An Approach to Syncope

An overview of the diagnostic approach to syncope, including comparison between reflex (i.e. vasovagal), cardiogenic, and orthostatic etiologies. A comparison between syncope, seizure, and other syncope mimics is also discussed.

[@danimaddadeh8069]

Give a Man a Fish, and You Feed Him for a Day. Teach a Man To Fish, and You Feed Him for a Lifetime.. what your are doing here sir is promoting a solid and organized clinical mindset. Thanks a million.

[@xipepb7887]

This is honestly one of the best med videos I've ever seen. Thanks so much for such a great work!!!

[@SK-ms7jc]

brilliant, I've always found this topic confusing to get my head around, but your logical break down of things has made it incredibly easy. brilliant summary table at the end, thank you

[@suebasset3052]

Very interesting. I’ve had a a number of blackouts over the last 8 yrs. I’ve had cardio tests, ecg, mri, lumber puncture and the tests resulting in tachycardia, palpitations. No neurological problems, so specific seizures were ruled out although I was not allowed to drive for a year. However I’ve had more blackouts the last month and cannot drive or fly again, I’ve had another Holter monitor, ecg, echocardiogram. I am now on beta blockers. Fortunately my blackouts have happened whilst sitting. It’s all very confusing but your explanation of Syncope was very clear and understandable, thank you.

[@Ace_BlickyTV]

I'm right there with you. Same tests same results. Doesn't make sense.

[@suebasset3052]

During COVID 2020 my heart stopped 27 secs... Resulting in a pacemaker a few days later. All seems to be working ok now.

[@Ace_BlickyTV]

@@suebasset3052 wow glad you are ok !

[@jacklawer6389]

Im scared because of losing license??

[@moni_dys96]

Amazing. To the point. Excellent summary and easy to remember approach. Thank you so much!

[@crit-ic]

Great video, dr Strong! Looking forward to the rest of these series!

[@starqueenlotus3755]

Thanky . U r an amazing teacher. I am so lucky to get to ur videos via KZbin. I am looking forward to more videos ahead. Wow.

[@jahangirshah2443]

Thank You and we are looking forward for more beautiful stuff from you...

[@mohammedalruwaite4026]

You are an absolute legend thank you for your work in spreading medical knowledge

[@bryanjones2102]

This is what i have been looking for as a student. Thank you doctor!

[@derozerr4856]

Wow...I look at your videos and I hear some really golden facts I read in huge books like Harrison and had forgotten. Facts really important for diagnosis but usually missed. Keep up the good work!

[@edwardstanulevich1764]

The internet needs more of this!!!

[@sirius1143]

Thank you for making this concise and organized. Looking forward to more videos in this series - particularly headaches, and dizziness.

[@StrongMed]

We'll be making videos on headaches and vertigo, but probably not for a while. The sequence of topics is roughly based on the sequence that our Stanford students learn about them in their pathology/pathophysiology courses. The approximate order will be: Group 1: Cards/pulm (uploading winter 2018) Group 2: Renal/GU/GI/endocrine (planned uploading mid spring through late summer 2018) Group 3: Neuro/heme/MSK (planned uploading fall 2018) Group 4: Derm/ophtho/peds-specific issues (planned uploading winter-spring 2019) Group 5: Additional topics TBD (planned uploading summer 2019 and onward)

[@sunving]

Thank you very much Doctor Eric Strong. It is so great lecture.

[@IgaShinobis]

This is gold. Thank you so much!

[@salmaelsenbawy6526]

absolutely amazing! thank you for this very informative video. I wish they taught us like this in medical school. Enjoying your approach to symptoms series many thanks!

[@haiderissa163]

Thanks for your efforts,sir. God bless you.

[@Bellamd4u]

Strong work! Thank you for this video.

[@mayaalaghi9544]

Thank you for the brilliant video Dr Strong

[@RomkeRozema]

Great video's! Taking e-education to the next level!!

[@philosophersam]

Very helpful. Had an episode myself. Obviously, not able to diagnose myself, it helps to know about the different types.

[@cooltroop2]

Thank you, Dr Strong!

[@RajkumarDarbar]

amazing content! thank you, Dr. Strong!!

[@matthewxavier2625]

Great video as always. Would a tilt-table test still be indicated at any point in this algorithm, and if so, when?

[@scleraclitoscuro]

Thank you so so so much!

[@drkhaled13]

thanks alot,good informative lecture, need more videos to learn from you.thnks

[@romeolhk1008]

This series is helpful!!

[@sandeshpaudel6821]

the best video for syncope

[@MuhammadAli-ml9bt]

excellent fantastic amazing teacher

[@KarolyVamos]

Very informative video. I deal with syncope and it makes my life a living hell.I try to learn more about it besides what the doctors tell me.

[@2341melinda]

Do you take medication for it?

