{"id":511,"date":"2023-07-10T10:57:32","date_gmt":"2023-07-10T07:57:32","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=511"},"modified":"2023-07-10T10:58:51","modified_gmt":"2023-07-10T07:58:51","slug":"yasli-hastada-senkop","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-hastada-senkop\/","title":{"rendered":"Ya\u015fl\u0131 Hastada Senkop"},"content":{"rendered":"\n<p><strong>Giri\u015f<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda gen\u00e7 eri\u015fkinlere g\u00f6re daha s\u0131k g\u00f6r\u00fclen senkop; h\u0131zl\u0131 ba\u015flang\u0131\u00e7, k\u0131sa s\u00fcre ve spontan tam iyile\u015fme ile karakterize, ge\u00e7ici global serebral hipoperf\u00fczyona ba\u011fl\u0131 bir ge\u00e7ici bilin\u00e7 kayb\u0131 olarak tan\u0131mlanmaktad\u0131r (1). Senkop tan\u0131m\u0131n\u0131n h\u0131zl\u0131 ve ge\u00e7ici bir bilin\u00e7 kayb\u0131na dayand\u0131r\u0131lmas\u0131, hipoksemi, hipoglisemi, n\u00f6bet, vertebrobaziler iskemi ve psikojenik ataklar gibi bilin\u00e7 de\u011fi\u015fikli\u011fine neden olan di\u011fer hastal\u0131klardan ay\u0131rt edilmesini sa\u011flar. Fakat \u00f6zellikle ya\u015fl\u0131 hastalarda kar\u015f\u0131la\u015ft\u0131\u011f\u0131m\u0131z yetersiz anamnez ve \u015fahitsiz olaylar senkopun tan\u0131nmas\u0131n\u0131 zorla\u015ft\u0131rmaktad\u0131r.<\/p>\n\n\n\n<p><strong>Senkop ile kar\u0131\u015fabilecek durumlar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Epileptik n\u00f6betler<\/li>\n\n\n\n<li>Psikojenik ps\u00f6dosenkop<\/li>\n\n\n\n<li>Ge\u00e7ici bilin\u00e7 kayb\u0131 olmadan d\u00fc\u015fmeler<\/li>\n\n\n\n<li>Katapleksi<\/li>\n\n\n\n<li>\u0130ntrakraniyal kanamalar<\/li>\n\n\n\n<li>Ge\u00e7ici iskemik atak<\/li>\n\n\n\n<li>Subklaviyan \u00e7alma sendromu<\/li>\n\n\n\n<li>Zehirlenmeler<\/li>\n\n\n\n<li>Koma<\/li>\n\n\n\n<li>Kardiyak arrest<\/li>\n<\/ul>\n\n\n\n<p>Senkopun tan\u0131nmas\u0131 ve acil servis y\u00f6netimi ile ilgili kafa kar\u0131\u015f\u0131kl\u0131\u011f\u0131, senkop terimini bir tan\u0131 olarak kullanmas\u0131 ile ba\u015flamaktad\u0131r. Unutmamak gerekir ki senkop bir tan\u0131 de\u011fil, pek \u00e7ok hastal\u0131\u011f\u0131n seyri s\u0131ras\u0131nda g\u00f6r\u00fclebilen en dramatik semptomlardan birisidir (2). Bu semptom ile ba\u015fvuran ya\u015fl\u0131 hastalarda acil servis hekimlerinin kilit g\u00f6revi altta yatan ve ya\u015fam\u0131 tehdit edebilecek tan\u0131lar\u0131 saptamak, hastan\u0131n ilk stabilizasyonunu sa\u011flamak, altta yatan nedenin saptanamad\u0131\u011f\u0131 durumlarda risk s\u0131n\u0131fland\u0131rmas\u0131 yaparak hastalar\u0131n uygun bir \u015fekilde y\u00f6netimi sa\u011flamakt\u0131r. Bu g\u00f6rev, acil servis hekimi i\u00e7in zorlu bir s\u00fcre\u00e7tir ve senkop hastalar\u0131n\u0131n yakla\u015f\u0131k %33 ila %56&#8217;s\u0131, kesin tan\u0131 alamadan taburcu edilmektedir (3).<\/p>\n\n\n\n<p><strong>Ya\u015fl\u0131larda Senkop Neden Daha Fazla G\u00f6r\u00fcl\u00fcr?<\/strong><\/p>\n\n\n\n<p>Senkop tan\u0131m\u0131ndaki farkl\u0131l\u0131klar ve yetersiz bildirim nedeniyle ger\u00e7ek insidans\u0131n\u0131 saptamak zordur (2). Framingham \u00e7al\u0131\u015fmas\u0131nda, ya\u015fa g\u00f6re d\u00fczeltilmi\u015f senkop insidans\u0131 1000 ki\u015fide y\u0131ll\u0131k 7,2&#8217;dir ve ya\u015fla birlikte daha g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 artarken 70 ya\u015f \u00fczerinde bu art\u0131\u015f daha keskindir (4). &nbsp;Kardiyovask\u00fcler hastal\u0131\u011f\u0131 olan hastalarda ya\u015fa g\u00f6re d\u00fczeltilmi\u015f insidans, kardiyovask\u00fcler hastal\u0131\u011f\u0131 olmayan hastalar\u0131n neredeyse iki kat\u0131d\u0131r ve bu hastalarda kardiyak senkop artm\u0131\u015f \u00f6l\u00fcm riski ile ili\u015fkilidir (5).<\/p>\n\n\n\n<p><strong>Ya\u015fl\u0131 hastalar, a\u015fa\u011f\u0131daki nedenlere ba\u011fl\u0131 olarak senkopa daha yatk\u0131nd\u0131r (2):<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\">\n<li>Serebral kan ak\u0131\u015f\u0131nda ve kardiyal rezervde azalma<\/li>\n\n\n\n<li>Renal sistemde su ve tuz homeostaz\u0131nda meydana gelen de\u011fi\u015fim<\/li>\n\n\n\n<li>Bozulmu\u015f baroresept\u00f6r fonksiyonu, kalp h\u0131z\u0131 ve vazokonstriksiyon yan\u0131tta azalma<\/li>\n\n\n\n<li>Yap\u0131sal kalp hastal\u0131\u011f\u0131<\/li>\n\n\n\n<li>Bozulmu\u015f diyastolik dolum ve at\u0131m hacmi<\/li>\n\n\n\n<li>Otonomik disfonksiyon<\/li>\n\n\n\n<li>Polifarmasi<\/li>\n<\/ol>\n\n\n\n<p><strong>Ya\u015fl\u0131 Hastada Senkop Nedenleri ve S\u0131n\u0131flamas\u0131<\/strong><\/p>\n\n\n\n<p>Senkop nedenleri \u00fc\u00e7 ana grupta s\u0131n\u0131fland\u0131r\u0131labilir: Refleks senkoplar (nokardiyojenik, n\u00f6ral arac\u0131l\u0131 senkoplar), ortostatik hipotansiyon ve kardiyovask\u00fcler senkoplar. \u00c7oklu nedenlere ba\u011fl\u0131 senkop, ya\u015fl\u0131 eri\u015fkinlerde yayg\u0131nd\u0131r, ancak kesin insidans\u0131 bilinmemektedir. Genellikle olas\u0131 tek bir neden belirlendi\u011finde di\u011fer olas\u0131 nedenler g\u00f6z \u00f6n\u00fcnde bulundurulmaz ve hastan\u0131n y\u00f6netiminde eksiklikler meydana gelir. Bu nedenle, ya\u015fl\u0131 hastada s\u0131kl\u0131kla \u00e7oklu nedenlerin senkopa yol a\u00e7abilece\u011fini unutmamak gerekir. En olas\u0131 ikincil nedenler ila\u00e7 etkisi ve komorbiditelerdir. Bunlar her zaman \u00e7ok fakt\u00f6rl\u00fc senkopun nedenleri olarak d\u00fc\u015f\u00fcn\u00fclmelidir (2).