of syncope &lt;br&gt; -Family history of[[SCD]] &lt;br&gt; -Non-sustained [[VT]] &lt;br&gt; -Conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[Sinus bradycardia]] &lt;br&gt; -Pre-exited QRS complex &lt;br&gt; -Prolonged or short QR interval &lt;br&gt; -Brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}}<br /> <br /> ===Treatment of Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | A01 | | | | | | A02 | | | | A03 | | | | A01=Reflex and orthostatic intolerance | A02= Cardiac | A03= Unexplained and high risk [[SCD]] }}<br /> {{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| | | | | | | | | }}<br /> {{familytree | | B01 | | B02 | | B03 | | B04 | | B05 | B01=Unpredictable or high- frequency | B02= Preictable or low frequency | B03= Cardiac arrythmias [[SCD]]| B04=Structural (cardiac or pulmonary) | B05= i.e. [[CAD]], [[HOCM]], [[ARV]], channelopathies}}<br /> {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| }}<br /> <br /> {{familytree | | C01 | | C02 | | C03 | | C04 | | C05 | C01=Consider specific therapy or delayed treatment based by [[ECG]] documentation | C02= Education, reassurance, avoidance of triggers | C03= Specfic therapy of the culprit arrythmia| C04=Treatment of underlying disease | C05= Consider [[ICD]] therapy}}<br /> {{familytree/end}}<br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931855 2014-01-10T22:49:22Z

<p>Karol Gema Hernandez: /* Treatment of Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> ===Treatment of Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | A01 | | | | | | A02 | | | | A03 | | | | A01=Reflex and orthostatic intolerance | A02= Cardiac | A03= Unexplained and high risk [[SCD]] }}<br /> {{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| | | | | | | | | }}<br /> {{familytree | | B01 | | B02 | | B03 | | B04 | | B05 | B01=Unpredictable or high- frequency | B02= Preictable or low frequency | B03= Cardiac arrythmias [[SCD]]| B04=Structural (cardiac or pulmonary) | B05= i.e. [[CAD]], [[HOCM]], [[ARV]], channelopathies}}<br /> {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| }}<br /> <br /> {{familytree | | C01 | | C02 | | C03 | | C04 | | C05 | C01=Consider specific therapy or delayed treatment based by [[ECG]] documentation | C02= Education, reassurance, avoidance of triggers | C03= Specfic therapy of the culprit arrythmia| C04=Treatment of underlying disease | C05= Consider [[ICD]] therapy}}<br /> {{familytree/end}}<br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931854 2014-01-10T22:48:17Z

<p>Karol Gema Hernandez: /* Management */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> ===Treatment of Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | A01 | | | | | | A02 | | | | A03 | | | | A01=Reflex and orthostatic intolerance | A02= Cardiac | A03= Unexplained and high risk [[SCD]] }}<br /> {{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | |^| | | | | | | | | }}<br /> {{familytree | | B01 | | B02 | | B03 | | B04 | | B05 | B01=Unpredictable or high- frequency | B02= Preictable or low frequency | B03= Cardiac arrythmias [[SCD]]| B04=Structural (cardiac or pulmonary) | B05= i.e. [[CAD]], [[HOCM]], [[ARV]], channelopathies}}<br /> {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| }}<br /> <br /> {{familytree | | C01 | | C02 | | C03 | | C04 | | C05 | C01=Consider specific therapy or delayed treatment based by [[ECG]] documentation | C02= Education, reassurance, avoidance of triggers | C03= Specfic therapy of the culprit arrythmia| C04=Treatment of underlying disease | C05= Consider [[ICD]] therapy}}<br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931853 2014-01-10T22:33:34Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis:'''&lt;br&gt; Treat as according | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931852 2014-01-10T22:31:31Z

