367.2 🩺 國考版

367.2.1 高頻考點

367.2.1.1 Definition

• LOC + global cerebral hypoperfusion + spontaneous recovery

367.2.1.2 Distinguish from Seizure

• Vasovagal: prodrome (warmth, nausea, sweat), brief LOC, quick recovery, brief myoclonic OK
• Seizure: aura, tonic-clonic, lateral tongue bite, post-ictal confusion (minutes)

367.2.1.3 Categories + %

• Reflex 60-70% (vasovagal #1)
• Orthostatic 15%
• Cardiac 10-15% (most concerning)

367.2.1.4 Cardiac Syncope Features

• Sudden onset, no prodrome
• During exertion
• Family history sudden death
• Known heart disease
• Abnormal ECG

367.2.1.5 ECG Red Flags

• Long QT (LQTS)
• Brugada pattern (Type 1, 2, 3)
• WPW
• Heart block
• HCM (LVH + Q-waves)
• Old MI
• ARVC (epsilon, T-wave inversion V1-V3)

367.2.1.6 San Francisco Syncope Rule

• CHESS
• CHF, Hct < 30, ECG abnormal, SOB, SBP < 90

367.2.1.7 Orthostatic Definition

• SBP ↓ ≥ 20 or DBP ↓ ≥ 10 within 3 min standing
• HR ↑ > 30 without BP drop = POTS

367.2.1.8 POTS

• Postural orthostatic tachycardia syndrome
• HR ↑ ≥ 30 within 10 min standing
• Symptoms of orthostatic intolerance
• Young women
• Treatment: salt + fluid + exercise + compression + propranolol + ivabradine

367.2.1.9 Vasovagal Treatment

• Reassurance
• Hydration
• Counter-pressure
• Tilt training
• Midodrine, fludrocortisone refractory
• Pacemaker rare (selected severe with bradycardia)

367.2.1.10 Carotid Sinus Hypersensitivity

• 3 sec pause or > 50 mmHg BP drop with massage

• Older patients
• Treatment: pacemaker for cardioinhibitory type

367.2.1.11 Channelopathies

• LQTS: β-blocker, avoid QT-prolonging drugs, ICD if high risk
• Brugada: ICD if symptomatic or high-risk
• CPVT: β-blocker, ICD

367.2.1.12 Imaging

• Routine CT head NOT useful in syncope without focal deficit/trauma

367.2.2 High-Risk Admission Criteria

Feature	Admit
Cardiac suspected	Yes
Abnormal ECG	Yes
Structural heart disease	Yes
FHx sudden death	Yes
Exertional	Yes
Severe injury	Yes
↑ troponin	Yes
Older + risk factors	Consider

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