<\/p>\n\n\n\n<p>Senkop epidemiyolojisi ya\u015fla birlikte \u00f6nemli \u00f6l\u00e7\u00fcde de\u011fi\u015fir. Ya\u015fl\u0131 eri\u015fkinlerde senkopun birincil nedenleri refleks senkop, karotis sin\u00fcs a\u015f\u0131r\u0131 duyarl\u0131l\u0131\u011f\u0131 ve aritmilerdir (6). Ortastatik hipotansiyon, ya\u015fl\u0131 yeti\u015fkinlerin %20 ila %30&#8217;unda senkopa neden olur (7). Kardiyak aritmi insidans\u0131 ya\u015fla birlikte \u00f6nemli \u00f6l\u00e7\u00fcde artar (2) ve romatizmal ate\u015f, KKY veya hipertansiyon \u00f6yk\u00fcs\u00fc olan herkes, senkop nedeni olarak kardiyak aritmi a\u00e7\u0131s\u0131ndan daha b\u00fcy\u00fck risk alt\u0131ndad\u0131r (8).<\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\">\n<li><strong>Refleks Senkop:<\/strong> Normalde dola\u015f\u0131m\u0131n kontrol\u00fcnde yararl\u0131 olan kardiyovask\u00fcler reflekslerin bir tetikleyiciye kar\u015f\u0131l\u0131k ge\u00e7ici olarak \u00e7al\u0131\u015fmamas\u0131 durumunda meydana gelen ve vazodilatasyona ve\/veya bradikardiye yol a\u00e7an ve bunun sonucunda arteriyel bas\u0131nc\u0131 ve global serebral perf\u00fczyonu d\u00fc\u015f\u00fcren \u00e7e\u015fitli heterojen durumlar\u0131 kapsar (9). Refleks senkop, tetikleyici aferan yola\u011fa g\u00f6re s\u0131n\u0131fland\u0131r\u0131labilir.<ol><li><strong>Vazovagal Senkop:<\/strong> \u201cBasit bay\u0131lma\u201d olarak da bilinen \u201cvazovagal\u201d senkop, duygusal veya ortostatik stres sonucunda meydana gelir. Genellikle \u00f6ncesinde otonomik aktivasyonun prodromal semptomlar\u0131 (terleme, solgunluk, bulant\u0131) g\u00f6r\u00fcl\u00fcr (10).<\/li><\/ol><ol><li><strong>Durumsal Senkop: <\/strong>\u201cDurumsal\u201d senkop, genellikle spesifik durumlarla ili\u015fkili refleks senkopa denir. \u00d6rne\u011fin, gen\u00e7 sporcularda egzersiz sonras\u0131nda g\u00f6r\u00fclen senkop \u201crefleks senkop\u201d olabilirken, i\u015feme, d\u0131\u015fk\u0131lama, \u00f6ks\u00fcrme, g\u00fclme veya yutma gibi belirli olaylar sonras\u0131nda g\u00f6r\u00fclebilir. Bununla birlikte, \u00f6zellikle ya\u015fl\u0131 hastalarda serebral hipoperf\u00fczyon nedeni ile g\u00f6r\u00fclen amnezi, hastan\u0131n bu tetikleyici olay\u0131 hat\u0131rlamas\u0131na engel olabilir.<\/li><\/ol>\n<ol class=\"wp-block-list\">\n<li><strong>Karotis Sin\u00fcs A\u015f\u0131r\u0131 Duyarl\u0131l\u0131\u011f\u0131:<\/strong> Asistoliye neden olan karotis sin\u00fcs\u00fcn uyar\u0131lmas\u0131ndan kaynaklanan normal olmayan bir yan\u0131tt\u0131r. \u0130zole olabilir veya yayg\u0131n bir otonomik bozuklu\u011fun par\u00e7as\u0131 olarak meydana gelebilir (2). Nadiren kendili\u011finden g\u00f6r\u00fclen t\u00fcr\u00fcnde senkop, karotis sin\u00fcslerin mekanik manip\u00fclasyonu ile tetiklenir. Daha s\u0131k g\u00f6r\u00fclen t\u00fcr\u00fcnde ise mekanik tetikleyici yoktur ve karotis sin\u00fcs masaj\u0131 ile tan\u0131 konur (10).<\/li>\n<\/ol>\n<\/li>\n\n\n\n<li><strong>Ortostatik Hipotansiyon:<\/strong> Aya\u011fa kalkmakla sistolik kan bas\u0131nc\u0131n\u0131n d\u00fc\u015fmesi ve bunun neticesinde senkop, ba\u015f d\u00f6nmesi, yorulma, uykuya e\u011filim, \u00e7arp\u0131nt\u0131, terleme, g\u00f6z kararmas\u0131 gibi belirti ve bulgulardan olu\u015fan klinik tablodur. Refleks senkopun aksine vazokonstr\u00fcksiyon eksikli\u011fi mevcuttur. Klasik ortostatik hipotansiyonda, ortostatik stres ile 3 dakika i\u00e7erisinde sistolik kan bas\u0131nc\u0131 \u226520 mmHg veya diastolik kan bas\u0131nc\u0131 \u226510 mmHg d\u00fc\u015fer ve semptomlar g\u00f6r\u00fcl\u00fcr. Sa\u011fl\u0131kl\u0131 bireylerde azalan kan bas\u0131nc\u0131yla karotid arter ve aortadaki baroresept\u00f6rler uyar\u0131l\u0131r ve parasempatik sistem inhibisyonu ve sempatik sistem aktivasyonu ile tansiyon k\u0131sa s\u00fcre i\u00e7erisinde dengelenir. Bu yolaktaki herhangi bir hasar ortostatik hipotansiyana neden olur. Ya\u015fla birlikte baroresept\u00f6r duyarl\u0131l\u0131\u011f\u0131n\u0131n azalmas\u0131, renal su ve tuz tutulumunun bozulmas\u0131, kardiyak diyastolik dolumdaki azalma ya\u015fl\u0131lar\u0131 ortostatik hipotansiyona yatk\u0131n hale getirir. N\u00f6rodejeneratif hastal\u0131ktan kaynaklanan birincil otonomik yetmezlik veya diyabet, karaci\u011fer veya b\u00f6brek yetmezli\u011fi ve kronik alkol k\u00f6t\u00fcye kullan\u0131m\u0131 gibi di\u011fer sistemik hastal\u0131klardan kaynaklanan ikincil otonomik yetmezli\u011fin bir sonucu olarak da ortostatik hipotansiyon g\u00f6r\u00fclebilir. Ortostatik hipotansiyon, geriatrik sendroma bir \u00f6rnektir ve k\u0131r\u0131lganl\u0131kta ortaya \u00e7\u0131kan sistemik d\u00fczensizli\u011fin bir par\u00e7as\u0131 olarak g\u00f6r\u00fclebilir ve k\u00f6t\u00fc prognoz ile ili\u015fkilidir (2).