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Senior - E Med > 6 - Syncope > Flashcards

6 - Syncope Flashcards

1
Q

Syncope definition?

A

Syncope or “fainting”
Is a symptom complex consisting of a brief loss of consciousness associated with an ability to maintain postural tone that

spontaneously resolves without medical intervention

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2
Q

Near syncope?

A

Same thing but you dont loose consciousness

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3
Q

Pathophys of fainting?

A

Inciting event causing drop in CO -> decreased O2

  • 10 sec of complete disruption of blood flow
  • or reduction of cerebral perfusion by 35-50%
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4
Q

Pathophys causes of syncope?

A
  • UKN - 37%
  • Vasovagal (reflex mediated) - 21%
  • cardiac - 10%
  • Orthostatic
  • meds
  • neurologic
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5
Q

Its just fainting, why do we care?

A

Each diagnosis classification carries with it progostic risk

  • cardiac double risk of death
  • neurologic, increased death by 50%
  • UKN - death by 30%

(Compared to gen pop)

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6
Q

Death risk of vasovagal?

A

No increased death risk over “normals”

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7
Q

Most deadly type of syncope?

A

Cardiac

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8
Q

Common cardiac causes of syncope?

A 
HCM
PE
Acute MI
- if myocardial dyskinesia reduces CO
Brady and tachy dysrhythmias -> transient hypoperfusion
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9
Q

Ho do dysrhythmia induced syncope’s present?

A

Sudden and without prodromal symptoms

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10
Q

What is the largest determination of how cardiac syncope presents?

A

The autonomic nervous system’s ability to compensate for decreased CO

Degree of underlying CVD

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11
Q

___ is a form of reflex-mediated or neurally mediated syncope, is associated with inappropriate vasodilation, bradycardia or both

A

Vasovagal syncope

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12
Q

Prodrome for vasovagal syncope?

A
  • Lightheadedness
  • w/ or w/out nausea,
  • pallor
  • sweating
  • feeling of warmth
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13
Q

Slow progressive onset with associated prodrome suggests?

A

Vasovagal syncope

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14
Q

Common triggers for vasovagal syncope?

A

Aka neurally/reflux-mediated

Exposure to:

  • sight/sound
  • smell
  • fear
  • pain
  • emotional distress
  • instrumentation

Prolonged standing in heat

Situations

  • coughing
  • micturition
  • defecation
  • swallowing
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15
Q

Carotid sinus hypersensitivity, another reflex-mediated syncope is characterized by?

A

Bradycardia or hypotension

MC: abnormal vagal response -> brady and asytole >3 sec

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16
Q

Patient population for carotid sinus hypersensitivity

A

Older patients with recurrent syncope and negative cardiac evaluations

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17
Q

Why do postural changes effect syncope?

What is this called?

A

The bodies compensation methods cannot keep blood where it needs to be against gravity (volume loss, tone lass etc)

Orthostatic hypotension or postural hypotension

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18
Q

Psych and syncope?

A

Up to 40% of vasovagal
Up to 62% of unexplained

Are associated with psych problems

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19
Q

Neurologic syncope is?

A

A zebra, this condition is rare

20
Q

What conditions must be met for syncope to be considered neurologic?

A

The pt will have neurologic deficits that are transient.

They must have NO persistent neuro deficits

21
Q

What is a rare cause of brainstem ischemia caused by exercise?

A

Subclavian steal syndrome

22
Q

What happens with subclavian steel syndrome?

A

Exercise of the ipsilateral arm causes blood to shunt or be “stolen” from the vertebrobasilar system to the subclavian artery supplying the arm muscles

23
Q

PE for subclavian steal syndrome?

A

MC narrowing on L

Decreased pulse volume and diminished blood pressure in the affected arm.

24
Q

Why are seizures and syncope often confused?

A

Brief tonic-clonic movements are often associated with syncope

  • confusion (postictal)
  • tongue biting
  • incontinence
  • epileptic aura
25
Subarachnoid hemorrhage and syncope?
Fall and head injury from syncope can be a cause of subarachnoid hemorrhage
26
Common med classes that cause syncope?
- ED meds - Anti-hypertensives - B-blocker - cardiac glycosides (digoxin) - anti-dysrhythmics - anti-psychotics - anti-depressants - anti-Parkinson’s - phenothiazines - nitrates - ETOH - Cocaine
27
Goals of evaluation for syncope pts in the ED?
ID death risk pts If diagnosis is made treat that If no diagnosis - risk stratification - through PE - EEG - any other tests needed
28
Red flag symptoms for syncope?
Chest pain Palpitations HA Abdominal pain So the same shit as everything else
29
Sudden syncope event without warning and events associated with exertion raise suspicion for?
Cardia dysrhythmia Structural cardiopulmonary lesion
30
More than 5 syncopal episodes in 1 year is most likely?
More likely - Vasovagal syncope for psych Less likely dysrhythmia
31
History questions?
``` Drugs Etoh Aggressive wt loss attempts Fam hx (prolong QT, SCD etc) Single car crashes (elderly) - dont get hung up on the trauma and miss the cause ```
32
Convulsive syncope?
Mild, brief, tonic-clonic activity (remember seizures are often misdiagnosed as syncope)
33
Urinary incontinence?
Dont care, not useful in distinction
34
What is the most important tool for diagnosis of syncope?
The history | - diagnostic tests have low diagnostic yields
35
ECG and syncope?
Rarely leads to diagnosis but its simple and non-invasive so get one
36
Lab test for syncope?
Based on hx But some common ones - heme stool test (orthostatic) - CBC (orthostatic) - Hcg - look for acidosis - b-type natiuretic peptide or pro-b type naturietic peptide levels are predictive for morbidity
37
Hyperventilation maneuver?
Open-mouthed, slow, deep breaths at rate of 20-30 breaths/min for 2-3 min - may help reproduce psychiatric syncope or prodromes
38
Clinical yield for CT, EEG, or LP with syncope?
Low
39
Which syncope pts get admitted?
Admit: Cardiac and neurologic Send home: Vasovagal, orthostatic, med induced - just fix the problem
40
Decision making and risk management, consider admission in pts with?
- hx of CHF - abnormal ECG - hematocrit <30 - dypsnea - SBP <90 in ED - syncope while supine - syncope during exercise - syncope w/out prodrome - palpitations prior to syncope - age >60 So all the cardiac shit
41
Syncope flow chart?
Slide 35
42
What tx do all the cardiac syncope pts need?
External defibrillators
43
Considerations for elderly pts with syncope?
- increased risk for bad outcomes - risk increases w age - L ventricle is less compliant - decreased vascular tone - decreased adrenergic response - increased pathophysiologic issues (HTN, atherosclerosis)
44
Big concerns for preggo syncope?
Ectopic pregnancy PE Not so worried about cardiac
45
Joker: How can you shoot women and children?!
Door Gunner: Easy! You just don't lead 'em so much! [laughs cunningly] Ain't war Hell?! [laughs]

Senior - E Med (8 decks)

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