gây hạ huyết áp tư thế (ví dụ như thuốc lợi tiểu, thuốc hạ áp, thuốc chống trầm cảm, chế levodopa, vv). Đánh giá tính chất kịch phát của vấn đề có nghĩa là bạn có thể xem bệnh nhân giữa các giai đoạn sụp đổ | ACUTE MEDICAL emergencies the practical approach causing postural hypotension . diuretics antihypertensives antidepressants levodopa preparations etc. . Assessment The paroxysmal nature of the problem means that you are likely to see the patient between episodes of collapse when primary assessment is likely to reveal no major problems. secondary assessment with a careful history and physical examination will provide the diagnosis in the majority of patients. History It is important to obtain a history from a witness in addition to the patient where possible. The circumstances of the collapse may be relevant . cough or micturition syncope. Vasovagal syncope is usually associated with a hot environment or stressful emotional situations. collapse associated with head turning may indicate carotid sinus hypersensitivity. Episodes associated with exertion suggest mechanical limitation of cardiac output aortic stenosis HOCM or an exercise induced arrhythmia. Symptoms on prolonged standing suggest postural hypotension or vasovagal syncope. Ask specifically about cardiovascular symptoms palpitations chest pain breathlessness and neurological symptoms headache weakness parasthesiae autonomic dysfunction . The importance of an accurate drug history cannot be overemphasised. A family history of syncope or sudden death may be relevant. The distinction between epilepsy and syncope can be difficult. A witnessed tonic-clonic convulsion associated with tongue biting and incontinence is obviously helpful in making a diagnosis but the story may not always be so clear. A patient with syncope will usually report symptoms of light headedness nausea sweating or blurring of vision before consciousness is lost. In contrast a generalised tonic-clonic seizure will usually have minimal prodromal symptoms. With syncope the duration of unconsciousness will be shorter than epilepsy seconds versus minutes and the recovery will be more rapid without the usual drowsy confused postictal .
