CHAPTER 18 SYNCOPE

Question 1

it is the transient self limited self conscious due to acute global impairment of cerebral blood flow

Answer 1

syncope

Question 2

onset of syncope

Answer 2

rapid duration brief and recovery spontaneous

Question 3

differential diagnosis for syncope

Answer 3

seizures
vertebrobasilar ischemia
hypoxemia
hypoglycemia

Question 4

what is the typical presyncope (syncopal prodrome)

Answer 4

dizziness
lightheadednes
faintess
weakness
fatigue
visual and auditory distrubances

Question 5

causes of syncope

Answer 5

neurally mediated syncope also called for reflex or vasovagal syncope
orthostatic hypotension
cardiac syncope

Question 6

type of syncope that comprises heterogenous group of functional disorders that is characterized by transient change in the reflexes responsible for maintaining cardiovascular homeostasis

Answer 6

neurally mediate syncope

Question 7

causes for the temporary failure of blood pressure control

Answer 7

episodic vasodilation (loss of vasoconstrictor tone)

Question 8

cause of orthostatic hypotension

Answer 8

autonomic failure where the cardiovascular homeostatic reflexes are chronically impaired

Question 9

causes of cardiac syncope

Answer 9

arrhythmias or structural cardiac disease that can cause a decrease in cardiac output

Question 10

what is peak incidence of syncope

Answer 10

age 10 to 30 years

Question 11

gender prevalence of syncope

Answer 11

females than in males

Question 12

pathophysiology of syncope

Answer 12

standing-pooling of blood in lower extremities-decrease in venous return to the heart-reduced ventricular filling-result to diminished cardiac output and blood pressure

Question 13

the decreased cardiac output will activate the

Answer 13

compensatory reflex response initiated by the baroreceptors in the carotid sinus and aortic arch resulting to increased sympathetic outflow and decreased vagal nerve activity

Question 14

the reflex will result to:

Answer 14

increased peripheral resistance, venous return to the heart, cardiac output thus limits the fall in the blood pressure

Question 15

if the response fails?

Answer 15

chronic: orthostatic hypotension
transient: neurally mediated syncope

leading to cerebral hypoperfusion

Question 16

responsible for autoregulation of cerebral blood flow

Answer 16

myogenic factors
local metabolites
autonomic neurovascular control

Question 17

how many minutes cessation of blood from the brain will result to loss of consciousness

Answer 17

6-8 seconds

Question 18

bp that will result to syncope

Answer 18

a fall in systolic blood pressure of 50 or lower

Question 19

causes of decreased cardiac output

Answer 19

decreased effective circulating blood
increased thoracic pressure
massive pulmonary embolus
cardiac brady and tachyarrhythmias
valvular heart disease
myocardial dysfunction

Question 20

what are the two patterns of EEG changes in syncopal subjects

Answer 20

slow flat slow pattern followed by sudden flattening of the EEG followed by the return of slow waves and then normal activity

slow pattern characterized by increasing and decreasing slow wave activity

Question 21

cause of flattening pattern

Answer 21

cessation or attenuation of cortical activity

Question 22

this type of syncope is the final pathway of a complex central and peripheral nervous system reflex arc where is sudden transient change in autonomic efferent activity with increased parasympathetic outflow resulting in bradycardia, vasodilatation and reduced constriction tone

Answer 22

neurally mediated syncope

Question 23

subtypes of neurally mediated syncope based on afferent pathway

Answer 23

vasovagal syncope and situational reflex syncope

Question 24

another term for vasovagal syncope

Answer 24

common faint

Question 25

common faint is provoked by

Answer 25

intense emotion pain orthostatic stress

Question 26

cause of situational reflex syncope

Answer 26

specific localized stimuli that provoke the reflex vasodilation and bradycardia that leads to syncope

Question 27

the subtypes of efferent syncope

Answer 27

vasodepressor syncope and cardioinhibitory syncope and mixed syncope

Question 28

features of neurally mediated syncope

Answer 28

``` orthostatic intolerance dizziness lightheadedness fatigue premonitory features of autonomic activation: pallor, diaphoresis, palpitations, nausea, hyperventilation, and yawning ```

Question 29

features during the attack

Answer 29

``` proximal and distal myoclonus- possibility of epilepsy eyes open and deviate upward pupils are dilated roving eye movement grunting moaning snorting stertous breathing urinary incontinence fecal incontinence postictal confusio visual and auditory hallucination ```

