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Flashcards in FN: Blackouts Deck (37):
1

Causes Pneumonia

CRASH
Cardiac
Reflexes
Arterial
Systemic
Head

2

Cardiac causes of blackouts

Stokes-Adams Attacks
- Brady: heart block, sick sinus, long QT
- Tachy: SVT, VT
- Structural
1. Weak heart: LVF, tamponade
2. Block: AS, HOCM, PE

3

Refexes

1. Vagal overactivity


2. sympathetic underactivity

4

Vagal overactivity

- vasovagal syncope
- Situational: cough, effort, micturition
- Carotid sinus syncope

5

Sympathetic underactivity

STANDUP
1. Salt deficiency: addisons, hypovolaemia
2. Toxin
3. Autonomic Neuropathy: DM, Parkinsons. GBS
4. Dialysis
5. Unwell: chronic bed rest
6. Pooling venous: varicose veins, prolonged standing

6

Toxins cause sympathetic underactivity

Cardiac: ACEi, diuretics, nitrates, alpha blockers

Neuro: TCAs, benzos, antipsychotics, L-DOPA

7

Arterial causes of blackouts

1. Vertebrobasilar insufficiency: migraine, TIA, CVA, subclavian steal
2. Shock
3. Hypertension: Phaeochromocytoma

8

Systemic causes fo blackouts

1. Metabolic: reduced glucose
2. Resp: hypoxia, Hypercapnoea (e.g. anxiety)
3. Blood: anaemia, hyperviscosity

9

Head causes of blackouts

Epileps
Drop attacks + cataplexy emotional collapse

10

Examiantion findings

Postural hypotension: difference of >20/10 after standing for 3 min vs. ;ing down
Cardiovascular examination
Neurological examination

11

investigations

ECG ± 24hr ECG
U+E, FBC, Glucose
Tilt table
EEG, sleep EEG
Echo, CT, MRI brain

12

Cardiogenic syncope presentation trigger

Exertion, drug, unknow

13

Cardiogenic syncope presentation before

palpitations, chest pain, dyspnoea

14

Cardiogenic syncope presentation during

pale, slow/absent pulse, conic jerks may occur

15

Cardiogenic syncope presentation after

rapid recovery

16

Cardiogenic syncope presentation investigations

ECG, 24hr ECG, Echo

17

Reflex: vasovagal presentation trigger

prolonged standing, heat, fatigue, stress

18

Reflex: vasovagal presentation before

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

19

Reflex: vasovagal presentation during

Pale, grey, clammy, brady
Clonic jerks and incontinence can occur, ut no tongue bitting

20

Reflex: vasovagal presentation after

Rapid recovery

21

Reflex: vasovagal presentation Investigations

Tlt-table testing

22

Reflex: Postural Hypotension trigger

STanding up

23

Reflex: Postural Hypotension before, during and after

same as vasovagal

24

Reflex: Postural Hypotension Ix

Tilt-table testing

25

Arterial trigger

Arm elevation (subclavin steel) migraine

26

Arterial before, during and after

As for vasovagal ± brainstem Sx (diplopia, nausea, dysarthria)

27

Arterial Ix

MRA, duplex vertebrobasilar circulation

28

Systemic symtpoms

Hypoglycaemia: tremor, hunger, sweating, light-headness - LOC

29

Head: epileptic trigger

Flashing lights, fatigue, fasting

30

Head: epileptic before

e.g. aura in complex partial seizures - feeling strange, epigastric rising, deja.jamais vu, smells, lights, automatisms

31

Head: epileptic during

Tongue biting, incontinence, stiffness - jeking, eyes open, cyanosis, reduced sats

32

Head: epileptic after

headache, confusion, sleeps, todds palsy

33

Head: epileptic Ix

EEG, raised Serum prlactin at 10-20 mins

34

Head: drop attacks trigger

nil

35

Head: drop attacks before

no warning

36

Head: drop attacks during

sudden weakness of legs cause older women to fall to the ground

37

Head: drop attacks after

no post-ictal phase

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