<p>Karol Gema Hernandez: /* Do&#039;s */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Perform tilt testing if psychiatric disease.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931851 2014-01-10T22:30:41Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|v|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931850 2014-01-10T22:29:27Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | |,|-|-|-|^|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | H01 | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | I01 | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | |,|-|^|-|.| | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | J01 | | J02 | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | | |`|-|^|-|'| | | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | |!| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H01 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931849 2014-01-10T22:26:56Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | |,|-|-|-|-|^|-|-|-|-|.| | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | H01 | | | | | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | |!| | | | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | I01 | | | | | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | |,|-|^|-|.| | | | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | J01 | | J02 | | | | J03 | | J04 | J01= '''If yes:''' &lt;br&gt; Treat as according | J02= No structural heart disease | J03= Yes | J04=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | |`|-|-|+|-|-|'| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | |!| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | H02 | | | | | H01= Tilt testing}}<br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931848 2014-01-10T22:19:48Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | | |,|-|-|^|-|-|.| | | | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | | H01 | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | | |!| | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | | I01 | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I02= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | | | | | | | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | | | | | | | | J01 | | J02 | J01= Yes | J02=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | |`|-|-|+|-|-|'| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | |!| | | | | | }}<br /> {{familytree | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | }}<br /> {{familytree | | | | | | | | | | H01 | | | | H02 | | | | | H01= Suspicion of structural heart disease | H02= Psychiatric disease}}<br /> <br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931847 2014-01-10T22:18:17Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | | |,|-|-|^|-|-|.| | | | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | | H01 | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | | |!| | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | | I01 | | | | I02 | | | I01= '''❑ If suspicion of structural heart disease:''' &lt;br&gt; Echocardiography | I012= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | | | | | | | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | | | | | | | | J01 | | J02 | J01= Yes | J02=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | |`|-|-|+|-|-|'| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | |!| | | | | | }}<br /> {{familytree | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | }}<br /> {{familytree | | | | | | | | | | H01 | | | | H02 | | | | | H01= Suspicion of structural heart disease | H02= Psychiatric disease<br /> <br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931845 2014-01-10T21:58:59Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | G01 | | | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> {{familytree | | | | | | |!| | | | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | H01 | | | |,|-|-|^|-|-|.| | | | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> {{familytree | | | | | | | | | | | H01 | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> {{familytree | | | | | | | | | | | | | | | | | |!| | | }}<br /> {{familytree | | | | | | | | | | | | | | | | | I01 | | | | I01= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | | | | | | | | |,|-|^|-|.| | }}<br /> {{familytree | | | | | | | | | | | | | | | J01 | | J02 | J01= Yes | J02=No: &lt;br&gt; No further evaluation }} <br /> {{familytree | | | | | | | | | | | |`|-|-|+|-|-|'| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | |!| | | | | | }}<br /> {{familytree | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | }}<br /> {{familytree | | | | | | | | | | H01 | | | | H02 | | | | | H01= Suspicion of structural heart disease | H02= Psychiatric disease<br /> <br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Syncope_resident_survival_guide&diff=931840 2014-01-10T21:53:38Z

