Blackouts

Question 1

Acronym for causes of blackouts

Answer 1

CRASH

Cardiac
Reflexes
Arterial
Systemic
Head

Question 2

Cardiac causes of blackouts

Answer 2

Stokes-Adams Attacks
Brady - heart block, sick sinus, long-QT
Tachy - SVT, VT
Structural - weak heart (LVF, tamponade), block (AS, HCM, PE)

Question 3

Reflex causes of blackouts

Answer 3

1) Vasovagal syncope
2) Sympathetic underactivity = postural hypotension

Question 4

Acronym for sympathetic underactivity causes of blackouts

Answer 4

STANDUP

Question 5

Sympathetic underactivity causes of blackouts

Answer 5

Salt deficiency
Toxins
Autonomic Neuropathy
Dialysis
Unwell
Pooling

Question 6

Salt deficiency causes of blackout

Answer 6

Addisons

Hypovolaemia

Question 7

Toxin causes of blackout

Answer 7

ACEi

Diuretics

TCAs

Benzos

L-Dopa

Question 8

Autonomic neuropathy causes of blackout

Answer 8

Parkinson’s

Lew body dementia

DM

Amyloidosis

Question 9

Pooling causes of blackout

Answer 9

Venous

Varicose veins

Prolonged standing

Question 10

Arterial causes of blackouts

Answer 10

Migraine

TIA

Stroke

Subclavian steal

HTN

Question 11

Systemic causes of blackouts

Answer 11

Hypoglycaemia

Hypoxia

Anaemia

Hyperviscosity

Question 12

Head causes of blackouts

Answer 12

Epilepsy
Drop attacks

Question 13

Ix for blackouts

Answer 13

1. lying and standing BP (>20/10 difference after 3 min → postural hypotension)
2. ECG ± 24hr ECG
3. U+E, FBC, Glucose
4. Tilt table
5. EEG, sleep EEG
6. Echo, CT, MRI brain

Question 14

Triggers for cardiogenic syncope

Answer 14

exertion, drugs, unknown

Question 15

Sx before cardiogenic syncope

Answer 15

palpitations, chest pain, dyspnoea

Question 16

Symptoms during cardiogenic syncope

Answer 16

pale, slow/absent pulse, clonic jerks may occur

Question 17

Symptoms after cardiogenic syncope

Answer 17

rapid recovery

Question 18

Ix for cardiogenic syncope

Answer 18

• ECG
• 24hr ECG
• Echo

Question 19

Triggers for vasovagal syncope

Answer 19

prolonged standing
heat
fatigue
stress

Question 20

symptoms before vasovagal syncope or postural hypotension

Answer 20

• Gradual onset: secs→mins
• Nausea, pallor, sweating, tunnel vision, tinnitus
• Cannot occur lying down

Question 21

symptoms during vasovagal syncope or postural hypotension

Answer 21

• Pale, grey, clammy, brady
• Clonic jerks and incontinence can occur, but no tongue biting

Question 22

symptoms after vasovagal syncope or postural hypotension

Answer 22

rapid recovery

Question 23

Ix for vasovagal syncope or postural hypotension

Answer 23

tilt-table testing

Question 24

Triggers for postural hypotension

Answer 24

standing up

Question 25

Triggers for arterial causes of blackout

Answer 25

- arm elevation (subclavian steal) - migraine

Question 26

symptoms of arterial blackout

Answer 26

same as vasovagal + diplopia, nausea, dysarthria

Question 27

investigations for arterial blackout

Answer 27

- MRA - duplex vertebrobasilar circulation

Question 28

symptoms of hypoglycaemic syncope

Answer 28

tremor, hunger, sweating, lightheadedness → LOC

Question 29

triggers for epileptic causes of blackout

Answer 29

flashing lights fatigue fasting

Question 30

symptoms before epileptic blackout

Answer 30

e.g. aura in complex partial seizures – feeling strange, epigastric rising, deja/jamias vu, smells, lights, automatisms

Question 31

symptoms during epileptic blackout

Answer 31

Tongue biting, incontinence, stiffness→jerking, eyes open, cyanosis, ↓SpO2

Question 32

symptoms after epileptic blackout

Answer 32

headache, confusion, sleeps, Todd’s palsy

Question 33

Ix for epileptic blackout

Answer 33

EEG ↑ se prolactin at 10-20min

Question 34

Triggers for drop attacks

Answer 34

nil

Question 35

Sx before drop attacks

Answer 35

no warning

Question 36

Sx during drop attacks

Answer 36

sudden weakness of legs causes older woman to fall to the ground.

Question 37

Sx after drop attacks

Answer 37

no post-ictal phase