晕厥的诊断和治疗.ppt

ECG leads and intra-arterial pressure tracing illustrating the final moments of a head-up tilt test just prior to induced syncope. Note that blood pressure tended to fall in advance of the bradycardia component. Later, even though the patient is returned to supine posture,and the heart rate returns to normal, it may take some time for the arterial pressure to fully recover. The latter is due to persistent vasodilatation which may disappear slowly. Neurologic studies (Head CT/MRI, EEG) are rarely useful in the diagnostic evaluation of the basis for syncope. Imaging may be justified if there is concern that syncope may have resulted in a head injury. Otherwise, absent apparent abnormal neurologic signs, such testing should be relegated to low priority. Example of a symptomatic wide-QRS tachycardia recorded during a near syncope in a patient undergoing AECG monitoring. The Reveal? Plus Insertable Loop Recorder system offers long-term, continuous, subcutaneous ECG monitoring and event-specific recording. This implantable device is designed to improve patient compliance with long-term AECG monitoring. The system includes an implanted loop recorder, a hand-held patient Activator, and a programmer with telemetry head that communicates noninvasively with the implanted device. When a patient experiences an episode, the device stores an ECG using the Activator or through the use of a auto-activating feature. The Reveal? Plus ILR can monitor continuously for up to 14 months. The probability of capturing an event is high—approximately 65-88%.1,2 The ECG captured during the episode may “reveal” the ECG during the patient’s episode or may allow the clinician to rule in or rule out arrhythmic causes. The stored ECG data is retrieved, viewed, and printed or saved to a disk, using a Medtronic 9790 programmer with a 9766 A or AL programmer head. The Reveal ILR can then be re-started for continued monitoring. 1. Krahn A, et al. Final results from a pilot study with an