<\/li>\n\n\n\n<li><strong>Kardiyak Senkop: <\/strong>Aritmi ve \u00e7e\u015fitli yap\u0131sal kalp hastal\u0131klar\u0131n\u0131n neden oldu\u011fu senkop tablolar\u0131d\u0131r. Senkopun kardiyak nedenleri, azalm\u0131\u015f kardiyak outputun serebral hipoperf\u00fczyona neden olmas\u0131 ile ortaya \u00e7\u0131kar.<ol><li>\u201cAritmiler\u201d kardiyak senkoplar\u0131n en s\u0131k nedenidir ve kalp debisinin d\u00fc\u015fmesi sonucunda beyin kan ak\u0131m\u0131n\u0131n azalmas\u0131na ve senkopa yol a\u00e7arlar. Aritmilerin bazen de ortastatik hipotansiyona neden olarak senkop olu\u015fmas\u0131na neden olabildi\u011fi g\u00f6sterilmi\u015ftir (11). Hasta sin\u00fcs sendromu, ikinci ya da \u00fc\u00e7\u00fcnc\u00fc derece AV bloklar, ventrik\u00fcler ta\u015fikardiler ve daha az olarak da supraventrik\u00fcler ta\u015fikardiler senkopa neden olan aritmiler olarak say\u0131labilir. Ritim bozuklu\u011funun en yayg\u0131n nedenleri kardiyak iskemi ve hipertansiyondur. Bradikardi ya da AV blok (bazen de ta\u015fikardiler) \u00f6zellikle ya\u015fl\u0131larda hastan\u0131n kulland\u0131\u011f\u0131 ila\u00e7lar\u0131n yan etkisi olarak g\u00f6r\u00fclebilir.<\/li><\/ol>\n<ol class=\"wp-block-list\">\n<li>Yap\u0131sal kardiyovask\u00fcler hastal\u0131klarda, kalbin debi oran\u0131n\u0131 art\u0131rma kapasitesi dola\u015f\u0131m ihtiyac\u0131n\u0131 kar\u015f\u0131layam\u0131yorsa, senkop g\u00f6r\u00fclebilir. Bununla birlikte, birka\u00e7 olguda senkop yaln\u0131zca s\u0131n\u0131rl\u0131 kardiyak output ile ili\u015fkilendirilmemekte, k\u0131smen uygunsuz refleks veya ortostatik hipotansiyona ba\u011fl\u0131 olabilmektedir. \u00d6rne\u011fin valv\u00fcler aort darl\u0131\u011f\u0131nda senkop yaln\u0131zca s\u0131n\u0131rl\u0131 kardiyak output sonucunda g\u00f6r\u00fclmez; k\u0131smen uygunsuz refleks vazodilatasyonu ve\/veya birincil kardiyak aritmiye ba\u011fl\u0131 olabilir (10).<\/li>\n<\/ol>\n<\/li>\n\n\n\n<li>Multifakt\u00f6riyel senkop, ya\u015fl\u0131 eri\u015fkinlerde yayg\u0131nd\u0131r ve olumsuz sonu\u00e7lar i\u00e7in ba\u011f\u0131ms\u0131z bir risk fakt\u00f6r\u00fcd\u00fcr (2). En olas\u0131 ilk neden zaten bulunmu\u015f olsa bile birden \u00e7ok nedeni ara\u015ft\u0131r\u0131lmal\u0131 ve ayn\u0131 anda birka\u00e7 neden s\u00f6z konusu oldu\u011funda, bu durum y\u00fcksek risk olarak kabul edilmelidir.<\/li>\n<\/ol>\n\n\n\n<p><strong>Acil Serviste \u0130lk De\u011ferlendirme<\/strong><\/p>\n\n\n\n<p><strong>\u00d6yk\u00fc<\/strong><\/p>\n\n\n\n<p>Senkop de\u011ferlendirmesinde temel ama\u00e7, ya\u015fam\u0131 tehdit eden nedenleri ay\u0131rt etmektir. Senkop de\u011ferlendirmesinde en \u00f6nemli ara\u00e7 iyi bir \u00f6yk\u00fcd\u00fcr. Tam bir senkop \u00f6yk\u00fcs\u00fc ek test ihtiyac\u0131n\u0131 ve maliyetleri azaltabilir, acil serviste kal\u0131\u015f s\u00fcresini k\u0131saltabilir ve hasta memnuniyetini art\u0131rabilir.<\/p>\n\n\n\n<p>\u00d6ncelikle bilin\u00e7 kayb\u0131na yol a\u00e7an atak sorgulanmal\u0131d\u0131r: Atak \u00f6ncesi hastan\u0131n aktivitesi ve pozisyonu, atak \u00f6ncesi prodromal semptomlar\u0131n varl\u0131\u011f\u0131, \u015fahitli olan durumlarda atak s\u0131ras\u0131nda g\u00f6r\u00fclen aktiviteler ve atak sonras\u0131 g\u00f6r\u00fclen bulgular sorgulanmal\u0131d\u0131r. Klasik olarak, vazovagal senkopta s\u0131cakl\u0131k hissi, mide bulant\u0131s\u0131, terleme ve sersemlik prodromu bulunur (2). Prodromu olmayan senkop veya \u00e7arp\u0131nt\u0131, s\u0131rt\u00fcst\u00fc pozisyonda meydana gelen senkop veya egzersiz ile ili\u015fkili senkop kardiyak nedenler ile ili\u015fkilidir. E\u015fzamanl\u0131 enfeksiyon veya \u00f6zellikle kusma, ishal, kanama ve i\u015ftah azalmas\u0131 gibi hipovolemi ile uyumlu semptomlar ortostatik hipotansiyonu d\u00fc\u015f\u00fcnd\u00fcrmelidir. Durumsal bir nedene i\u015faret edebilecek herhangi bir durum (Ik\u0131nma veya \u00f6ks\u00fcr\u00fck vb.) sorgulanmal\u0131d\u0131r. Di\u00fcretikler, antihipertansifler ve hacim durumunu, otonomik stabiliteyi veya kardiyak i\u015flevi etkileyebilecek di\u011fer olas\u0131 ajanlar a\u00e7\u0131s\u0131ndan hastan\u0131n kulland\u0131\u011f\u0131 ila\u00e7lar mutlaka \u00f6\u011frenilmelidir. Herhangi bir ila\u00e7 dozu de\u011fi\u015fikli\u011fi, yeni ila\u00e7lar ve yak\u0131n zamanda alkol veya uyu\u015fturucu kullan\u0131m\u0131 hakk\u0131nda bilgi al\u0131nmal\u0131d\u0131r. Serebral hipoperf\u00fczyon ya\u015fl\u0131 hastalarda %40 oran\u0131nda olay\u0131n amnezisine neden olabilece\u011finden, yukar\u0131da \u00f6zetlenen \u00f6zelliklerin \u00f6yk\u00fcde saptanmas\u0131 zor olabilir (2) ve olaya tan\u0131klar\u0131n bulunmamas\u0131 veya tutars\u0131z anlat\u0131mlar \u00f6yk\u00fcy\u00fc daha da karma\u015f\u0131k hale getirebilir. Ayr\u0131ca, senkop olaylar\u0131n\u0131n %4 ila %40&#8217;\u0131nda g\u00f6r\u00fclen konv\u00fclsif aktivite nedeniyle senkopu n\u00f6betten ay\u0131rmak genellikle zordur (12). Genellikle zor olan bu ayr\u0131m\u0131 kolayla\u015ft\u0131rmak i\u00e7in Sheldon, \u00f6yk\u00fcye dayal\u0131 bir puanlama sistemi \u00f6nermi\u015ftir (12) (Tablo 1).