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SYNKOPA
Doporučené postupy
pro diagnostiku a léčbu
M. Táborský
27.11.2015
Poslední verze DP: 2009
European Heart Journal (2009) 30, 2631–2671; doi:10.1093/eurheartj/ehp298
Update 2012
J Am Coll Cardiol 2012;59:1583-91
Syncope Unit: EHRA/HRS
Definice synkopy:
o Synkopa je přechodná ztráta vědomí ( Transient Loss of Consciousness - T-LOC)
díky přechodné globální cerebrální
hypoperfuzi charakterizovaná
1. náhlým vznikem
2. krátkou dobou trvání
3. spontánní kompletní úpravou
Figure Legend:
Classification of Syncope According to Etiology
AV = atrioventricular; BP = blood pressure; ECG = electrocardiogram; ESC = European Society of Cardiology; ISSUE = International Study on
Syncope of Uncertain Etiology.
Nový koncept klasifikace synkop 2012
Brignole M: J Am Coll Cardiol. 2012;59(18):1583-1591. doi:10.1016/j.jacc.2011.11.056
University of Utah
The Faint-Algorithm as Currently Used at the University of Utah
The case of a patient referred for unexplained syncope without ECG abnormalities or structural heart disease is shown. After all of the essential information obtained from history, physical examination, 12-lead ECG, echocardiogram, and appropriate blood tests was entered, the software determined the short-term risk and need for admission (A, red arrow). If the decision is made not to admit the patient, the software uses the available information to verify whether a certain diagnosis can be made or not as defined in the recent ESC guidelines.
If no diagnosis can be made, the software suggests the most likely diagnosis (B, red arrow) and recommends the appropriate tests to be performed in a sequential manner, resulting in cost-effective practices (C, red arrow). At any step, the health care provider is given the opportunity to agree or disagree with the software recommendation.
In addition, he or she has access to the most recent educational material, including the guidelines, by clicking on the “?” button. AHA = American Heart Association; TIA = transient ischemic attack; other abbreviations as in Figure 1.
Webové algoritmy vyšetřování synkopy
J Am Coll Cardiol. 2012;59(18):1583-1591. doi:10.1016/j.jacc.2011.11.056
Diagnostické testy
Figure Legend:Time-Dependent Cumulative Diagnostic Yield of ILR
The actuarial curve with its 95% confidence intervals is presented. ILR = implantable loop recorder.
Úloha ILR v detekci příčiny synkopy
J Am Coll Cardiol. 2012;59(18):1583-1591. doi:10.1016/j.jacc.2011.11.056
Terapie
Koncept Syncope Unit
Proč vytvářet SU