Physical Examination of Acute Syncope/Faint

In this article, we will discuss the Physical Examination of Acute Syncope/Faint. So, let’s get started.

Physical Examination

1. Observations of pulse rate, BP, and
symptoms in the recumbent and after
3 mintues of standing position for postural or orthostatic hypotension (a fall of 20 mm in systolic BP and 10 mm in diastolic BP on standing suggests postural hypotension).

2. Valsalva manoeuvre to induce cough syncope, if suspected.

3. Carotid sinus massage for vasodepressor syncope. It is done under BP and ECG control commonly in supine position. Generally massage is done for 5 seconds on one side, bilateral massage must never be done. Reproduction of the symptoms
indicate carotid sinus hypersensitivity. If there is 50 mmHg or more fall in systolic BP associated with bradycardia, vasodepressor response is diagnosed.

4. Head-up tilt table testing (autonomic testing) is useful provocative technique for diagnosis of autonomic testing. Upright lift to a maximum of 60 to 70° in conjunction with isoproterenol infusion (sympathetic testing) or sublingual nitro glycerin (parasympathetic testing) usually precipitates symptomatic hypotension or syncope within 30 to 60 seconds in patients with autonomic failure. Autonomic testing is helpful to uncover objective evidence of autonomic failure and also to demonstrate a predisposition to vasovagal (naturally mediated) syncope. Valsalva manoeuvre can be performed for dysautonomia in patients with diabetes and familial dysautonomia.

Bradycardia, hypotension or both indicate a positive result on upward head tilt.

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