Syncope Flashcards

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1
Q

Categories of Syncope

A

Neurally mediated/Vaso-Vagal syncope,
Orthostatic Syncope,
Cerebrovascular,
Cardiopulmonary

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2
Q

Pathophysiology

A

Occurs d/t global cerebral hypo-perfusion.
3-5 sec when upright.
15 sec when recumbent.

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3
Q

PE for Syncope Eval

A
  1. Vital signs with pulse oximetry
  2. Orthostatics
  3. Cardiac exam: murmurs, bruits, displaced apex
  4. Neuro: exclude focal deficit
  5. Careful head/skeletal assessment to exclude fall trauma.
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4
Q

Labs/Diagnostics for syncope eval

A

ECG,
Cardiac monitor,
Urine pregnancy

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5
Q

Initial Intervention

A

IV access,

Crystalloid IV fluids if warrented by fluid status

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6
Q

Features of Seizures

A

Onset unrelated to postural changes or activity,
Preceding aura,
Tonic-clonic movements,
Incontinence,
Post-ictal period/syptoms–>confusion, drowsiness, paresis, myalgias,
LOC often >5 min

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7
Q

Pathophysiology of Vaso-vagal syncope

A

reflex tone causes bradycardia & vasodilation

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8
Q

Triggers/History Clues to vaso-vagal syncope

A

usually standing or sitting;
Pain, cough, micturation, defecation, pregnancy & situational;
Typically Young

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9
Q

PE of vaso-vagal syncope

A

pale, diaphoresis, dilated pupils & bradycardia

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10
Q

Disposition for vaso-vagal syncope

A

Reassurance & DC

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11
Q

Pathophysiology of orthostatic syncope

A

arterial hypotension in upright position

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12
Q

Triggers/history clues to orthostatic syncope

A

Rapid change to upright position;
Preceding light-headedness, weakness or vision change;
GI Blood loss, dehydration, or autonomic dysfunction

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13
Q

PE for orthostatic syncope

A

+symptoms, or HR increase by 30, BP decreased by 20, or SBP <90

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14
Q

Dispoition for orthostatic syncope

A

DC unless uncorrectable with fluids

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15
Q

Causes of Cerebro-vascular syncope

A

Migraine,
Carotid sinus syncope,
Subclavian steal syndrome,
Basilar artery insufficiency

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16
Q

carotid sinus syncope

A

tight collars or strangulation

17
Q

Subclavian steal syndrome

A

vertigo or angina with left arm movement;

PE clue: unequal BP in arms

18
Q

Basilar artery insufficiency

A

think of as stroke syndrome;

May have ass. vertigo, diplopia, or ataxia

19
Q

Etiologies of cardiopulmonary syncope

A
Rhythm Disturbances,
Ventricular outflow obstruction,
Ventricular inflow obstruction,
MI,
Pulmonary vascular dz,
Aortic dissection
20
Q

Clues that suggest cardiopulmonary syncope

A
recumbent onset (happens while sitting down);
Exertional onset (worry about aortic stenosis);
Palpitations (Vtach is most common);
Personal or family hx of structural or ischemic dz
21
Q

Most common dysrhythmias casing cardiopulmonary syncope

A

ventricular tachycardia

22
Q

Most common structural cause of cardiopulmonary syncope

A

Aortic stenosis

23
Q

Aortic Stenosis

A

exertional syncope with SOB & angina;

Mid-systolic murmur with LV lift

24
Q

Hypertrophic Cardiomyopathy

A

Exertional syncope with/without chest pain or DOE;
Systolic murmur increases with exertion
S4 heart sound

25
Q

Pulmonary vascular causes of cardiopulmonary syncope

A

Pulmonary Embolus,

Pulmonary HTN

26
Q

RF predictive of 1 yr mortality following syncope

A

Abnormal EKG,
Hx of dysrhythmias,
Age>45,
Hx of CHF

27
Q

Young pts (<45) are low risk unless:

A

Exertional syncope,

Family hx of sudden death

28
Q

ACEP Syncope admission Recommendations

A
Abnormal EKG,
Age >45,
Established CAD,
Ventricular dysrhythmias,
Structural heart disease,
CHF,
Hematocrit < 30%,
Suspicion of life threatening disease