Cardiac Arrhythmia (e.g.

, Generally abrupt Presence of

bradyarrhythmias, and unprovoked, heart disease,
ventricular palpitations may family history of
tachyarrhythmias, precede symptoms sudden death,
supraventricular symptoms
tachyarrhythmias, during or after
long QT syndrome), exertion, sudden
pacemaker onset of
dysfunction palpitations,
electrocardiogra
phic
abnormalities
Obstructive Hypertrophic Often
cardiomyopathy cardiomyopathy asymptomatic;
may cause
shortness of
breath, chest
pain, arrhythmia,
or syncope;
hypertrophic
cardiomyopathy
may cause
systolic murmur
that intensifies
from squatting to
standing or
during Valsalva
maneuver
Structural disease Aortic stenosis Symptoms
(cardiac) dependent on
severity; severe
aortic stenosis
can manifest
with congestive
heart failure,
syncope, or
angina usually
with exertion
Pulmonary Rare as an
stenosis isolated finding
in adults, often in
association with
congenital
defects;
symptoms based
on severity and
 range from
asymptomatic to
shortness of
breath/dyspnea
on exertion,
congestive heart
failure, and
syncope
Acute myocardial Exertional chest
infarction/ischemia pain, nausea,
diaphoresis and
shortness of
breath; rare
cause of
syncope
Structural disease Pulmonary Acute shortness
(other) embolus of breath, chest
pain, hypoxia,
sinus
tachycardia or
right heart strain
Acute aortic Severe sharp
dissection chest pain with
or without
radiation to the
back,
hypotension or
shock, history of
hypertension
Pulmonary Often
hypertension asymptomatic,
may cause
shortness of
breath and
fatigue
Neurally mediated Carotid sinus Head rotation or Perform carotid
(reflex) syndrome/hypersensi pressure on the sinus massage;
tivity carotid sinus (e.g., ventricular
shaving, tight pause more than
collar) can three seconds or
reproduce decrease in
symptoms; systolic blood
consider in pressure 50
patients with mm Hg is
unexplained falls diagnostic
Situational Micturition, post- Absence of heart
 exercise, disease, history
postprandial, of similar
gastrointestinal syncope,
stimulation, cough, prolonged
phobia of needle standing, eating
or blood a meal or
voiding, sudden
startle or pain
Vasovagal Mediated by Premonitory
stress, fear, symptoms (e.g.,
noxious stimuli, nausea,
heat exposure dizziness) or
precipitating
factors
Neurologic/miscellan Cerebrovascular Induced by a steal Arm exercise
eous syndrome induces a
syncopal event
Neurogenic Preceding Abnormal
transient ischemic findings on
attack/cerebrovasc neurologic
ular injury examination,
symptoms; severe cardiovascular
basilar artery risk factors
disease present,
syncope from
transient
ischemic attack
is rare
Psychogenic Depression, Psychiatric
anxiety, panic history,
disorder, secondary gain,
somatization unremarkable
disorders examination and
evaluation
findings
Orthostatic Drug-induced Alcohol, insulin or Initiation or
antidiabetic change in dose
agents, of causative
antihypertensives, medication;
antianginals, assess for drug-
antidepressants, drug interactions
antiparkinsonian
agents
Primary autonomic Parkinson Occurs after
failure disease/parkinsoni standing up,
sm, multiple presence of
 system atrophy autonomic
(i.e., Shy-Drager dysfunction,
syndrome), precipitated by
multiple sclerosis, standing after
Wernicke exercise
encephalopathy
Secondary autonomic Diabetes mellitus, Occurs after
failure amyloidosis, standing up,
uremia, spinal cord presence of
injury, chronic autonomic
inflammatory dysfunction,
polyneuropathy, precipitated by
connective tissue standing after
diseases exercise
Volume depletion Vomiting, diarrhea, Hypotension,
poor intake, acute tachycardia,
blood loss (i.e., history of
gastrointestinal volume/blood
bleeding) loss, dehydration
on examination

Central nervous system conditions to consider in patients with

suspected syncope include the following:
Hyperventilation syndrome
Hydrocephalus
Migraine headache
Narcolepsy
Panic attacks
Seizure disorder

1. ul abses kedalam ventrikel atau ke ruangan subarakhnoidal

Glasgow Coma Scale: untuk menentukan derajat kesadaran penderita

Rontgen foto kepala, sinus atau mastoid, thorax: untuk mencari sumber infeksi.

326

Majalah Kedokteran Nusantara Volume 38 No. 4 Desember 2005

Penyumbatan Hidrosefalus

serebrospinal

cairan
Herniasi tentorial oleh massa abses otak