Question 30

predisposing factor of neurally mediated syncope

Answer 30

``` motionless upward posture warm ambiance temperature intravascular volume depletion alcohol ingestion hypoxemia anemia pain sight of blood venipuncture intense emotion ```

Question 31

cornerstone treatment for neurally mediate syncope

Answer 31

reassurance avoidance of proactive stimuli plasma volume expansion with fluid and salt

Question 32

how to raise blood pressure by increasing blood central volume and cardiac output

Answer 32

isometric counterpressure maneuvers of limbs such as leg crossing or handgrip and arm tensing

Question 33

pharmacotherapy for neurally mediated syncope

Answer 33

fludrocortisone vasoconstricting agents beta adrenenoreceptor antagonist

Question 34

when is cardiac pacemaker used

Answer 34

older px >40 years old in which the syncope is associated with asystole or severe bradycardia and in patients with prominent cardioinhibition due to carotid sinus syndrome

Question 35

type of syncope that is defined as reduction in systolic blood pressure of at least 20mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing or head tilt up

Answer 35

orthostatic hypotension

Question 36

variant of orthostatic syncope that hypotension is delayed which occurs beyond 3 mins of standing

Answer 36

mild or early form of sympathetic adrenergic dysfunction

Question 37

a variant of orthostatic syncope where hypotension occurs within 15 seconds of standing that reflect a transient mismatch between cardiac output and peripheral vascular resistance and it does not represent autonomic failure

Answer 37

initial orthostatic hypotension

Question 38

features of orthostatic hypotension

Answer 38

``` light headedness dizziness presyncope (near faintness) nonspecific: general weakness, fatigue, cognitive slowing, leg buckling or headache visual blurring neck pain dyspnea angina ```

Question 39

cause of visual disturbance

Answer 39

retinal and occipital lobe ischemia

Question 40

location of neck pain

Answer 40

suboccipital posterior cervical shoulder region (the coat hanger headache)

Question 41

cause of dyspnea

Answer 41

ventilation-perfusion mismatch due to inadequate perfusion of ventilated lung apicess

Question 42

cause of agina

Answer 42

impaired myocardial perfusion even with normal coronary arteries

Question 43

aggravating factors for symptoms

Answer 43

exertion prolonged standing increased ambient temperature or meals

Question 44

causes of neurogenic orthostatic hypotension

Answer 44

central and peripheral autonomic nervous system dysfunction

Question 45

drugs that can cause orthostatic hypotension

Answer 45

``` alpha adrenoreceptor antagonists antihypertensive nitrates vasodilators tricyclic agents phenothiazines ```

Question 46

first step of treatment for orthostatic hypotension

Answer 46

remove the reversible causes such as vasoactive medications

Question 47

second step in treatment of orthostatic hypotension

Answer 47

nonpharmacologic interventions such as patient education regarding staged moves from supine to upright warnings about the hypotensive effects of large meals

Question 48

pharmacologic intervention for orthostatic hypotension

Answer 48

fludrocortisone acetate | vasoconstricting agents

Question 49

cause of cardiac syncope

Answer 49

arrhythmias and structural heart disease

Question 50

bradyarrhythmias that can cause syncope includes

Answer 50

sinus node dysfunction such as sinus arrest or sinoatrial block atrioventricular block

Question 51

most common association of bradyarrhythmias due to sinus node dysfuction

Answer 51

atrial tacyarrhythmia known as tachycardia-bradycardia syndrome

Question 52

syncope due to bradycardia or asytole is referred as

Answer 52

strokes-adams attack

Question 53

cause of the compromised hemodynamic function during ventricular tachycardia

Answer 53

infective ventricular contraction

Question 54

the long QT syndrome that is associated with prolonged cardiac repolarization and a predisposition to ventricular arrhythmias

Answer 54

torsades de pointes

Question 55

it is a inherited associated with exercise stress induced ventricular arrhythmias syncope or sudden death

Answer 55

catecholaminergic polymorphic tachycardia

Question 56

treatmen for cardiac syncope caused by arrythmias

Answer 56

cardiac pacing for sinus node | AV block and ablation-antiarrhytmic drugs and cardioverter defibrillators

Question 57

type of seizure present in syncope

Answer 57

myoclonic-generalized or multifocal

Question 58

reorientation from drowsiness in syncope

Answer 58

occurs immediately after the syncopal event

Question 59

syncope are provoked by emotions unlike seizures

Answer 59

true