<p>Karol Gema Hernandez: /* Diagnostic Flowchart in Patients with Suspected Syncope */</p> <hr /> <div>{{WikiDoc CMG}}; {{AE}} {{KGH}}<br /> <br /> ==Definition==<br /> [[Syncope]] is defined as a transient [[LOC]], characterized by rapid onset, short duration and spontaneous complete recovery due to cerebral hypoperfusion.<br /> <br /> ==Causes==<br /> ===Life Threatening Causes===<br /> Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<br /> <br /> *[[Hemorrhage]]<br /> *[[Hypotension]]<br /> *[[Hypoxia]]<br /> *[[Ruptured abdominal aortic aneurysm]]<br /> *[[Ventricular arrhythmia]]&lt;ref name=&quot;Khoo-2013&quot;&gt;{{Cite journal | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 |doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}&lt;/ref&gt;<br /> <br /> ===Common Causes===<br /> *[[Arrhythmia]]<br /> *[[Medication]]<br /> *[[Orthostatic hypotension]]<br /> *[[Vagal stimulation]]<br /> *[[Vertebrobasilar insufficiency]]&lt;ref name=&quot;Kapoor-2000&quot;&gt;{{Cite journal | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}&lt;/ref&gt;<br /> <br /> ==Management==<br /> ===Syncope in the Context of Transient [[LOC]]===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | A01 |A01= Determine if there was [[LOC]] }} <br /> {{familytree | | | | |,|-|-|-|^|-|-|-|.| | | }}<br /> {{familytree | | | B01 | | | | | | | B02 | | |B01= '''If yes:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Rapid onset? &lt;br&gt; ❑ Short duration? &lt;br&gt; ❑ Spontaneous complete recovery? &lt;/div&gt; |B02='''If no:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;height: 8em; width: 25em; padding:1em;&quot;&gt; ❑ [[Cataplexy]] &lt;br&gt; ❑ Drop attacks &lt;br&gt; ❑ Falls &lt;br&gt; ❑ Functional /psychogenic pseudosyncope &lt;br&gt; ♦ Psychiatric evaluation &lt;br&gt; ❑ [[TIA]] of carotid origin &lt;/div&gt;}}<br /> {{familytree | |,|-|^|-|.| | | | | | | | | }}<br /> {{familytree | C01 | | C02 | | | | | | |C01='''If no to ≥1; exclude the following before proceeding with syncope evaluation:''' &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ [[Coma]] &lt;br&gt; ❑ Aborted [[SCD]] &lt;br&gt; ❑ [[Epilepsy]] &lt;br&gt; -Perform neurological evaluation &lt;br&gt; -Perform tilt testing, preferably with concurrent EEG and video monitoring if doubt of mimicking epilepsy &lt;br&gt; ❑ Metabolic disorders: &lt;br&gt; ♦ [[Hypoglycemia]] &lt;br&gt; ♦ [[Hypoxia]] &lt;br&gt; ♦ [[Hyperventilation]] with [[hypocapnia]] &lt;br&gt; ❑ [[Intoxication]] &lt;br&gt; ❑ Vertebrobasilar [[TIA]]&lt;/div&gt; |C02= '''If yes:''' &lt;br&gt; ❑ Transient [[LOC]] }}<br /> {{familytree | | | |,|-|^|-|.| | | | | | }}<br /> {{familytree | | | E01 | | E02 | | |E01= Non traumatic |E02= Traumatic }}<br /> {{familytree | | | |!| | | | | | | | | | | | | }}<br /> {{familytree | | | F01 | | | | | | |F01='''Suspect:''' &lt;div style=&quot;float: left; text-align: left; width: 7em; padding:1em;&quot;&gt;❑ Syncope &lt;br&gt; ❑ [[Seizure]] &lt;br&gt; ❑ Psychogenic&lt;/div&gt; }}<br /> {{familytree/end}}<br /> <br /> ===Diagnostic Flowchart in Patients with Suspected Syncope===<br /> {{familytree/start}}<br /> {{familytree | | | | | | | | | | A01 | | | | | | | | A01= '''❑ Initial Assessment:''' }}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | | }}<br /> {{familytree | | | | | | | | | | B01 | | | | | | | | B01= &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Clinical history &lt;br&gt; ❑ Physical examination (including supine and standing BP measurement after 3 minutes if [[OH]] is suspected) &lt;br&gt; ❑ [[EKG]] &lt;/div&gt; }}<br /> {{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | }}<br /> {{familytree | | | | | | C01 | | | | | | C02 | | | | | | C01= Syncope | C02= T-LOC non syncopal}}<br /> {{familytree | | |,|-|-|-|^|-|-|-|.| | | |!| | | | | }}<br /> {{familytree | | D01 | | | | | | D02 | | D03 | | | D01= '''Certain diagnosis''' | D02= Uncertain etiology | D03= ❑ Confirm with specific test: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; - EEG &lt;br&gt; - US of neck arteries &lt;br&gt; - Brain [[CT]] &lt;br&gt; - Brain [[MRI]] &lt;/div&gt; '''OR''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Consult with specialist&lt;/div&gt;}}<br /> {{familytree | | |!| | | | | | | |!| | | | | | | | }}<br /> {{familytree | | E01 | | | | | | E02 | | | E01=If arrhythmic cause identified: &lt;br&gt; (EPS)| E02= '''Risk stratification'''}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | | | | F01 | | | | | | | F01= Determine if there are any high risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or[[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non-sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt;}}<br /> {{familytree | | | | | | | | | | |!| | | | | | | | }}<br /> {{familytree | | | | | | | |,|-|-|^|-|-|.| | | | | | | }}<br /> <br /> {{familytree | | | | | | | G01 | | | | G02 | | | | | | | G01= '''❑ If yes:'''&lt;br&gt; High risk |G02= '''❑ If no:''' &lt;br&gt; Low risk }}<br /> <br /> {{familytree | | | | | | | |!| | | | | |!| | | | | | | }}<br /> {{familytree | | | | | | | H01 | |,|-|-|^|-|-|.| | | | | | H01=Immediate in-hospital monitoring: &lt;br&gt; In bed or telemetry | }}<br /> <br /> {{familytree | | | | | | | | | | H01 | | | | H02 | | | | | H01= Low risk, recurrent syncopes: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt;❑ Cardiac or neurally mediated testst as appropriate: &lt;br&gt; -Holter if &gt;1 episode/week &lt;br&gt; -ELR if interval between episodes &lt;4 weeks &lt;br&gt; Delayed treatment guided by [[ECK]] documentation &lt;/div&gt; |H02= Low risk, single syncope }}<br /> <br /> {{familytree | | | | | | | | | | | | | | | | I01 | | | | I01= Was it in high risk setting?}} <br /> {{familytree | | | | | | | | | | | | | | | | |!| | | | }}<br /> {{familytree | | | | | | | | | | | | | | | | J01 | | | | I01= Was it in high risk setting?}} <br /> <br /> {{familytree | | | | | | | | | | | | | |,|-|-|^|-|-|.| }}<br /> {{familytree | | | | | | | | | | | |`|-|-|+|-|-|'| | | | | | }}<br /> {{familytree | | | | | | | | | | | | | | |!| | | | | | }}<br /> {{familytree | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | }}<br /> {{familytree | | | | | | | | | | H01 | | | | H02 | | | | | H01= Suspicion of structural heart disease | H02= Psychiatric disease<br /> <br /> {{familytree/end}} <br /> <br /> <br /> <br /> <br /> <br /> Algorithms based in 2009 ESC Guidelines for the Diagnosis and Management of Syncope. &lt;ref name=&quot;pmid19713422‎&quot;&gt;{{cite journal| author=Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A et al.| title=Guidelines for the diagnosis and management of syncope (version 2009). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 21 | pages= 2631-71 | pmid=19713422‎ | doi=10.1093/eurheartj/ehp298 | pmc=PMC3295536 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=19713422 }} &lt;/ref&gt;<br /> <br /> ==Do's==<br /> *Tilt testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.<br /> *Tilt testing should be considered to discriminate between reflex and OH syncope.<br /> *Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.<br /> *If syncope happened after standing up position, there should be documentation with active standing or tilt testing in order to diagnose [[OH]].<br /> *Perform [[CSM]] if patient &gt;40 years with syncope of unknown aetiology after initial evaluation.<br /> *If multiple unexplained falls; perform tilt testing.<br /> *Consider [[ILR]] before embarking on cardiac pacing in patients with suspected or certain reflex syncope presenting with frequent or traumatic syncopal episodes.<br /> *Evaluate neurologically if syncope is due to [[ANF]], to evaluate underlying disease.<br /> <br /> ==Don'ts==<br /> *Don't perform[[CSM]] in patients with previous [[TIA]] or [[stroke]] within the past 3 months and in patients with carotid sinus bruits (except if carotid sinus Doppler studies excluded significant stenosis.<br /> *Don't use tilt testing for assessment of treatment.<br /> *Don't perform isoproterenol tilt testing in patients with ischaemic heart disease.<br /> *Don't use ATP test as a diagnostic test to select patients for cardiac pacing, owing to lack of correlation with spontaneous syncope,.<br /> *Don't perform EPS if there is already indication for [[ICD]] in patients with ischemic heart with suspected arrhythmic cause.<br /> *Don't perform EPS in patients with normal [[ECK]], no heart disease, and no palpitations.<br /> <br /> ==References==<br /> {{Reflist|2}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Sandboxkarol&diff=931835 2014-01-10T21:25:43Z

