Syncope

Question 1

define syncope v pre-syncope

Answer 1

syncope: transient loss of consciousness due to poor cerebral blood flow and oxygen – droped systolic BP
- quick onset
- short lived (less than 2 minutes)
- spntaneous resolution

pre-syncope: prodrome thae leads up to syncope, but may not result in syncope

Question 2

how is syncope different thant TLOC

Answer 2

total loss of consciousness is not alwasy syncope!!! can be causes by other things and you may not boucn back after 2 minutes

other TLOCS:
- seizures
- CVA
trauma
intoxication
metabolic hypoglycemia
psychiatric
narcolepsy

Question 3

three types of syncope

patho of syncope

Answer 3

1. neural medicated (vasovagal)
2. orthostatic
3. cardiogenic

most common is neural medicated/vasovagal

patho
- barorecptors sense the chagne in pressure (stop firing to brain)
- body stops sympatheitc response – lowers BP
- increased vagal tone (PSNS) slows heart rate

Question 4

Neural Mediated Syncope
- mechanism
- 3 kinds of neural

Answer 4

• neural reflexes chagne the HR and BP inappropriately – causing you to pass out

vasovagal: high stress: para system takes over too much
carotid sinus: rubbing this induces syncope
situational: defecations, swallowing, urination or coughing triggers

Question 5

what is happening in orthostatic hypotension
- mechanism
- causes

Answer 5

mechanism: decreased blood flow when you stand causes decreases pressure
BP: systolic < 20 drop when you stand

causes
- decreased volume of blood
- medications (vasodialting action): antidepressants, anti-HTN, opioids
- autonomic dysfunction (parkinsons, DM)
- age
- prolonged stadning to sit qucikly

Question 6

Cardiogenic Syncope
mechanism
3 types

Answer 6

• heart rate too slow or too quick, results in poor cardiac output to maintain adequate pressure

arrythmias: bradyarrythmias (sick sinus, av blocks), vtach/vfib, torsades

structural: congenital or aquired myopathies
- poor cardiac output (due to hypertropic, restritive or dilated)
- masses and tumors too

Vascular(least common)
- PE, pulmonary HTN, aortic dissection cause drop in BP and syncope

Question 7

questions to ask durign history of syncope

5 ps

Answer 7

prodrome: what was happening
- dizzy, N/V, sweating, audiotry

Precipitating event: high stress.fear?
-coughing, swallowing, etc.
dehydrated?

postional: prolonged stanidng, supine, exercsing?

palpataions: on EKG look for torsades or blocks

post event:spontaneous recovery? – syncope
- if dizzy, confused; think abnormal or seizure

Question 8

past medical history components

Answer 8

ask bystander: pale and sweating? (syncope), lip-smakcing,a d toungue biting (not syncope)

• hisory of syncope
• heart disease or arrythmias
• DM, nero, psych, automnic conditiosn

medications
- dieuretics, beta blockoers, electroyles, HTN meds, BPH meds, OT prolonging meds
- family history of disorders

Question 9

diagnsois of syncope
- what to get
- treatment by type

Answer 9

labs
-ekg
cbc, cmp, accucheck for glucose

tilt table test, ECho, EEG or imaging to R/O other causes

do not need CT head, MRI or carotid US

treatment
admit when.. ** severe cardiac history, new arrythmia, co morbid conditions**

neural mediated:
- vasovagal maneuvers
- no beta blockers
- know triggers
- midodrine, florienf, droxidopa

orthostatis
- revewi meds, give fluids, wathc salt

cardiac
- pacemaker for brady conditions
- tachy- ICD or surgery to ablate
- OTC prolong — chagne med

Question 10

two elavations you can use for syncope

Answer 10

• EGSYS score: estimates lieklihood of cardiac syncope
• San Fran: Syncope Rule