[@KarolyVamos]

@@2341melinda I have a pacemaker put in but even than sometimes I have to take Gutron so my pressure won’t fall under the pacemaker’s limit which set to 60

[@laurentiu244]

Every one should watch regardless of specialty .

[@toothdocp90x]

Very Nice! Love your videos.

[@humeyraer5649]

you are doing a wonderful job

[@cooltroop2]

Strong content, as always

[@walidshater3126]

Very informative ..thank you

[@DenDB1804]

Great video !!!

[@guleidali3391]

Thank you so much Sir

[@drsoumya8925]

Very much informative video

[@Block-yc6bh]

Amazing!

[@tanishasha01]

I LOVE YOU. Thank you so much

[@clevelog]

Thank you so much! Excellent presentation. The graphics alone must have taken a long time to prepare. The beautiful presentation is evidence of your time and concern for detail. I will look forward to your future presentations. -paul CNP

[@cooltroop2]

The medical genius is Strong in this one.

[@espinosa3059]

U are the best sir thank u 😍😍😍

[@sharifahnurainun]

very useful..thx

[@NAME51274]

perfect.

[@majow]

Thanks

[@olusesanonasanya7107]

Hello Dr Strong, could you send please differentiate Syncope/ Loss of Consciousness/ Dizziness/Blackout/Fainting/Lightheadedness/ Fall/ Collapse for me please. I keep getting confused.

[@snakesonthebrain]

These videos rule!

[@meryamlazrak1329]

Thank you sir

[@adhipmitra]

Excellent

[@musicandmore7180]

Sir waht can be the cause of myoclonic such jerks yet normal

[@MuhammadAli-ml9bt]

Perfect

[@kimo5059]

Brilliant

[@cmhmck]

The categories of reflex do not seem exclusive. Aren't prolonged standing, emotional stress, severe pain, and blood draw just further examples of SITUATIONAL syncope due to vasovagal response?

[@StrongMed]

I agree that the way the "reflex syncope" category is organized is a little arbitrary - there are a number of different variations on this in the literature. The way I current see these categories: "vasovagal syncope" (including blood draw, emotional distress, etc...) is syncope that is a one time (or 2-3 time) event, while "situational syncope" is a chronic, recurring problem because the situation that triggers it is relatively common in life.

[@Christenloves1999]

I had a pass out spell back in April of this year and had to wear a heart monitor for a week. And then I had to see a cardiologist after the results were bad and they did an echo and stress test and everything came back normal. So idk what caused me to pass out.

[@age93]

I thought my experience was a syncope originally, but have been questioning it. I have regularly experienced POTS. A few months ago, I became dizzy, my sound became extremely muffled, and I drop which during I tried catching myself. My vision was gone, but I was at least half conscious given I recall feeling my arms and legs convulse smashing against the wall and trying to stop it while thinking, “what the hell is going on”. I’m guessing it lasted no more than a min,l 🤷🏼‍♀️ After coming too I was confused. I was worried that my child would’ve heard it, so I just shook it off and went to lay down. I have a history of meningitis, endocarditis, and septic shock- no idea if that would impact this. Then last month, I felt the signs occurring again- dizzy, blurry vision, muffled sound, etc. I sat down and took deep breathes and was able to prevent it from progressing. Any guesses?

[@StrongMed]

I'm sorry, but I can't offer specific, individualized medical advice here. I recommend discussing your symptoms with a healthcare professional familiar with your medical history in person.

[@ashlynnwatkins5495]

So, i thought vasovagal syncope and Neurocardiogenic syncope are the same. Am i correct?

[@StrongMed]

The terminology isn't universally applied, but you are correct - most clinicians use neurocardiogenic syncope as a synonym for vasovagal syncope. However, I'm not personally a fan of this usage since other forms of reflex syncope besides vasovagal are also caused by pathological communication between the neurological and cardiovascular systems; and also because "neurocardiogenic syncope" sounds very similar to "cardiogenic syndrome" despite them being very different.

[@ashlynnwatkins6855]

Strong Medicine thank you very much for the clarification!

[@kayleebrooke2376]

I had quite the scare this weekend. I've been in my room with the AC on, around 55 to 65 degrees, and went outside in about 80-degree weather. I stood out there for 10-15 minutes before my heart began to race. I went back into my room to cool down because I thought I was just getting hot, but the sound began to deafen, and my ears started to emit a low ringing sound. I could barely hear my friend that came into my room. I started panting heavily, and she asked what was wrong, quickly turning my lights on. I started to dry heave and quickly went to the bathroom, but put myself in the corner, and I wasn't able to move, I just stood there dry heaving. My friend pulled me to the floor in front of the toilet, holding my hair back. I began to puke 4 or 5 times, mainly liquid before I started to feel better. I was talking to my friend but then the next thing I knew, I was waking up on the floor with my friend standing over me. I recovered quickly and sat up, breathing carefully and slowly. I was still light-headed, and I had tunnel vision. I don't remember immediately what happened after that, but I do remember sitting in front of my kitchen AC, around 65-71 degrees, and I started to barf again, this time, 2-3 times, again, mainly liquid. The tunnel vision went away, and so did most of the light-headedness, but it was still there. I drunk some cold water and slowly started to feel better. For the rest of the day, I was only a little light-headed (I could still process my surroundings) and tired. The next day, I was still a little light-headed, and a little bit tired. Doctor, could this be signs of syncope? Or possibly something else?