<p>Karol Gema Hernandez: </p> <hr /> <div>{{familytree/start}}<br /> {{familytree | | | | | | | A01 | | | | | | | | A01='''High risk criteria:''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or [[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non- sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt; ❑ Important comorbidities: &lt;br&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt; }}<br /> {{familytree/end}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Sandboxkarol&diff=931834 2014-01-10T21:25:02Z

<p>Karol Gema Hernandez: </p> <hr /> <div>{{familytree/start}}<br /> {{familytree | | | | | | | A01 | | | | | | | | A01='''High risk criteria:''' &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or [[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non- sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt;&lt;/div&gt; ❑ Important comorbidities: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt; }}<br /> {{familytree/end}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Sandboxkarol&diff=931833 2014-01-10T21:24:34Z

<p>Karol Gema Hernandez: </p> <hr /> <div>{{familytree/start}}<br /> {{familytree | | | | | | | A01 | | | | | | | | A01=High risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[CAD]]&lt;br&gt;❑ Clinical or [[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non- sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt;&lt;/div&gt; ❑ Important comorbidities: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt; }}<br /> {{familytree/end}}</div>

Karol Gema Hernandez https://www.wikidoc.org/index.php?title=Sandboxkarol&diff=931832 2014-01-10T21:24:10Z

<p>Karol Gema Hernandez: </p> <hr /> <div>{{familytree/start}}<br /> {{familytree | | | | | | | A01 | | | | | | | | A01=High risk criteria: &lt;br&gt;&lt;div style=&quot;float: left; text-align: left;&quot;&gt; ❑ Severe structural or [[©AD]]&lt;br&gt;❑ Clinical or [[ECG]] features suggesting arrhythmic syncope: &lt;br&gt; -syncope during exertion or supine &lt;br&gt; -palpitations at the time of syncope &lt;br&gt; -family history of[[SCD]] &lt;br&gt; -non- sustained [[VT]] &lt;br&gt; -conduction abnormalities with QRS &gt;120 ms &lt;br&gt; -[[sinus bradycardia]] &lt;br&gt; -pre-exited QRS complex &lt;br&gt; -prolonged or short QR interval &lt;br&gt; -brugada pattern &lt;br&gt; -[[ARVC]] &lt;br&gt;&lt;/div&gt; ❑ Important comorbidities: &lt;br&gt; &lt;div style=&quot;float: left; text-align: left;&quot;&gt; -Severe anemia &lt;br&gt; -Electrolyte intolerance &lt;/div&gt; }}<br /> {{familytree/end}}</div>

Karol Gema Hernandez