EP305: Syncope CSANZ 2023

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode to educate listeners about cardiovascular health and disease prevention. In this episode, he shares insights from a Cardiac Society of Australia and New Zealand scientific meeting, specifically focusing on a session about syncope (blackouts) and how to differentiate between cardiac-related, neurological, and other causes of loss of consciousness. Key Takeaways: Syncope refers to a temporary loss of consciousness and can have various causes, including cardiac issues, epileptic seizures, or rare conditions like brain bleeds or psychogenic episodes. Cardiac syncope may occur during physical exertion (suggesting valve narrowing) or at rest (suggesting arrhythmia), and typically presents with sudden onset and little to no warning. Orthostatic hypotension is a type of syncope triggered by standing up from a seated or lying position, often related to autonomic nervous system breakdown and exacerbated by prolonged standing, recent meals, or exercise. Vasovagal or reflex syncope occurs when the parasympathetic nervous system is over-triggered by emotional stress, unpleasant sights, smells, prolonged standing, or crowded environments, often with warning symptoms like feeling hot or nauseous. Epileptic seizures typically involve jerking movements (myoclonus) that begin at the onset of loss of consciousness, whereas syncope-related jerking occurs after consciousness is lost due to oxygen deprivation. Lateral tongue biting is more indicative of epilepsy, while tip-of-tongue biting or injury may result from cardiac syncope patients falling face-first and being injured. A detailed history is crucial for diagnosis, as patients often cannot recall events due to amnesia; information from witnesses or family members present during the episode is invaluable. Post-seizure confusion, incontinence, and fatigue are more commonly associated with epilepsy rather than cardiac syncope. Family history of sudden cardiac death and presence of structural heart disease increase the likelihood of cardiac causes of syncope. Accurate differentiation between syncope types requires careful consideration of prodromal symptoms, triggers, physical presentation, and circumstances surrounding the episode.