<\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table><tbody><tr><td>Dil \u0131s\u0131rma var m\u0131?<\/td><td>2<\/td><\/tr><tr><td>Atak \u00f6nce de \u0301 ja` vu hissi var m\u0131?<\/td><td>1<\/td><\/tr><tr><td>Emosyonel stres ile ili\u015fki var m\u0131?<\/td><td>1<\/td><\/tr><tr><td>Atak s\u0131ras\u0131nda ba\u015f\u0131n\u0131n d\u00f6nd\u00fc\u011f\u00fcn\u00fc fark etti mi?<\/td><td>1<\/td><\/tr><tr><td>Anromal bir post\u00fcr, uzuvlar\u0131n sallanmas\u0131 veya olay sonras\u0131 haf\u0131za kayb\u0131 oldu mu?<\/td><td>1<\/td><\/tr><tr><td>Atak sonras\u0131 konf\u00fczyon var m\u0131?<\/td><td>1<\/td><\/tr><tr><td>Sersemlik hissetti mi?<\/td><td>-2<\/td><\/tr><tr><td>Ataktan \u00f6nce terleme oldu mu?<\/td><td>-2<\/td><\/tr><tr><td>Uzun s\u00fcre ayakta durma veya oturma oldu mu?<\/td><td>-2<\/td><\/tr><tr><td colspan=\"2\"><strong>Skor \u22651 ise n\u00f6bet ve &lt;1 ise senkop olas\u0131l\u0131\u011f\u0131 daha y\u00fcksektir.<\/strong><\/td><\/tr><\/tbody><\/table><\/div><figcaption class=\"wp-element-caption\"><strong>Tablo 1.<\/strong> Senkop ve n\u00f6beti ay\u0131rt etmeye y\u00f6nelik sorular<\/figcaption><\/figure>\n\n\n\n<p>Mevcut atak sorguland\u0131ktan sonra, hastan\u0131n ge\u00e7mi\u015f \u00f6yk\u00fcs\u00fc sorgulanarak olas\u0131 risk fakt\u00f6rleri ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. Herhangi bir kalp yetmezli\u011fi, miyokard enfarkt\u00fcs\u00fc \u00f6yk\u00fc, yap\u0131sal kalp hastal\u0131\u011f\u0131 ve ailede kalp hastal\u0131\u011f\u0131 veya ani \u00f6l\u00fcm \u00f6yk\u00fcs\u00fc sorgulanmal\u0131d\u0131r. Kalp hastal\u0131\u011f\u0131 \u00f6yk\u00fcs\u00fc, %95 duyarl\u0131l\u0131k ve %45 \u00f6zg\u00fcll\u00fck ile kardiyak senkopun ba\u011f\u0131ms\u0131z bir g\u00f6stergesidir. Buna kar\u015f\u0131l\u0131k, hastalar\u0131n %97&#8217;sinde kalp hastal\u0131\u011f\u0131n\u0131n olmamas\u0131, senkopun olas\u0131 kardiyak bir nedenini d\u0131\u015flar (2).<\/p>\n\n\n\n<p><strong>Fizik Muayene<\/strong><\/p>\n\n\n\n<p>Dikkatli bir \u00f6yk\u00fcden sonra kapsaml\u0131 bir fizik muayene yap\u0131lmal\u0131d\u0131r. \u0130lk olarak, ortostatik vital bulgular dahil vital bulgular de\u011ferlendirilmelidir. \u0130nat\u00e7\u0131 (&gt;15 dakika) anormal vital bulgular k\u00f6t\u00fc sonlan\u0131m a\u00e7\u0131s\u0131ndan daha y\u00fcksek risk anlam\u0131 ta\u015f\u0131maktad\u0131r (13). Vital bulgular\u0131n de\u011ferlendirilmesi sonras\u0131 kalp yetmezli\u011fi veya yap\u0131sal kalp hastal\u0131\u011f\u0131 belirtilerini de\u011ferlendirmek i\u00e7in dikkatli bir kardiyopulmoner muayene yap\u0131lmal\u0131d\u0131r. N\u00f6rolojik muayenede, fokal defisit veya mental durum de\u011fi\u015fikli\u011fi a\u00e7\u0131s\u0131ndan hasta de\u011ferlendirilmelidir. Dil \u0131s\u0131rma n\u00f6bet i\u00e7in \u00e7ok spesifik oldu\u011fundan (%96), dili incelemek yararl\u0131d\u0131r (2). G\u0130S kanama \u015f\u00fcphesi varl\u0131\u011f\u0131nda rektal muayene yap\u0131lmal\u0131d\u0131r. Ya\u015fl\u0131 hastada senkop ataklar\u0131 genellikle travmatik yaralanmalara neden oldu\u011fundan hasta k\u0131yafetleri tamamen \u00e7\u0131kart\u0131lmal\u0131 ve travma bak\u0131s\u0131 yap\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p>Karotis sinus masaj\u0131, ba\u015flang\u0131\u00e7 de\u011ferlendirmesinden sonra etyolojisi bilinmeyen, &gt;40 ya\u015f\u0131ndaki senkoplu hastalarda endikedir. Karotis sinus masaj\u0131 sonras\u0131 &gt;3 saniyelik ventrik\u00fcler duraksama ve\/veya sistolik kan bas\u0131mc\u0131nda &gt;50 mmHg\u2019lik d\u00fc\u015f\u00fc\u015f, karotis sin\u00fcs hipersensitivitesi olarak tan\u0131mlan\u0131r. Spontan senkop ile ili\u015fkilendirildi\u011finde, bu durum \u201ckarotis sinus sendromu\u201d olarak adland\u0131r\u0131l\u0131r.<\/p>\n\n\n\n<p><strong>Tan\u0131sal tetkikler<\/strong><\/p>\n\n\n\n<p>Acil serviste istenecek tetkikler, b\u00fcy\u00fck \u00f6l\u00e7\u00fcde \u00f6yk\u00fc ve fizik muayeneden elde edilen bilgiler do\u011frultusunda \u00f6n tan\u0131lara y\u00f6nelik olarak belirlenmelidir. Bir istisna olarak, senkoplu t\u00fcm hastalara ilk de\u011ferlendirmede 12 derivasyonlu EKG \u00e7ekilmesi gerekmektedir (2).