B7-010 CBCL Syncope Flashcards by Felicia Jones

predominately thoracolumbar outputs

sympathetic system

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predominately craniosacral outputs

parasympathetic nervous sytem

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peripheral blood vessels have exclusively […] inputs

sympathetic

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has long preganglionic neurons

parasympathetic

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has short preganglionic neurons

sympathetic

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[…] outputs most strongly drive changes in MAP

sympathetic

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how does the SNS compensate for low MAP [2]

increase peripheral resistance
tachycardia

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how does the PNS compensate for high MAP

bradycardia

**this effect is very limited compared to SNS effects, SNS is main driver of MAP

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stimulates all preganglionic efferent autonomic fibers

ACh

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stimulates most parasympathetic postganglionic and a few sympathetic postganglionic (sweat glands) fibers

ACh

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neurotransmitter that stimulates postganglionic neurons in GI and erectile tissue

nitric oxide

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stimulates sympathetic fibers of thermoregulatory sweat glands

ACh

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stimulates most postganglionic sympathetic fibers

Norepinephrine

**excludes thermoregulatory sweat glands

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epinephrine and norepinephrine are released from

adrenal glands

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cotransmitter for ACh

VIP

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cotransmitter for NE

neuropeptide Y

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breaks ACh into choline and acetate

acetylcholinesterase

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parasympathetic effects on the eye [2]

contraction of iris (miosis)
contraction of ciliary muscle (accommodation)

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parasympathetic effects on cardiovascular system

bradycardia

(can reduce peripheral resistance in GI and erectile tissue ONLY via NO)

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parasympathetic effects on respiratory system [2]

contract muscle of bronchial trees
stimulates secretion of fluids

(exacerbates asthma symptoms)

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parasympathetic effects on GI system [2]

increase secretions
increase peristalsis

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parasympathetic effects on GU system [3]

contracts detrusor muscle
relaxes trigone and spinchter
promotes voiding

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rate limiting enzyme in production of NE

tyrosine hydroxylase

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describe the production of NE

tyrosine –> dopa (tyrosine hydroxylase)
dopa –> dopamine (dopa decarboxylase)
dopamine –> NE (dopamine-beta-hydroxylase)

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the release of NE is [...] dependent

calcium

transporter that reuptakes NE from the synaptic cleft into the neuron

uptake 1

uptake 1 inhibitors [2]

cocaine TCAs (increase the amount and action of NE in the synapse)

sympathetic effects on cardiovascular system [3]

alpha r: increase arterial resistance beta 2: relax venous smooth muscle renin secretion stimulated by beta receptors

sympathetic effects on heart [2]

beta 1: increased calcium --> increases contractility increased AV conduction

sympathetic effects on respiratory system [2]

beta: relaxes bronchial smooth muscle alpha: contracts blood vessels of URT mucosa (relieves congestion)

sympathetic effects on GI system [3]

alpha: contraction of spinchter beta: longitudinal smooth muscle relaxation decreases PNS drive on enteric system

sympathetic effects on GU system [2]

alpha: contraction of bladder and urethral spinchter for urinary retention beta: relaxation of bladder wall smooth muscles for urinary retention

apocrine sweat glands are driven by [...] SNS activity

adrenergic

thermoregulatory sweat glands are driven by [...] SNS activity

cholinergic

sympathetic effects on the eye [2]

alpha: mydriasis beta: increase aqueous humor

metabolic effects of SNS

increase lipolysis, glycogenolysis, glucose release, insulin secretion

plasma glucose is typically [...] during sympathetic discharge

increased

how does autonomic dysfunction cause orthostatic hypotension?

inadequate SNS contraction of vasculature in lower extremities

how does autonomic dysfunction cause bradycardia?

SNS loss

how does autonomic dysfunction cause tachycardia?

loss of PSNS

a drop in systolic of [...] or in diastolic of [...] is an abnormal orthostatic BP change

systolic >20 diastolic >10 (also considered abnormal if lightheaded/dizzy)

2 common causes of orthostatic hypotension

volume depletion ANS dysfunction

increase in heart rate >30 points on standing no drop in BP

postural orthostatic tachycardia syndrome (POTS)

most common cause of syncope

neurally-mediated reflex "vaso-vagal", "vaso-depressor"

medications for orthostatic hypotension [3]

flourinef midodrine droxidopa

Horner's syndrome is an example of a [...] condition

focal autonomic nervous system condition

causes of acute ANS dysfunction [2]

toxins drugs

are antihistamines cholinergic or anticholinergic?

anticholinergic

hereditary causes of chronic diffuse autonomic neuropathy [2]

familial amyloid polyneuropathy (ATTR) hereditary sensory autonomic neuropathies

acquired causes of chronic diffuse autonomic neuropathy [2]

idiopathic neurodegenerative (parkinson's) secondary disorders (**diabetes**, amyloidosis, autoimmune)

most common amyloidosis

light chain (AL)

acquired types of amyloidosis [2]

light chain (AL) secondary amyloidosis (AA)

amyloid deposition damages [...] fibers

small, unmyelinated

hereditary amyloidosis

ATTR

light chain (AL) amyloidosis is caused by

underlying plasma cell dyscrasia

inotersen can be used to treat

ATTR (hereditary amyloidosis)

sympathetic postganglionic neurons release [...] as their primary neurotransmitter

what types of neurons release ACh as their primary neurotransmitter? [3]

sympathetic preganglionic neurons parasympathetic preganglionic neurons parasympathetic postganglionic neurons

only system with exclusive sympathetic innervation

systemic vasculature

why is it common for small fiber neuropathies to co-occur with autonomic neuropathies?

both the small fibers and postganglionic axon of the autonomic system are unmyelinated thus, predisposed to protein deposition

best test for diagnosis of secondary amyloidosis

abdominal fat pad biopsy

elevated protein and normal WBC on lumbar puncture

AIDP

elevated protein and elevated WBC on lumbar puncture

infection

medications used to treat POTS [5]

beta blockers fludrocortisone ivabradine erythropoietin pyridostigmine

catecholamine released from the ends of sympathetic fibers

chief neurotransmitter of the parasympathetic nervous system

acetylcholine

largest autonomic plexus

celiac

plexus that supplies the viscera of the pelvic cavity

hypogastric

plexus located at base of the heart

cardiac

continuation of the celiac plexus that surrounds the SMA

superior mesenteric plexus

test that measures the autonomic nerves that control sweating

QSART

grading of adrenergic impairment requires what tests [2]

valsalva maneuver tilt test

systolic murmur can indicate

aortic stenosis

mid-systolic click can indicate

mitral stenosis

next best test for a patient with suspected structural cardiac changes

transthoracic echocardiogram

accounts for 60% of syncope cases

neurally-mediated syncope

B7-010 CBCL Syncope Flashcards

(77 cards)