SINKOP & TILT TABLE TEST

Dony yugo
DEFINITION
➤ Transient loss of conciousness
➤ Rapid onset & short duration
➤ Spontaneous complete recovery
➤ Global cerebral hypoperfusion
PATHOPHYSIOLOGY
CLASSIFICATION
CLASSIFICATION
CLASSIFICATION
INITIAL EVALUATION
INITIAL EVALUATION
➤ In all patients, perform a complete history taking, physical examination
(including active standing BP measurement), and standard ECG.
➤ Perform immediate ECG monitoring (in bed or telemetry) in high- . risk
patients when there is a suspicion of arrhythmic syncope. .
➤ Perform an echocardiogram when there is previous known heart .
disease, or data suggestive of structural heart disease or syncope .
secondary to cardiovascular cause. .
➤ Perform CSM in patients >40 years of age with syncope of unknown .
origin compatible with a reflex mechanism. .
➤ Perform tilt testing in cases where there is suspicion of syncope due . to
reflex or an orthostatic cause. .
➤ Perform blood tests when clinically indicated
ACTIVE STANDING TEST
➤ Orthostatic challenge
CAROTID SINUS MASSAGE
➤ Masase dilakukan di batas anterior otot
sternocleinomastoideus setinggi kartilago krikoid, dimana
pulsasi arteri karotis paling kuat teraba selama 10 detik di 2 sisi
TILT TABLE TEST
TTT PROTOCOL
➤ Persiapan
➤ Puasa 6 jam pre-tindakan (minimal) termasuk minuman
➤ Pasang iv line 2 jam pre-tindakan untuk mengurangi pengaruh
nyeri terhadap hasil tes
➤ Selama tindakan pasien tidak boleh bicara. Prosedur tindakan
dijelaskan sebelumnya
➤ Pasien harus diikat sebagai tindakan keselamatan (safety).
Perhatikan kuat/tidaknya ikatan
➤ Pasang iv line dengan cairan (D5 pada pasien non-DM, NaCl
0.9% pada pasien DM)
➤ Ruangan digelapkan
TTT PROTOCOL
➤ Tatalaksana
➤ Posisi supine dalam 10-15 menit pertama. Observasi TTV
tiap 3 menit
➤ Posisi tilt 70-80 derajat selama 45 menit. Observasi TTV
tiap 3 menit
➤ Start provokasi
TTT PROTOCOL
➤ Provokasi isoproterenol
➤ Isuprel Start 2 mcg/kgBB/menit.
➤ Target HR >100x/menit dan atau naik 20% di atas baseline. Jika
dalam 3 menit target tidak tercapai, uptitrasi 1 mcg/kgBB/menit tiap
3 menit sampai dosis maksimal 6 mcg/kgBB/menit.
➤ Observasi hingga 30 menit.
➤ Tes distop bila pasien pingsan dan semua data telah terkumpul.
➤ Provokasi nitrat
➤ Start 1 mcg/kgBB/menit, uptitrasi 1 mcg/kgBB/menit tiap 3 menit
sampai dosis maksimal 6 mcg/kgBB/menit.
➤ Observasi hingga 18 menit.
➤ Tes distop bila pasien pingsan dan semua data telah terkumpul.
TTT INTERPRETATION
THANK YOU