OnlineMedEd: Intern Content - "Syncope"

Question 1

Again, review Dr. Williams’ system of causes of syncope.

Answer 1

• Pump can’t hold water up: heart
• Water not sufficient: hypovolemia
• Tank size too big: vasovagal, sepsis
• Brain doesn’t use water: seizure, PCA stroke

Question 2

How do you differentiate syncope from seizure using history?

Answer 2

•Seizure:

• Post-ictal state (greater than 3 minutes)
• Prominent tonic-clonic jerking
• Incontinence

• Syncope:

• No post-ictal state (back to normal in less than 3 minutes)
• Mild convulsions
• No incontinence

Question 3

List Dr. Williams’ mnemonic for syncope.

Answer 3

WOMAN 321 PE
•VV (vasovagal)
- Visceral organs
- Carotid baroreceptors
- Psychogenic causes
•Orthostasis
- Hypovolemic (diarrhea, dehydration, hemorrhage, vomiting)
- Autonomic nervous system dysfunction (DM, elderly, Parkinson's) 
•Mechanical cardiac (aortic stenosis) 
•Arrhythmias (prolonged QT) 
• Neurogenic (
•PE
•Psychogenic
•Electrolyte imbalances

Question 4

Review the historical features that suggest each etiology of sycnope.

Answer 4

•VV (vasovagal): all have prodromes
- visceral organ irritation: micturition, bowel movement, cough
- carotid baroreceptors: tie to tight, boxer punch
- psych: situational, reproducible
•Orthostasis: presyncopal; history showing diarrhea, dehydration, hemorrhage, vomiting
•M: on exertion, no prodrome
•A: sudden, with no prodrome, may or may not be exertional
• N: rare, sudden, without syncope
•PE
•P:
•E:

Question 5

The vital signs that indicate orthostasis are ________________.

Answer 5

SBP decrease by 20, DBP decrease by 10, or HR increase by 15

Question 6

True or false: tilt-table is used to diagnose orthostatic syncope.

Answer 6

False

Tilt-table is used to diagnose vasovagal syncope.

Question 7

Holter monitors are usually only done for ______________.

Answer 7

one day

Question 8

What are the longer options for capturing arrhythmic syncopal events?

Answer 8

• Event recorder (if they can feel them or remain conscious)
• Loop recorder (if they lose consciousness)