Working problem 1 -Syncope

Question 1

What is syncope?

Answer 1

Syncope s a transient loss of consciousness due to transient global cerebral hypoperfusion,characterised by rapid onset,short duration and spontaneous complete recovery
Onset of syncope is relatively rapid and the subsequent recovery is spontaneous and complete and usually prompt

Question 2

What is the aetiology of syncope

Answer 2

Cardiac syncope(10%) due to arrhythmias or structural heart disease or cardiopulmonary disease

Vascular(62%) which can be neurally mediated or orthostatic

Question 3

Vasovagal response

Answer 3

Malaise mediated by vagus nerve
Nucleus tractus solitarii of brainstem is activated directly or indirectly by triggering stimulus,resulting in simultaneous enhancement PNS and withdrawal of sympathetic Nervous control leading to decrease CO due to decrease HR (cardioinhibitory effect)
Decreased Blood pressure due to vasodilation

Question 4

What is orthostatic hypotension

Answer 4

aka postural hypotension is defined by the bp falling when suddenly standing up or stretching

Defined as falling of systolic blood pressure 20 mmhg or 10 mmhg when person assumes standing position
symptoms caused by blood pooling in the lower extremities

Question 5

How do you assess syncope

Answer 5

Initial step is to differentiate syncope from non syncopal conditions(eg;seizure or transient ischemic attack)

Identify red flags symptoms present

Question 6

What are the red flags symptoms in Syncope

Answer 6

exertional onset
Chest pain
Dyspnea
Lower back pain
Palpitations
severe headache 
focal neurological deficits
Diplopia
Ataxia(loss of body control)
Dysarthria (unclear articulations)

Question 7

How is seizure distinguished from syncope?

Answer 7

Seizures are distinguished from syncope by
-longer duration of loss of consciousness, disorientation after the episode,
loss of bowel and bladder control, and rhythmic clonic movements.

Question 8

what are the Physical examination done for syncope?

Answer 8

Vital signs(fever and changes in BP)

Detailed cardiopulmonary examination

Detailed neurological examination

Stool Guaiac test (blood
loss leading to anemia)

Patient must be examined for signs of trauma(sustained secondary to syncope resulting in head injury)
Orthostatic Changes

Question 9

What are the initial tests conducted for syncope?

Answer 9

• A 12-lead ECG
• Cardiac enzymes
• FBC and blood glucose levels
• UEC
• CXR
• Pregnancy testing is required for all sexually active women of childbearing age
• Blood and urine toxicology screens - high clinical suspicion for alcohol misuse or illicit drug use

Question 10

What is the management for Syncope

Answer 10

Primary Survey
• Check for response
o A patient who has collapsed must be quickly assessed to determine whether there is a coma, indicating possible cardiac arrest or just a simple fall.
o This is assessed by a gentle ‘shake & shout’ followed by assessment of verbal & motor response (GCS)
• Airway
o Place the patient in the recovery position, or supine.
o Check airway with visual inspection, use a jaw thrust and sweeping out foreign material or vomitus with a finger
o Intubation may be required if the patient remains unconscious and unable to maintain own airway (GCS