Syncope Flashcards
(23 cards)
What is the definition of syncope?
A transient loss of consciousness due to global cerebral hypoperfusion, with rapid onset, short duration, and spontaneous complete recovery.
What are the major categories of syncope?
Reflex (vasovagal, situational), orthostatic hypotension, and cardiac (arrhythmias, structural heart disease).
What features are typical of vasovagal syncope?
Triggered by stress, pain, or prolonged standing; prodrome with nausea, pallor, sweating; brief LOC with rapid recovery.
What are red flag features suggesting cardiac syncope?
Occurs during exertion or supine, family history of sudden cardiac death, abnormal ECG, or no warning symptoms.
What is orthostatic hypotension and how is it defined?
Drop in systolic BP ≥20 mmHg or diastolic ≥10 mmHg within 3 minutes of standing, often causing light-headedness or syncope.
What features suggest seizures rather than syncope?
Prolonged LOC, tonic-clonic movements, postictal confusion, tongue biting (lateral), and incontinence.
What initial clinical assessment is crucial in syncope evaluation?
Detailed history (event and prodrome), witness account, medication review, orthostatic BP measurement, cardiac and neurological examination.
What is the role of ECG in syncope evaluation?
Detects arrhythmias, conduction blocks, long QT, Brugada, pre-excitation (WPW), or myocardial ischemia.
When is echocardiography indicated in syncope?
If structural heart disease is suspected or abnormal ECG findings are present.
What additional tests might be needed in unclear or recurrent syncope?
24-hour Holter monitoring, tilt-table testing (for reflex/orthostatic), EEG (if seizure suspected), and implantable loop recorder.
How is vasovagal syncope managed?
Patient education, trigger avoidance, physical counter-pressure maneuvers (e.g., leg crossing), hydration, and reassurance.
How is orthostatic hypotension treated?
Hydration, gradual position changes, compression stockings, fludrocortisone or midodrine if persistent.
What is the management of cardiac syncope due to bradyarrhythmia or heart block?
Pacemaker insertion is indicated; treat underlying cardiac disease and consider electrophysiological studies if uncertain.
What is the key difference in consciousness between syncope and seizures?
Syncope: transient, brief LOC with rapid recovery. Seizure: longer LOC, often followed by postictal confusion and drowsiness.
What are typical prodromal symptoms of syncope?
Lightheadedness, visual blurring, nausea, sweating, palpitations — vagal or cardiac origin.
What are common auras or premonitory signs in seizures?
Déjà vu, fear, unusual smells, rising epigastric sensation — suggest focal seizure onset.
What physical signs are more suggestive of a seizure than syncope?
Lateral tongue biting, urinary incontinence, tonic-clonic movements, cyanosis, head turning.
Is recovery faster after syncope or seizure?
Syncope: rapid and complete recovery. Seizure: slow recovery with postictal confusion and fatigue.
What is the usual position at onset of syncope vs seizure?
Syncope often occurs in upright posture (e.g., standing). Seizure can occur in any position, including sitting or lying down.
Can myoclonic or convulsive movements occur in syncope?
Yes — brief tonic or myoclonic jerks (convulsive syncope) can occur due to brain hypoxia, but shorter and less rhythmic than in seizures.
How does duration help distinguish syncope from seizure?
Syncope usually lasts <30 seconds. Seizure (tonic-clonic) typically lasts 1–2 minutes with longer post-event recovery.
What ECG findings are important in syncope work-up?
Look for arrhythmias, prolonged QT, heart block, Brugada pattern, or signs of ischemia.
How is EEG useful in differentiating seizure from syncope?
EEG may show interictal epileptiform discharges or ictal activity in epilepsy. It is not useful in diagnosing syncope.