[@jasmelacosta3420]

Can a syncope event happen during sleep? can this make seizure type movements?

[@StrongMed]

Since syncope is defined, in part, as a transient loss of consciousness, it cannot happen during sleep by definition. However, movement during sleep is super common. It's totally normal and nearly universal to experience myoclonic jerks as one is falling asleep (though these are not typically repetitive in nature; i.e. don't really look like seizures). There is also nocturnal myoclonus or periodic limb movement disorder, which is much less common, and consists of repetitive movement of the legs during sleep itself; this is generally benign. People can experience all kinds of movement during REM sleep (i.e. "acting out dreams"). There are parasomnias like sleepwalking. And of course, people can have true seizures while sleeping.

[@jasmelacosta3420]

If may I go deeper in the question. If a seizure like movement during sleep and loss of consciousness for couple minutes but disoriented for 15 minutes. Happened twice within 5 years apart. Normal all the blood / EEG / MRI test hours after the event.

[@KarolyVamos]

It always happens to me during sleeping. Unfortunately, Doctors put a pacemaker in me to regulate the sudden blood pressure drop.

[@rembeadgc]

I have the vasovagal. Cardiologist ended up giving me a stent. This was before I was correctly diagnosed.

[@evelynrivera6013]

My case is different, I collapsed and I stayed unconscious for 10 hours. I need 8 bags of sodium iv, cos my blood pressure drops to 49/26. I don't have any signs b4 the collapsed. I don't remember anything.

[@reaganroslin367]

what is the source?

[@JohnnyWishbone85]

I take it that aortic dissection goes under cerebrovascular syncope with the other zebras?

[@StrongMed]

A rare cause of syncope, and yes, that's where I would categorize it.

[@pataleno]

I was drinking coffee whilst sat on my couch, which went down the wrong way. I jumped up quickly to run to the kitchen coughing violently on the way. I woke up a few seconds later and smashed my face in. My wife said she thought I was dead. I remember running to the kitchen and nothing else.

[@srikanthxxxxx]

What about laughter induced syncope?

[@StrongMed]

That's a form of situational syncope, similar to syncope triggered by coughing or sneezing.

[@tastyDungeon]

watching this i start to sense the first symptoms of vasovagal syncope. it triggers it badly lol

[@jacklawer6389]

I pass out, no warning at all, drop like a sack of potatoes What should I do ??? Help

[@StrongMed]

I can't give medical advice on here, but I strongly advise for you to speak with a doctor in person about this problem (in person because a cardiovascular examination and ECG are necessary). The more recent that the onset of the symptom has been, the more quickly you should seek care. For example, if this started happening today, you should go to the ER immediately. Whereas, if this has been going on unchanged for years, then a call to your primary care doctor to set up an appointment is likely fine. I'm sorry, I can't be more specific than that.

[@jacklawer6389]

@StrongMed i understand, thanks. I've had 3 EKG's All normal. Happening for 5 yrs. Only once a year for the first 4 yrs. Now 3 times in one month

[@carolinaulloa-ramey4633]

I need help, I live in Florida I've been having this symptoms for 8 years now, Doctors here tell me they think I might be epileptic, but after seeing 5 different neurologists they have come out with nothing, they tell me I'm healthy in paper because all my tests come normal, I have even gone to voodoo doctor!!! Yeah I know but when every health provider tells you you're healthy and you know you're not making this symptoms up, you start thinking it might be witchcraft!!! Please any advise anyone can give me, thank you. Blessings😊

[@nadeemimam7139]

You are absolutely right being a muslim i have these symptom i have been on antidepressants for last 10 year syncope is like witchcraft

[@danieldeilgat7558]

The reason why every health provider says that is because the first guy said that, and now none want to contradict whichever last diagnosis you had by whichever doctor.

[@melissamulter5846]

i have the same problem.

[@shawnpinn9177]

8.00,15.10

[@James-vb3ci]

My daughter has episodes 20 times a day, we’ve never need able to figure it out. Epilepsy has been ruled out. It’s not postural

[@LuisGutierrez-bz9xn]

Does anyone else get an annoying sound in the background?

[@StrongMed]

I don't hear any on my computer. What does it sound like?

[@mixedmango]

Yes..

[@bayleevoss3398]

haha i have syncope