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>EKG:<\/strong> H\u0131zl\u0131, ucuz ve g\u00fcvenlidir. Acil serviste EKG ile yap\u0131sal kalp hastal\u0131\u011f\u0131 ve aritmi bulgular\u0131n\u0131 de\u011ferlendirilmelidir. EKG ile tan\u0131mlanan Ottawa Kriterleri, 30 g\u00fcnl\u00fck k\u00f6t\u00fc kardiyak sonlan\u0131m riski ta\u015f\u0131yan hastalar\u0131 belirlemede yararl\u0131d\u0131r (14):<ul><li>\u0130kinci derece Mobitz tip 2 veya \u00fc\u00e7\u00fcnc\u00fc derece AV blok<\/li><\/ul><ul><li>Birinci derece AV blok ile dal blo\u011fu<\/li><\/ul><ul><li>Sol \u00f6n veya arka fasik\u00fcler blok ile sa\u011f dal blo\u011fu<\/li><\/ul><ul><li>Yeni iskemik de\u011fi\u015fiklikler<\/li><\/ul><ul><li>Sin\u00fcs d\u0131\u015f\u0131 ritim<\/li><\/ul><ul><li>Sol eksen sapmas\u0131<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Acil serviste kardiyak monit\u00f6r anormallikleri<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>Ayr\u0131ca EKG&#8217;de herhangi bir aritmi, erken atriyal vuru, erken ventrik\u00fcler vuru, pacing, ikinci ve \u00fc\u00e7\u00fcnc\u00fc derece AV bloklar ve sol dal blo\u011fu saptanan hastalar ekokardiyografiden fayda g\u00f6rebilir. EKG&#8217;leri normal olan ve yap\u0131sal kalp hastal\u0131\u011f\u0131 olma olas\u0131l\u0131\u011f\u0131 d\u00fc\u015f\u00fck hastalarda ekokardiyografinin bir yarar\u0131 yoktur (15). Bir di\u011fer \u00f6nemli EKG tan\u0131s\u0131 Brugada sendromudur. Brugada sendromu, yap\u0131sal olarak normal kalplerde ta\u015fiaritmi ve ani \u00f6l\u00fcme yol a\u00e7abilen kardiyak sodyum kanal\u0131ndaki mutasyonun neden oldu\u011fu bir kanalopatidir. Prekordiyal derivasyonlarda belirgin ST elevasyonu ile karakterizedir. Sa\u011f prekordiyal derivasyonlardan birinde (V1\u20132) e\u011fimli tip ST segment y\u00fckselmesi (tip I) tan\u0131 i\u00e7in temeldir. Eyer s\u0131rtl\u0131 tip 2 ve 3 Brugada paternleri d\u00fc\u015f\u00fcnd\u00fcr\u00fcc\u00fcd\u00fcr ancak te\u015fhis i\u00e7in yeterli de\u011fildir.<\/p>\n\n\n\n<p>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"832\" height=\"717\" src=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/ba827a6b284f08dc76f06e9e7e49574a.png\" alt=\"\" class=\"wp-image-512\" srcset=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/ba827a6b284f08dc76f06e9e7e49574a.png 832w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/ba827a6b284f08dc76f06e9e7e49574a-300x259.png 300w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/ba827a6b284f08dc76f06e9e7e49574a-768x662.png 768w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/ba827a6b284f08dc76f06e9e7e49574a-731x630.png 731w\" sizes=\"(max-width: 832px) 100vw, 832px\" \/><\/figure>\n\n\n\n<p><strong>\u015eekil 1.<\/strong> Brugada Sendromu EKG paternleri.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Laboratuvar Testleri:<\/strong> Laboratuvar testleri her hastaya g\u00f6re planlanmal\u0131, rutin tetkik isteminden ka\u00e7\u0131n\u0131lmal\u0131d\u0131r. Senkopun genel de\u011ferlendirmesinde rutin kan tetkikleri d\u00fc\u015f\u00fck verimli\u011fe sahiptir. Bununla birlikte, t\u00fcm senkop hastalar\u0131n\u0131n kan glukoz d\u00fczeyine bak\u0131lmal\u0131d\u0131r. Bu ucuz ve kolay test, kolayca geri d\u00f6nd\u00fcr\u00fclebilir bir senkop nedenini d\u0131\u015flayabilir. Y\u00fcksek \u00f6neme sahip bir test, beyin natri\u00fcretik peptididir (BNP). \u00d6zellikle, BNP&#8217;nin y\u00fckselmesi mortalitede \u00f6nemli bir art\u0131\u015fla ili\u015fkilendirilmi\u015ftir (16).<\/li>\n\n\n\n<li><strong>G\u00f6r\u00fcnt\u00fcleme: <\/strong>\u00d6yk\u00fc veya fizik muayene gerektirmedik\u00e7e rutin olarak g\u00f6r\u00fcnt\u00fclemeye gerek yoktur. Rutin bilgisayarl\u0131 tomografi (BT) taramalar\u0131, ekokardiyografi, karotis ultrasonu ve elektroensefalografi hep birlikte vakalar\u0131n %5&#8217;inden daha az\u0131nda tan\u0131 veya&nbsp; hasta y\u00f6netiminde etkilidir ve %2&#8217;den daha az oranda senkop nedeninin belirlenmesine yard\u0131mc\u0131 olmaktad\u0131r (17).<\/li>\n<\/ul>\n\n\n\n<p><strong>Senkopta Risk S\u0131n\u0131flamas\u0131<\/strong><\/p>\n\n\n\n<p>Acil serviste senkop nedeni ile de\u011ferlendirilen bir hastada a\u015fa\u011f\u0131daki 3 soruya yan\u0131t verilmelidir (1):<\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\">\n<li>Tespit edilen ciddi bir senkop nedeni var m\u0131?<\/li>\n\n\n\n<li>K\u00f6t\u00fc sonlan\u0131m i\u00e7in risk durumu nedir?<\/li>\n\n\n\n<li>Hasta hastaneye yatmal\u0131 m\u0131?<\/li>\n<\/ol>\n\n\n\n<p><strong>Soru 1: Tespit edilen ciddi bir senkop nedeni var m\u0131?<\/strong><\/p>\n\n\n\n<p>K\u0131sa vadeli k\u00f6t\u00fc sonlan\u0131m\u0131 en s\u0131k belirleyen, senkopun kendisinden ziyade altta yatan akut hastal\u0131kt\u0131r. Acil servis hekiminin \u00f6ncelikli amac\u0131, \u00f6zellikle h\u0131zl\u0131 bir \u015fekilde hayat\u0131 tehdit edebilecek altta yatan nedeni ortaya koymakt\u0131r (18). Sonras\u0131nda hasta y\u00f6netimi, altta yatan bu nedeni tedavi etmeye odaklanacakt\u0131r (\u015eekil 2).