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CMT > Syncope > Flashcards

Syncope Flashcards

1
Q

common in who?

A

elderly, increases w/ age

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2
Q

high risk features

A
  1. hx of structural heart disease
  2. abnormal EKG
  3. > 60 y/o
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3
Q

most common cause of syncope?

A

vasovagal

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4
Q

prognosis is favorable unless there is what?

A

accompanying cardiac disease

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5
Q

what is neurally mediated syncope?

A
  • syncope due to excessive vagal tone or impaired reflex control peripheral circulation
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6
Q

3 types of neurally mediated syncope

A
  1. vasovagal syncope
  2. carotid sinus hypersensitivity
  3. situational syncope
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7
Q

neurally mediated syncope

what is vasovagal syncope caused by typically?

A

caused by a stressful, painful, or claustrophobic experience

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8
Q

neurally mediated syncope

what is carotid sinus hypersensitivity caused by?

A

stimulation of abnormally sensitive carotid body, with subsequent abnormal vagal response

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9
Q

neurally mediated syncope

what does carotid sinus hypersensitivity result in?

A
  • bradycardia
  • arterial relaxation/dilation
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10
Q

neurally mediated syncope

pathophys of situational syncope?

A

enhanced vagal tone w/ resulting hypotension

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11
Q

neurally mediated syncope

what causes situational syncope?

A
  • coughing
  • sneezing
  • micturition
  • exercise
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12
Q

Orthostatic/Postural Hypotension

describe

v basic

A
  • BP drops upon standing
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13
Q

Orthostatic/Postural Hypotension

common in who?

4 groups of pts

A
  • pts with autonomic neuropathy
  • blood loss/hypovolemia
  • pts taking vasodilators, diuretics, adrenergic-blocking medications
  • more common in elderly pts
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14
Q

Orthostatic/Postural Hypotension

pathophys

A

failure of the vasoconstrictive response to changing to an upright position

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15
Q

Orthostatic/Postural Hypotension

when are sx most likely to occur?

A
  • in the early morning
  • after heavy meals
  • w/ prolonged standing
  • when core body temp rises
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16
Q

Orthostatic/Postural Hypotension

who does chronic idiopathic orthostatic hypotension primarily exist in?

A

older men

17
Q

Cardiogenic Syncope

causes of this if bradycardic?

3

A
  • sinus brady
  • sinus pauses
  • AV blocks
18
Q

Cardiogenic Syncope

causes of this is tachycardic?

A

ventricular tachycardia

19
Q

Cardiogenic Syncope

causes of this is mehicanical?

4

A
  • aortic/pulm stenosis
  • hypertrophic CM
  • congenital lesions
  • massive PE
20
Q

common presyncope sx

9

A
  1. lightheadedness
  2. unstable when standing
  3. warm or cold/clammy
  4. diaphoretic
  5. palpitations
  6. n/v/abd pain
  7. visual blurring or “white out”
  8. diminution of hearing and/or occurence of unusal sounds
  9. pallor
21
Q

Essential History Questions

5

A
  • what happened right before the event? (what were you doing/sx that happened)
  • were you injured when you fell?
  • did you lose consciousness?
  • how long did it take to “feel normal” following the event?
  • did anyone witness the event?
22
Q

events longer than ??? are genereally not considered syncope?

A

than 5 min

23
Q

which drugs can cause syncope?

8

A
  1. anti-hypertensives
  2. BBs
  3. anti-arrhythmics
  4. anti-parkinson drugs
  5. anti-depressants
  6. phenothiazines
  7. nitrates
  8. cocaine/alcohol
24
Q

PE Components

5

A
  1. orthostatic vital signs (determine etiology)
  2. heart rate + rhythm
  3. respiratory rate
  4. cardio exam
  5. neruo exam
25
Q

key neuro components to include:

A
  • strength, reflex, pronator drift
  • ambulate the patient
26
Q

what testing to consider for reflex syncope

A
  • ambulatory EKG
27
Q

testing to order w/ cardiogenic syncope

A
  • cardio exam
  • ambulatory EKG
  • echo
  • cardiac imaging
28
Q

testing to order w/ orthostatic syncope?

A
  • IV fluids
  • stop offending meds
29
Q

typical syncope workup

8

A
  • unremarkable H&P
  • absence of cardiac disease
  • absence of significant comorbidities
  • normal baseline EKG
  • echo
  • routine cardiac imaging PRN
  • carotid artery imaging PRN
  • routine comprehensive lab testing not useful
30
Q

which syncopial features are low risk?

7

A
  • prodrome sx
  • after sudden unexpected sight, sound, smell, or pain
  • after prolonged standing, crowding, or hot places
  • during a meal/postprandial
  • triggered
  • w/ head rotation or pressure on carotid sinus
  • standing up from supine position
31
Q

which syncopial features are high risk?

4

A
  • new onset of CP, breathlessness, abd pain, or HA
  • syncope on exertion or when supine
  • sudden onset palpitation followed by syncope
  • EKG changes consistent w/ ischemia
32
Q

reflex/vasovagal management

5

A
  • trigger avoidance
  • avoid fluids, salt
  • compression socks (to increase flow)
  • counterpressure maneuvers
  • pharm tx or pacemaker if severe
33
Q

reflex/vasovagal management

describe counterpressure maneuvers

A
  • leg: crossing w/ simultaneous tensing of leg, abd, and buttock muscles
  • handgrip: max grip on something
  • arm tensing: hands together, simultaneously abduct both arms
34
Q

describe orthostatic hypotension syncope management

8

A
  • avoiding physical deconditioning in the elderly
  • external compression devices
  • physical maneuvers (squats, lunges, etc)
  • review of home meds
  • discontinue diuretics/vasodilators
  • increase water/fluid intake, increase salt
  • sleep at 10deg elevation
  • avoid hot showers, spas, hot tubs, saunas
35
Q

orthostatic hypotension syncope med goal

A

increase blood volume

36
Q

orthostatic hypotension syncope med options

A
  • midodrine
  • fludrocortisone
  • pyridostigime
  • yohimbine
  • octreotide
  • cafergot (caffeine, erotamine)
37
Q

cardiogenic syncope management

A
  • tx of underlying cardiac disorder
38
Q

education to provide

A

driving restrictions

CMT (72 decks)

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