Syncope

Cardiac arrhythmias are an important cause of morbidity and mortality approximately 400,000 people per year die from myocardial infarctions (MI) in the United States alone. Individuals with MI exhibit some form of dysrhythmia within 48 h. Post-mortem examinations of MI victims indicate that many die in spite of the fact that the mass of ventricular muscle deprived of its blood supply is often quite small. These data suggest that the cause of death is ventricular fibrillation and that the immediate availability of a safe and efficacious antiarrhythmic agent could have prolonged a number of Hves. The goals of antiarrhythmic therapy are to reduce the incidence of sudden death and to alleviate the symptoms of arrhythmias, such as palpitations and syncope. Several excellent reviews of the mechanisms of arrhythmias and the pharmacology of antiarrhythmic agents have been pubflshed (1,2). 

Heat syncope Fainting that occurs in some people after standing for a long period of time. 

Ohnmacht, /. weakness fainting, syncope. ohnmiAtift a. weak, faint, unconscious. 

Q Risk for Injury related to vertigo, dizziness, weakness, and syncope secondary to orthostatic hypotension... 

I postural hypotenson) and syncope with sudden loss of con-... 

The first dose effect may be minimized by decreasing the initial dose and administering the dose at bedtime The dosage can then be slowly increased every 2 weeks until a full therapeutic effect is achieved. If die patient experiences syncope, die nurse places die patient in a recumbent position and treats supportively. This effect is self-limiting and in most cases does not recur after the initial period of tiierapy. Light-headedness and dizziness are more common tiian loss of consciousness. The section below discusses these effects and provides interventions for management. 

Respiratory and central nervous system depression, nausea, vomiting, constipation, diarrhea, bradycardia, hypotension, syncope, hypersensitivity reactions, headache Same as amobarbital sodium... 

Risk for Injury related to an adverse drug reaction (eg, dizziness, syncope, dumsiness) or disease process... 

Dizziness, weakness, lassitude, syncope, postural or exertional hypotension, diarrhea, bradycardia, fluid retention and edema, inhibition of ejaculation, CHF Sedation, weakness, dizziness, dry mouth, constipation, impotence... 

Edema, fluid and electrolyte imbalance, headache, blurred vision, nausea, vomiting, diarrhea, urinary retention Headache, nausea, vomiting, fluid and electrolyte imbalance, syncope... 

Thromboembolism or fat embolism, thrombophlebitis, necrotizing angiitis, syncopal episodes, cardiac arrhythmias, aggravation of hypertension... 

Some patients with mastocytosis report flushing, shortness of breath, palpitations, nausea, diarrhea, hypotension or even syncope [9, 24]. Lethargy and fatigue lasting several hours may follow. Gastrointestinal complaints are common in patients with SM [9, 24]. Abdominal pain is the most frequent symptom, followed by nausea. 

Simpson JK, Brockow K, Turner ML, et al Generalized erythematous macules and plaques associated with flushing, repeated syncope, and refractory anemia. J Am Acad Dermatol 2002 46 588-590. Caplan RM The natural course of urticaria pigmentosa. Arch Dermatol 1963 87 146-157. 

Generally, arblockers are considered as second-line agents to be added on to most other agents when hypertension is not adequately controlled. They may have a specific role in the antihypertensive regimen for elderly males with prostatism however, their use is often curtailed by complaints of syncope, dizziness, or palpitations following the first dose and orthostatic hypotension with chronic use. The roles of doxazosin, terazosin, and prazosin in the management of patients with hypertension are limited due to the paucity of outcome data and the absence of a unique role for special populations or compelling indications from JNC 7. 

Because of the potential for postural hypotension, warn patients that dizziness, presyncope, and even syncope may result from abrupt changes in body position during initiation or up-titration of drugs with a-blocking effects. 

Myocardial ischemia Carotid-sinus hypersensitivity Neurocardiac syncope... 

Symptoms of bradyarrhythmias include dizziness, fatigue, lightheadedness, syncope, chest pain (in patients with underlying myocardial ischemia), and shortness of breath and other symptoms of heart failure (in patients with underlying left ventricular dysfunction). 

Idiopathic degeneration of the atrioventricular node Myocardial ischemia or infarction Neurocardiac syncope Carotid-sinus hypersensitivity... 

Symptoms typical of tachyarrhythmias include palpitations, dizziness, lightheadedness, shortness of breath, chest pain (if underlying CAD is present), near-syncope, and syncope. Patients commonly complain of palpitations often the complaint is "I can feel my heart beating fast" or "It feels like my heart is going to beat out of my chest."... 

The majority of patients who experience simple or complex VPDs are asymptomatic. Occasionally, patients with complex or frequent VPDs may experience symptoms of palpitations, lightheadedness, fatigue, near-syncope or syncope. 

The symptoms produced by respiratory alkalosis result from increased irritability of the central and peripheral nervous systems. These include light-headedness, altered consciousness, distal extremity paresthesias, circumoral paresthesia, cramps, carpopedal spasms, and syncope. Various supraventricular and ventricular cardiac arrhythmias may occur in extreme cases, particularly in critically ill patients. An additional finding in many patients with severe respiratory alkalosis is hypophosphatemia, reflecting a shift of phosphate from the extracellular space into the cells. Chronic respiratory alkalosis is generally asymptomatic. 

O Determining a correct and accurate diagnosis is essential prior to any consideration of pharmacotherapy. When a patient complains of paroxysmal, stereotypical spells that may be seizures, it must be determined if the spells are really seizures. Numerous other disorders, including syncope, psychogenic nonepileptic events (i.e., pseudoseizures), anxiety attacks, cardiac arrhythmias, hypoglycemia, transient ischemic... 

Disulfiram works by irreversibly blocking the enzyme aldehyde dehydrogenase, a step in the metabolism of alcohol, resulting in increased blood levels of the toxic metabolite acetaldehyde. As levels of acetaldehyde increase, the patient experiences decreased blood pressure, increased heart rate, chest pain, palpitations, dizziness, flushing, sweating, weakness, nausea and vomiting, headache, shortness of breath, blurred vision, and syncope. These effects are commonly referred to as the disulfiram-ethanol reaction. Their severity increases with the amount of alcohol that is consumed, and they may warrant emergency treatment. Disulfiram is contraindicated in patients who have cardiovascular or cerebrovascular disease, because the hypotensive effects of the disulfiram-alcohol reaction could be fatal in such patients or in combination with antihypertensive medications. Disulfiram is relatively contraindicated in patients with diabetes, hypothyroidism, epilepsy, liver disease, and kidney disease as well as impulsively suicidal patients. 

Bromocriptine (Parlodel ) 0.625-1.25 mg/day at bedtime 1.25 mg increments at 1 -week interval 2.5-1 5 mg/day 40 mg/day 2 to 3 divided doses per day Dizziness, headache, syncope, nausea, vomiting, Gl cramps, orthostatic hypotension ... 

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