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"1024\" height=\"441\" src=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-1024x441.jpg\" alt=\"\" class=\"wp-image-513\" srcset=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-1024x441.jpg 1024w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-300x129.jpg 300w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-768x331.jpg 768w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-1536x662.jpg 1536w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-2048x883.jpg 2048w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/b8f0bdcf41a17344165d964ae36175a5-1200x517.jpg 1200w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><strong>\u015eekil 2.<\/strong> Senkop oldu\u011fundan \u015f\u00fcphelenilen ge\u00e7ici bilin\u00e7 kayb\u0131 nedeniyle acil servise ba\u015fvuran hastalar\u0131n y\u00f6netimi (1).<\/p>\n\n\n\n<p>\u00c7o\u011fu (%40-45) kardiyovask\u00fcler olmayan ve baz\u0131 kardiyovask\u00fcler ya\u015fam\u0131 tehdit eden altta yatan durumlar acil serviste h\u0131zl\u0131 bir \u015fekilde saptanabilir. Tablo 2\u2019de, altta yatan ciddi bir nedenin varl\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcren y\u00fcksek riskli \u00f6zellikleri ve altta yatan ya\u015fam\u0131 tehdit etmeyecek bir nedeni d\u00fc\u015f\u00fcnd\u00fcren d\u00fc\u015f\u00fck riskli \u00f6zellikleri listelenmi\u015ftir (1).<\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table><tbody><tr><td><strong>SENKOP OLAYI<\/strong><strong><\/strong><\/td><\/tr><tr><td><strong>D\u00fc\u015f\u00fck Risk Kriterleri<\/strong> Refleks senkopun tipik prodromu ile ili\u015fkili (\u00f6rn. sersemlik, s\u0131cakl\u0131k hissi, terleme, mide bulant\u0131s\u0131, kusma)Beklenmedik ani ho\u015f olmayan g\u00f6r\u00fcnt\u00fc, ses, koku veya a\u011fr\u0131 sonras\u0131ndaUzun s\u00fcre ayakta kald\u0131ktan veya kalabal\u0131k, s\u0131cak yerlerde bulunduktan sonraYemek s\u0131ras\u0131nda veya yemekten sonra\u00d6ks\u00fcr\u00fck, d\u0131\u015fk\u0131lama veya i\u015feme ile tetiklenmi\u015fBa\u015f\u0131 d\u00f6nd\u00fcrme veya karotid sin\u00fcs \u00fczerine bask\u0131 ileS\u0131rt\u00fcst\u00fc\/oturma pozisyonundan aya\u011fa kalma ile<strong><\/strong><\/td><\/tr><tr><td><strong>Y\u00fcksek Risk Kriterleri<\/strong> <strong>Major<\/strong><strong><\/strong>Yeni ba\u015flayan g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, nefes darl\u0131\u011f\u0131, kar\u0131n a\u011fr\u0131s\u0131 veya ba\u015f a\u011fr\u0131s\u0131Efor s\u0131ras\u0131nda vaya supin pozisyonda iken senkopHemen ard\u0131ndan senkopun takip etti\u011fi ani ba\u015flang\u0131\u00e7l\u0131 \u00e7arp\u0131nt\u0131<strong>Min\u00f6r (yap\u0131sal kalp hastal\u0131\u011f\u0131 veya anormal EKG ile ili\u015fkili ise y\u00fcksek risk)<\/strong><strong><\/strong>Uyar\u0131c\u0131 semptom yoklu\u011fu veya k\u0131sa (&lt;10 s ) prodromAilede gen\u00e7 ya\u015fta ani kardiyak \u00f6l\u00fcm hikayesiOturur pozisyonda senkop <strong>&nbsp;<\/strong><\/td><\/tr><tr><td><strong>\u00d6ZGE\u00c7M\u0130\u015e<\/strong><strong><\/strong><\/td><\/tr><tr><td><strong>D\u00fc\u015f\u00fck Risk Kriterleri<\/strong> Mevcut atak ile benzer \u015fekilde, d\u00fc\u015f\u00fck riskli \u00f6zelliklere sahip uzun s\u00fcre \u00f6nce (y\u0131llar) tekrarlam\u0131\u015f senkop \u00f6yk\u00fcs\u00fcYap\u0131sal kalp hastal\u0131\u011f\u0131n\u0131n olmamas\u0131<strong><\/strong><\/td><\/tr><tr><td><strong>Y\u00fcksek Risk Kriterleri<\/strong> <strong>Major<\/strong><strong><\/strong>Ciddi yap\u0131sal veya koroner arter hastal\u0131\u011f\u0131 (kalp yetmezli\u011fi, d\u00fc\u015f\u00fck sol ventrik\u00fcl ejeksiyon fraksiyonu veya eski miyokardiyal infarkt) <strong>&nbsp;<\/strong><\/td><\/tr><tr><td><strong>F\u0130Z\u0130K MUAYENE<\/strong><strong><\/strong><\/td><\/tr><tr><td><strong>D\u00fc\u015f\u00fck Risk Kriterleri<\/strong> Normal fizik muayene<\/td><\/tr><tr><td><strong>Y\u00fcksek Risk Kriterleri<\/strong> <strong>Major<\/strong><strong><\/strong>Acil serviste a\u00e7\u0131klanamayan sistolik kan bas\u0131nc\u0131 &lt;90 mm HgRektal muayenede gastrointestinal kanama d\u00fc\u015f\u00fcncesiUyan\u0131k durumda ve fiziksel egzersiz yoklu\u011funda persistan bradikardi (&lt;40 at\u0131m\/dk)Tan\u0131 konulmam\u0131\u015f sistolik \u00fcf\u00fcr\u00fcm <strong>&nbsp;<\/strong><\/td><\/tr><tr><td><strong>EKG<\/strong><strong><\/strong><\/td><\/tr><tr><td><strong>D\u00fc\u015f\u00fck Risk Kriterleri<\/strong> Normal EKG<\/td><\/tr><tr><td><strong>Y\u00fcksek Risk Kriterleri<\/strong> <strong>Major<\/strong><strong><\/strong>Akut iskemi ile uyumlu EKG de\u011fi\u015fiklikleriMobitz 2 ikinci derece ve \u00fc\u00e7\u00fcnc\u00fc derece av blokPersistan sin\u00fcs bradikardisi (&lt;40 at\u0131m\/dk), yava\u015f AF (&lt;40 at\u0131m\/dk)Hasta sin\u00fcs sendromuDal bo\u011fu, intraventik\u00fcler iletim bozuklu\u011fu, ventrik\u00fcler hipertrofi S\u00fcrekli veya s\u00fcreksiz VT\u0130mplante edilebilir bir kardiyak cihaz\u0131n disfonksiyonu Tip 1 Brugada pattern, uzun QT sendromunu g\u00f6steren QTc &gt;460 ms<strong>Min\u00f6r<\/strong><strong><\/strong>Mobitz 1 ikinci derece AV blok ve 1. derece AV blokAsemptomatik, uygunsuz, hafif sin\u00fcs bradikardisi veya yava\u015f AF (40-50 at\u0131m\/dk)Paroksismal SVT veya atriyal fibrilasyonPreeksite QRS kompleksiK\u0131sa QT intervali (340 ms veya daha k\u0131sa)Atipik Brugada paternleriSa\u011f prekordiyal derivasyonlarda negatif T dalgalar\u0131, aritmojenik sa\u011f ventrik\u00fcl kardiyomiyopatisi d\u00fc\u015f\u00fcnd\u00fcren epsilon dalgalar\u0131 &nbsp;<\/td><\/tr><\/tbody><\/table><\/div><figcaption class=\"wp-element-caption\"><strong>Tablo 2.