Syncope in the Elderly 응급의학과 R1 전종한

Presentation on theme: "Syncope in the Elderly 응급의학과 R1 전종한"— Presentation transcript:

1 Syncope in the Elderly 응급의학과 R1 전종한
Clinical in geriatric medicine 23 (2007) Robert Hood, MD 응급의학과 R1 전종한

2 Introduction Definition Pathophysiology Epidemiology Etiology
Diagnosis Treatment

3 Definition Result of generalized cerebral hypoperfusion
Sudden, transient loss of consciousness and postural tone

4 Pathophysiology 양측 cerebral hemispheres 혹은 brainstem/midbrain reticular activating system 의 cerebral blood flow 감소 Cerebral blood flow => metabolic, chemical, auto-regulation 에 의해 결정되는MAP 와 cerebrovascular resistance

5 Epidemiology 응급실을 통한 전체 입원환자의 1~6 % 1.의 80% => 65세 이상
1.의 42% => unexplained syncope

6 Etiology

7 Neurocardiogenic syncope
Most common Vasodepressor , vasovagal, reflex 노인환자의 30% : prodrome (-) C-fiber stretch receptor의 변화로 인한 hypercontractile, small ventricle => Bezold-Jarisch reflex

8 Orthostasis Orthostatic hypotension 나이가 들어감에 따라 심박동 보상기능감소
Systolic BP ↓ > 20 mmHg Diastolic BP ↓> 10 mmHg HR ↑ > 20 bpm Sitting => standing 3 분후 나이가 들어감에 따라 심박동 보상기능감소 Medication , postprandial state Antihypertensive(b-locker, diuretics)

9 Postprandial hypotension
Indefinite etiology Relationship of syncope to meal

10 Carotid sinus hypersensitivity
Bradycardia, asystole > 3 sec. Vasodepression 50세 이후 노화에 따라 증가 노인 > 65세 의 39% : syncope/dizziness (-/-)

11 Arrhythmia AV block sick sinus syndrome supraventicular arrhythmia
Aging ⇒ AV block risk ↑ sick sinus syndrome Recurrent syncope, congestive failure supraventicular arrhythmia 단독 드뭄 Ischemic or nonischemic source⇒ EF↓

12 Atypical presentation
Myocardial infarction Rarely Sx. 나이에 따라 증가 경향 Pulmonary embolism > 65세 : 24 % vs < 65세 : 3% Acute aortic dissection 5~10 % : syncope

13 Obstruction Aortic stenosis Mitral stenosis Atrial myxoma
Inappropriated vasodilatation ⇒ ventricular pr.↑ Mitral stenosis Atrial myxoma

14 Alcohol & Illicits CDC 보고 : 노인에서 증가경향
2004 National Survey : > 60세 : 1.5% illicit drugs Syncope 의 multiple cause 중 하나

15 Diagnosis Careful history taking & physical exam. EKG
Echocardiogram, tilt table testing, ambulatory monitoring Cardiac catheterization, neurological test 1+2 : most important, cheap, noninvasive 3+4 : very selected patients

16 Treatment 원인에 따라 다양 Bradyarrhythmia : pacemaker
Vasodepressor syncope: volume expansion Midodrine (a-agonist)

17 감사합니다.