Cardiac Syncope

Question 1

What is Syncope?

Answer 1

Transient loss of conciousness with inability to maintain postural tone

Question 2

What commonly causes syncope?

Answer 2

Decreased CO leading to decrease O2 to the brain

Question 3

Common Etiologies of syncope?

Answer 3

Vasovagal reflex - pain or fear

Orthostatic hypotension

Question 4

What is orthostatic hypotension?

Answer 4

• decreased SBP > 20 and increase in HR >10 bpm when assuming upright position

Question 5

What is the pathophysiology of syncope broken up into?

Answer 5

Structural

Dysrtaythmias

Question 6

What are the strucutral causes of syncope?

Answer 6

Valvular
Hypertrophic cardiomyopathy
AMI
PE

Question 7

What are the dysrhythmias for cardiac syncope?

Answer 7

Bradycardia
AV Block
V-tach
A-Fib
PSVT
WPW

Question 8

Prodromal symptoms of syncope? (occurring just before)

Answer 8

• blurred vision
• dizzy
• pallor
• nausea
• vomiting
• diaphoresis
• seeing stars/spots

Question 9

Other clinical findings of syncope?

Answer 9

Positive tilt test: orthostatic syncope

Rectal exam: evaluate for bleeding (if warranted)

Cardiac syncope: murmurs, S3, S4

Question 10

Differential of syncope

Answer 10

Anything that also involves poor cardiac output

Question 11

Labs for Syncope?

Answer 11

CBC - drop in hemoglobin
Chemistry - sodium can cause edema
EKG
Echocardiogram for valve disease or cardiomyopathy

Question 12

Tx for Syncope

Answer 12

ABCs, IV, O2, Monitor

• Treat cardiac causing conditions
• Treat orthostatic hypotension with IV bolus
• Identify hemorrhage or trauma

** Continue monitoring until you can rule out cardiac origin

** MEDEVAC if you can’t rule out Cardiac Origin

Question 13

Initial Care for syncope

Answer 13

Good hx from witnesses

• Events leading up to syncope
• Characteristics of LOC
• Symptoms and duration
• Determine if cardiac is issue

Question 14

Complications of Syncope?

Answer 14

Dysrhythmias
Cardiac arrest
Death