Syncope - full summary

Question 1

What is meant by syncope?

Answer 1

Transient loss of consciousness due to cerebral hypo perfusion, characterised by rapid onset, short duration and spontaneous, complete recovery

Question 2

What is meant by a transient loss of consciousness?

Answer 2

a state of real or apparent loss of consciousness with loss of awareness, characterised by amnesia for the period of unconsciousness, loss of motor control, loss of responsiveness and of a short duration

Question 3

What are the 3 main types of syncope?

Answer 3

Reflex syncope
Orthostatic hypotension
Cardiac syncope

Question 4

What testing is required in cases of syncope?

Answer 4

Careful history
Orthostatic blood pressure measurement
12 lead ECG

Question 5

What is meant by reflex syncope?

Answer 5

Syncope caused by neural modification heart rate and/or vascular tone, causing a fault in arterial blood pressure of sufficient severity to affect cerebral perfusion

Question 6

What are the 3 types of reflex syncope?

Answer 6

Vasovagal syncope
Situational syncope
Carotid sinus syncope

Question 7

What is vasovagal syncope?

Answer 7

Syncope triggered by emotional or orthostatic stress

Question 8

What are some prodromes of vasovagal syncope?

Answer 8

Pallor
Sweating
Nausea

Question 9

What are some actions that can control vasovagal syncope?

Answer 9

Leg crossing
Adoption of a horizontal gravity neutralisation position

Question 10

How is vasovagal syncope treated?

Answer 10

Education
Reassurance
Trigger avoidance
Adequate hydration

Question 11

What is situational syncope?

Answer 11

Syncope that occurs during or immediately after a trigger

Question 12

What are some possible triggers of situational syncope?

Answer 12

Cough
Micturition
Swallowing

Question 13

What are some treatment options in situational syncope?

Answer 13

Removal of trigger (e.g. cough)
Lying down
Avoiding dehydration
Decreasing alcohol intake
Cardiac pacing (If indicated)

Question 14

What is carotid sinus syncope?

Answer 14

This is syncope caused by manipulation of the carotid sinus

Question 15

What are some possible causes of carotid sinus syncope?

Answer 15

Mechanical manipulation of the neck
Shaving
Tight collars

Question 16

Who is most susceptible to carotid sinus syncope?

Answer 16

Elderly males
Those with previous neck or head surgery
Those with coronary artery atherosclerosis

Question 17

What is the treatment for carotid sinus syncope?

Answer 17

Cardiac pacing

Question 18

What is orthostatic hypotension?

Answer 18

This is syncope that occurs from a failure of baroreceptor response to gravitational shifts in blood, when moving from horizontal to vertical

Question 19

What are some risk factors for orthostatic hypotension?

Answer 19

Age
Certain medications
Certain diseases
Prolonged bed rest

Question 20

What is a positive orthostatic blood pressure test for orthostatic hypotension?

Answer 20

A positive result is indicated by a drop in blood pressure within 3 minutes of standing from a lying position of:

• > 20mmHg drop in systolic BP
• > 10mmHg drop in diastolic BP + symptoms

Question 21

What are some symptoms of orthostatic hypotension?

Answer 21

Dizziness
Lightheadedness
Blurred vision
Faintness
Falls

Question 22

What is cardiac syncope?

Answer 22

Syncope caused by a cardiac event, resulting in a sudden drop in cardiac output

Question 23

What are some possible causes of cardiac syncope?

Answer 23

Arrhythmia
Acute MI
Structural cardiac disease
Cardiovascular diseases

Question 24

What are some features that may be suggestive of cardiac syncope?

Answer 24

Syncope when supine
Syncope during excretion
Presence of structural abnormalities
Sudden palpitations
Family history of early sudden death