Revista de Medicina Desportiva (English) May 2018 - Page 7

• In the event of a suspicion of syn- cope, is the etiological diagnosis evident? • Is there evidence to suggest high risk of cardiovascular events or death? The transient loss of conscious- ness should be of a syncopal nature in cases where there are • Specific signs and symptoms of reflex syncope • Syncope due to hypotension orthostatic • Specific signs and symptoms of other forms of transient loss of con- sciousness (head injury, epilepsy, psychogenic cause and/or rare causes). Through a detailed clinical history, the doctor can differentiate the syncope from other forms of transient loss of consciousness in approximately 60% of the cases. On physical examination, the measurement of blood pressure in supine and standing and still the in-rest EKG should always be part of the first evaluation. On the basis of these findings, the additional examinations considered necessary shall be carried out: • Immediate monitoring of the EKG when there is suspicion of arrhythmic syncope • Echocardiogram when there is pre- viously known heart disease, that could suggest a structural heart disease or syncope to secondary a cardiovascular cause • Carotid sinus massage (CSM) in patients older than 40 years • Slope test when there is suspi- cion of syncope due to orthostatic hypotension or reflex syncope • Blood tests when clinically indicated, e.g. hematocrit or hemoglobin when suspected of hemorrhaging, oxygen saturation and blood gas analysis when sus- pected of hypoxia, troponin when suspected of syncope related to Ischemia or D-dimers when you suspect pulmonary embolism. When a diagnosis is almost right or highly probable, no additional evaluation is required and the treat- ment – if any – can be planned. As for the action on the syncope in the Emergency Service (ES), the answer to these three questions is fundamental: • Is there a serious underlying cause that can be diagnosed in the ES? It is the acute underlying dis- ease that will often determine the adverse event, more than the syn- cope itself. Many (40-45%) of non- cardiovascular critical causes, and some cardiovascular, are obvious at the ES (recent onset of precordial discomfort, dyspnea, abdominal pain or headache; syncope during exercise or lying; palpitations imme- diately preceding the syncope). • What is the risk of a complicated evolution? The high-risk patient is more likely to have cardiogenic syncope. Structural heart disease and pri- mary electrical diseases are major risk factor for sudden death and increased mortality. The low-risk patient is more likely to have reflex syncope. Orthostatic hypotension is associated with the risk twice higher than that of the general population due to the severity of the associated morbidities. Should the patient be hospitali- zed? Approximately 50% of patients who use the ES for syncope are admitted, although the rate of hospi- talization varies from 12 to 86%. The studies of evolution show that in the 7-30 days thereafter only 0.8% die and 6.8% have a serious non-fatal event while remaining in the ES and in continuous observation. In short, and in the inability to highlight all the important concepts covered in this magnificent publica- tion, I strongly suggest the reading to all colleagues. It is a key docu- ment for all those who have to deal with such a frequent symptom in all the population, with many tables and summary frames to merit care- ful attention (https://academic.oup.com/eur- heartj/advance-article/doi/10.1093/ eurheartj/ehy037/4939241) And, by the way, do not lose the practical instructions in the comple- mentary document as well: https://academic.oup.com/eur- heartj/advance-article/doi/10.1093/ eurheartj/ehy071/4939242 I’m sure they’ll take good use of the dedicated time. Formação Contínua Ensino a distância b-learning Pós-graduação em Medicina Desportiva 50 ECTS Destinatários Licenciados ou detentores de Mestrado Integrado em Medicina Pós-graduação em Reabilitação em Medicina do Exercício e do Desporto 50 ECTS Destinatários Licenciados em fisioterapia, enfermagem, profissionais de educação física ou outros profissionais de saúde associados ao desporto Formação Contínua Medicina do Futebol Medicina e Reabilitação no Futebol Curso Inicial de Auscultação Cardíaca Curso Básico de Eletrocardiografia Nutrição Clínica na Medicina Geral e Familiar Mais informações medicinadesportiva.med.up.pt geriatria.med.up.pt E: pgmdgeg@med.up.pt T: 22 04 26 922 Revista de Medicina Desportiva informa may 2018 · 5