<\/strong> Senkop nedeni ile de\u011ferlendirilen hastalarda y\u00fcksek ve d\u00fc\u015f\u00fck risk kiriterleri (1).<\/figcaption><\/figure>\n\n\n\n<p><strong>Soru 2: K\u00f6t\u00fc sonlan\u0131m i\u00e7in risk durumu nedir?<\/strong><\/p>\n\n\n\n<p>Risk s\u0131n\u0131fland\u0131rmas\u0131 iki nedenden dolay\u0131 \u00f6nemlidir:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Yeterli hasta e\u011fitimi ile taburcu edilebilecek d\u00fc\u015f\u00fck riskli hastalar\u0131 tan\u0131mak.<\/li>\n\n\n\n<li>\u0130leri tetkik gerektirecek y\u00fcksek riskli, \u00f6zellikle kardiyovask\u00fcler rahats\u0131zl\u0131\u011f\u0131 olan, hastalar\u0131 tan\u0131mak. Bu hastalar\u0131n genellikle hastaneye yat\u0131r\u0131larak takibi gerekecektir (1).<\/li>\n<\/ul>\n\n\n\n<p>Tablo 2\u2019de verilen \u00f6zelliklere g\u00f6re saptanan risk profilinin y\u00f6netim ve d\u00fczenlemeye rehberlik etmek i\u00e7in nas\u0131l kullan\u0131laca\u011f\u0131 \u015eekil 3&#8217;de g\u00f6sterilmektedir.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"1024\" height=\"606\" src=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-1024x606.jpg\" alt=\"\" class=\"wp-image-514\" srcset=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-1024x606.jpg 1024w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-300x177.jpg 300w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-768x454.jpg 768w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-1536x908.jpg 1536w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-2048x1211.jpg 2048w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2023\/07\/484a1f40a579abc931a42f3e94cc4073-1065x630.jpg 1065w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><strong>\u015eekil 3. <\/strong>Senkop sonras\u0131 acil serviste ilk de\u011ferlendirme.<\/p>\n\n\n\n<p>Y\u00fcksek riskli hastalarda kardiyak senkop g\u00f6r\u00fclme olas\u0131l\u0131\u011f\u0131 daha y\u00fcksektir. Yap\u0131sal kalp hastal\u0131\u011f\u0131 ve primer elektriksel iletim ile ilgili hastal\u0131klar, senkoplu hastalarda ani kardiyak \u00f6l\u00fcm ve genel mortalite i\u00e7in ba\u015fl\u0131ca risk fakt\u00f6rleridir. D\u00fc\u015f\u00fck riskli hastalarda refleks senkop g\u00f6r\u00fclme olas\u0131l\u0131\u011f\u0131 daha y\u00fcksektir ve \u00e7ok daha iyi bir prognoza sahiptirler.<\/p>\n\n\n\n<p><strong>Soru 3: Hasta hastaneye yatmal\u0131 m\u0131?<\/strong><\/p>\n\n\n\n<p>Acil servise senkop ile ba\u015fvuran hastalar\u0131n yakla\u015f\u0131k %50&#8217;sinin hastaneye yat\u0131r\u0131larak takibi gerekmektedir. Erken, h\u0131zl\u0131 ve yak\u0131n ileri inceleme sa\u011flamak i\u00e7in y\u00fcksek riskli hastalar\u0131n belirlenmesi \u00e7ok \u00f6nemli olsa da, y\u00fcksek riskli hastalar\u0131n bir k\u0131sm\u0131 hastaneye yat\u0131r\u0131lmadan da takip edilebilir (1). Fakat \u00fclkemizdeki acil servislerin yo\u011funlu\u011fu g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, y\u00fcksek riskli ya\u015fl\u0131 hastalar\u0131n optimal takibinin acil servislerde yap\u0131lmas\u0131n\u0131n m\u00fcmk\u00fcn olmamas\u0131 nedeni ile, bu hastalar\u0131n hastaneye yat\u0131r\u0131larak takibi daha uygun olacakt\u0131r.<\/p>\n\n\n\n<p><strong>Acil Servisten Taburculuk ve Takip<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalar\u0131n senkop sonras\u0131 g\u00fcvenle acil servisten taburcu edilebilmelerinin anahtar\u0131, uygun ve yeterli bir hasta takibi plan\u0131n\u0131n yap\u0131lmas\u0131d\u0131r. Acil servisten taburcu edilen ve sonras\u0131 ciddi k\u00f6t\u00fc sonu\u00e7lar\u0131n g\u00f6r\u00fcld\u00fc\u011f\u00fc hastalar\u0131n \u00e7o\u011fu takipsiz hastalard\u0131r (2). \u00d6zellikle d\u00fc\u015f\u00fck risk kriterlerini kar\u015f\u0131lamayan fakat ayn\u0131 zamanda hastaneye yat\u0131\u015f gerektirecek y\u00fcksek risk kriterlerine de sahip olmayan ya\u015fl\u0131 hastalar\u0131n 24-48 saat i\u00e7in g\u00f6zlemlendi\u011fi veya takip edildi\u011fi, kuruma \u00f6zg\u00fc bir bak\u0131m s\u00fcreci geli\u015ftirilmelidir. Bu t\u00fcr protokollerin geli\u015ftirilmesi, hasta g\u00fcvenli\u011finin en kolay ve en iyi \u015fekilde g\u00fcvence alt\u0131na al\u0131nmas\u0131yla takip olana\u011f\u0131 sa\u011flar. Genel olarak, ya\u015fl\u0131 senkop hastalar\u0131n\u0131n bir birinci basamak veya uzman hekim taraf\u0131ndan takip de\u011ferlendirmesi yap\u0131lmal\u0131d\u0131r. Bu takibin aciliyeti ve kim taraf\u0131ndan yap\u0131laca\u011f\u0131 risk s\u0131n\u0131fland\u0131rmas\u0131na ba\u011fl\u0131d\u0131r. Nedeni belirlemenin m\u00fcmk\u00fcn olmad\u0131\u011f\u0131 durumlarda kardiyoloji ve n\u00f6roloji kliniklerinin hastay\u0131 ortak olarak de\u011ferlendirmeleri d\u00fc\u015f\u00fcn\u00fclmelidir.