Syncope

Question 1

What is Syncope?

Answer 1

A transient sudden loss of consciousness and postural tone
due to acute decrease in cerebral blood flow

Question 2

Causes of syncope

Answer 2

Neural causes
Cardiac syncope
Due to metabolic
Hysterical Syncope
Orthostatic Syncope

Question 3

Subtypes of Neural Syncope

Answer 3

Neural syncope= due to decreased cerebral flow
.Vasomotor syncope
.Postural Syncope
.Cerebral Syncope
.Situational Syncope.

Question 4

Subtypes of Vasomotor Syncope

Answer 4

Vasovagal Syncope
Carotid Sinus Syndrome

Question 5

What is Vasovagal Syncope

Answer 5

(Common faint)

Question 6

Which individuals most susceptible to vasovagal syncope

Answer 6

susceptible
individuals emotional and physical stimuli such as
fright, pain and unpleasant sights, exhaustion, hot
atmosphere, long period of standing in same position
may produce syncope

Question 7

Symptoms of vasovagal syncope

Answer 7

pale, there
is usually
slow pulse
, low blood pressure and
dilated
pupils

Question 8

Main cause of carotid sinus syndrome

Answer 8

hypersensitivity of carotid sinus

Question 9

Susceptible individuals in carotid sinus syndrome

Answer 9

Elderly people in assc. with htn and arteriosclerosis
eg: Tight neck collar +head turning

Question 10

Symptoms of carotid sinus syndrome

Answer 10

Bradycardia,hypotension,occas. asystole for 10-15 secs

Question 11

Main cause of postural syncope

Answer 11

failure of baroreceptors which normally adjust heart rate and peripheral
resistance in response to change of posture.

Question 12

Causes of postural syncope

Answer 12

Arising abruptly from a prolonged period in recumbent position often causes giddiness and syncope particularly in presence of cerebral vascular insufficiency.

(b) Following strenuous physical exercise.

(c) Chronic
orthostatic hypotension may result in giddiness or syncope or both following a decline of systolic pressure
usually at least 30 mm Hg. when the patient remains
stationary in the upright position.

(d) In association
with neurologic disorders

Question 13

Main cause of cerebral syncope

Answer 13

direct brain damage secondary to trauma or associated with carotid or vertebrobasilar disease

Question 14

Recureent attacks most in which poture in cerebral syncope

Answer 14

erect posture

Question 15

Other features in cerebral syncope

Answer 15

In subclavian steal syndrome exercise of the involved arm is
followed by syncope

Question 16

Causes of situational syncope

Answer 16

Cough ,micturition,basilar artery migraine

Question 17

Explain syncope due to cough

Answer 17

occur after paroxysms of cough especially in patients with bronchitis and emphysema

increase in
intrathoracic pressure which occurs with coughing
and impedes venous return to the heart.

Question 18

Explain syncope due to micturition

Answer 18

in men with lower
urinary tract obstruction

excessive straining- to pass urine usually at night

Due to postural fall in
B.P., reflex vagal activity stimulated by a full bladder, and reduced venous return caused by straining

Question 19

Susceptible people in basilar artery migraine

Answer 19

children with history of severe occipital headache.

Question 20

Subtypes of cardiac syncope

Answer 20

CVS ,Reflex syncope

Question 21

causes of cvs syncope

Answer 21

Obstrucn to LV outflow
Obstrucn to Pulm outflow
Cardiac tamponade
Aortic dissection
Arrythmias

Question 22

What is reflex syncope?

Answer 22

– Cardiac standstill occurring from
reflex vagal activity,

eg:following distension of
viscera, fainting associated with irritation of pleura
or peritoneum, cardiac asystole associated with
oesophagoscopy or bronchoscopy, and in glossopharyngeal neuralgia and cardiospasm, and
pathological lesions in larynx and mediastinum

Question 23

Subtypes of metabolic causes syncope

Answer 23

Hypoxia,hypoglycemia,hyperventilation

Question 24

Syncope due to hypoxia in which places and which individuals

Answer 24

– Oxygen lack may occur at high altitudes
or at lower levels of altitude in patients with aortic stenosis, congenital heart disease, pulmonary
hypertension or anemia

Question 25

C/F of hypoxia induced syncope

Answer 25

Cyanosis at onset

convulsions

Question 26

Hypoglycemia syncope causes

Answer 26

diabetic patient, or spontaneous due to insulin secreting tumor

Question 27

Commonly occrs due to (hypogycemia syncope)

Answer 27

Starvation

Question 28

C/F of hypoglyc

Answer 28

profuse sweating relieved with gluocse

Question 29

How does hyperventilation cause syncope

Answer 29

respiratory lkalosis

Question 30

Hysterical Syncope

Answer 30

–Loss of consciousness of psychologic origin. No alteration of pulse or blood pressure.

Question 31

Syncope managemetn

Answer 31

Management –
(a) Vasovagal attacks and syncope in
general – Immediate treatment is to place the patient at
once in recumbent position in order to restore sufficient
B.P. for cerebral perfusion to be resumed.
(b) Cough syncope – Vigorous treatment of chest condition with antibiotics and antitussive drugs.

(c) Micturition syncope – Patient
on waking at night must be advised to sit on edge of the
bed for a short period before going to lavatory. He should
be encouraged to micturate in the sitting position.
(d)
Carotid sinus syndrome – Anticholinergic drugs or if this
fails surgical denervation of carotid sinus (nerve of Herring).

(e) Postural hypotension – Elevation of foot of bed,
elasticated stockings. Mineralocorticoid fludrocortisone,
indomethacin, sympathomimetic drugs or cardiac pacing
may be indicated

Question 32

What is Orthostatic syncope

Answer 32

Orthostatic syncope - defined as a reduction in systolic
blood pressure of at least 20 mm Hg or diastolic blood
pressure of at least 10 mm Hg within 3 min of standing
or head-up tilt on a tilt table, a manifestation of sympathetic vasoconstrictor (autonomic) failure