<\/p>\n\n\n\n<p><strong>Sonu\u00e7<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastada gen\u00e7 eri\u015fkinlere g\u00f6re daha s\u0131k g\u00f6r\u00fclen senkop, tan\u0131sal s\u00fcre\u00e7lerde ya\u015fanan \u00e7e\u015fitli zorluklar ve genellikle hastalar\u0131n yak\u0131n takibinin gerekmesi nedeni ile \u00f6zellikli bir durumdur. Hastalar\u0131n acil serviste yeterli bak\u0131m\u0131 alamamas\u0131 ve acil servisten taburculuklar\u0131 sonras\u0131 uygun takip hizmetine ula\u015famamas\u0131 mortalite ve morbidite riskini artt\u0131rmaktad\u0131r. Bu nedenle \u00f6zellikle acil servis hekimleri ya\u015fl\u0131 senkop hastalar\u0131nda daha dikkatli ve donan\u0131ml\u0131 olmal\u0131, kurumlarda bu hastalar i\u00e7in olu\u015fturulmas\u0131 gereken protokollere \u00f6nc\u00fcl\u00fck etmelidir.<\/p>\n\n\n\n<p><strong>Kaynaklar<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\">\n<li>Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883\u2013948.<\/li>\n\n\n\n<li>Hogan TM, Constantine ST, Crain AD. Evaluation of Syncope in Older Adults. Emerg Med Clin North Am. 2016 Aug;34(3):601\u201327.<\/li>\n\n\n\n<li>D\u2019Ascenzo F, Biondi-Zoccai G, Reed MJ, Gabayan GZ, Suzuki M, Costantino G, et al. Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: an international meta-analysis. Int J Cardiol. 2013 Jul 15;167(1):57\u201362.<\/li>\n\n\n\n<li>Savage DD, Corwin L, McGee DL, Kannel WB, Wolf PA. Epidemiologic features of isolated syncope: the Framingham Study. Stroke. 1985;16(4):626\u20139.<\/li>\n\n\n\n<li>Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878\u201385.<\/li>\n\n\n\n<li>McIntosh S, Da Costa D, Kenny RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a \u201csyncope\u201d clinic. Age Ageing. 1993 Jan;22(1):53\u20138.<\/li>\n\n\n\n<li>Allcock LM, O\u2019Shea D. Diagnostic yield and development of a neurocardiovascular investigation unit for older adults in a district hospital. J Gerontol A Biol Sci Med Sci. 2000 Aug;55(8):M458-462.<\/li>\n\n\n\n<li>Adkisson WO, Benditt DG. Syncope due to Autonomic Dysfunction: Diagnosis and Management. Med Clin North Am. 2015 Jul;99(4):691\u2013710.<\/li>\n\n\n\n<li>van Dijk JG, Sheldon R. Is there any point to vasovagal syncope? Clin Auton Res Off J Clin Auton Res Soc. 2008 Aug;18(4):167\u20139.<\/li>\n\n\n\n<li>Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur Heart J. 2009 Nov 1;30(21):2631\u201371.<\/li>\n\n\n\n<li>Brignole M, Gianfranchi L, Menozzi C, Raviele A, Oddone D, Lolli G, et al. Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol. 1993 Oct;22(4):1123\u20139.<\/li>\n\n\n\n<li>Sheldon R. How to Differentiate Syncope from Seizure. Card Electrophysiol Clin. 2013 Dec;5(4):423\u201331.<\/li>\n\n\n\n<li>Grossman SA, Fischer C, Lipsitz LA, Mottley L, Sands K, Thompson S, et al. Predicting adverse outcomes in syncope. J Emerg Med. 2007 Oct;33(3):233\u20139.<\/li>\n\n\n\n<li>Thiruganasambandamoorthy V, Hess EP, Turko E, Tran ML, Wells GA, Stiell IG. Defining abnormal electrocardiography in adult emergency department syncope patients: the Ottawa Electrocardiographic Criteria. CJEM. 2012 Jul;14(4):248\u201358.<\/li>\n\n\n\n<li>Anderson KL, Limkakeng A, Damuth E, Chandra A. Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting. Ann Emerg Med. 2012 Oct;60(4):478-484.e1.<\/li>\n\n\n\n<li>Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010 Feb 23;55(8):713\u201321.<\/li>\n\n\n\n<li>Mendu ML, McAvay G, Lampert R, Stoehr J, Tinetti ME. Yield of diagnostic tests in evaluating syncopal episodes in older patients. Arch Intern Med. 2009 Jul 27;169(14):1299\u2013305.<\/li>\n\n\n\n<li>Crane SD. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J EMJ. 2002 Jan;19(1):23\u20137.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Giri\u015f Ya\u015fl\u0131 hastalarda gen\u00e7 eri\u015fkinlere g\u00f6re daha s\u0131k g\u00f6r\u00fclen senkop; h\u0131zl\u0131 ba\u015flang\u0131\u00e7, k\u0131sa s\u00fcre ve spontan tam iyile\u015fme ile karakterize, ge\u00e7ici global&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":515,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[],"class_list":["post-511","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/511","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=511"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/511\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/515"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=511"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=511"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=511"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}