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Flashcards in Syncope Deck (32)
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1

Syncope

The abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery.

2

Syncope is a ______ and NOT a ______

Symptom
Diagnosis

3

Pre-Syncope

lightheadedness without LOC

4

Drop Attack

loss of posture without LOC

5

Seizure

Tonic-Clonic Movements that start WITH LOC (vs hypoxic myoclonus which can occur with syncope), post-ictal recovery period

6

Vasodepressor Syncope
(AKA Vasovagal/Neurocardiogenic)

-Most common
-Pain/Noxious Stimuli
-Situational (micturation, cough, defecation)
-Carotid Sinus
-Hypersensitivity (CSH)
-Fear
-Prolonged heat exposure

7

Cardiovascular Syncope

-Most dangerous
-Arrhythmia – Tachycardia/Bradycardia
-Mechanical – Aortic Stenosis, HOCM

8

Orthostatic Hypotension Syncope

-Drugs: BP meds - Vasodilators, Diuretics, Alpha blockers
-Autonomic Insufficiency (Parkinsons, DM, Adrenal Insufficiency)
-Hypovolemia: Dehydration, Blood loss, infection

MOA- going from sitting to standing, blood pools in legs, low profusion to brain

9

Neuro / Functional / Psychiatric -

Psuedosyncope
TIA or Vertibro-basilar Insufficiency

10

Vasovagal-

Vagal tone increases, peripheral vasodilation, preload decreases and brief period of time, blood to head is low, supply of heart catches up and profuse brain adequately

11

Vasodepressor Syncope is due to

excessive vagal tone
-Vasovagal Hypotension: Initiated by stressful, painful situation

12

Situational Vasovagal Syncope: Associated with activity that may cause ________

increase in vagal tone

Micturation Syncope
After Defecation
Post Prandial (after eating)

13

Carotid Sinus Hypersensitivity:

-Common in Elderly
-Sensitive Baroreceptors in Carotid body – when activated can decrease HR and drop BP = possible Syncope
-May occur with pressure on neck – tight collar, turning neck

14

During syncope EKG may show

Large pauses (usually old patients)

15

Orthostatic Syncope

Common in Elderly
Essentially Pooling of blood in LE – while standing or sitting up – leading to decreased Preload = Syncope

16

Causes of orthostatic Syncope

-Autonomic Insufficiency, ex: DM Neuropathy
-Hypovolemia: Dehydration (from decreased thirst or infections) or Blood loss, Alpha Blockers, Diuretics

17

Orthostatic BP Measurement:

-Measure same arm
-Measure while patient laying, sitting and standing
-Wait 5min between change of position

18

Orthostatic BP Measurement is positive if

-a drop in BP of 20 mmhm or more, OR
-a drop in diastolic BP of 10 or more, OR
-pt is experiencing lightheadedness or dizziness (abnormal)

19

KNOW: Diabetic neuropathy often presents as

orthostatic hypotension

20

Mechanical causes of cariogenic syncope

Valvular problems (aortic or pulmonic stenosis)
Structural problems (HOCM, severe cardiomyopathy, myxoma)

21

Arrhythmias that can cause cariogenic syncope

Tachycardia (SVT, VT, VF)
Bradycardia (Sinus, AV blocks, AV dissociation)

22

During aortic stenosis, t

-LV outflow tract gradient secondary to stenosis of Aortic Valve (lower pressure in aorta than normal, higher pressure in LV than normal)
-Aortic Stenosis likely secondary to senile degeneration/ bicuspid aortic valve
-Syncope from Aortic stenosis= poor prognosis

23

CO=

SV x HR

24

Murmur heard with AS

-crescendo-decrescendo systolic ejection murmur
-LV pressure > aortic P
-Loudest at heart base
-Radiates to carotids
-Pulses are weak w/ delayed peak
-can lead to SAD: syncope, angina, dyspnea
-often age related calcification

25

Hypertrophic Obstructive Cardiomyopathy

walls of atria, ventricles and septum are all enlarged (can lead to syncope), not pumping enough blood out bc ventricles and atria are small due to hypertrophic muscle

26

SA/AV node dysfunction will show _____ on EKG

long pauses

27

SVT (supraventricular tachycardia) will show ____ on EKG

narrow QRS complex

28

Vasodepressor Syncope is usually associated with

premonitory symptoms – Nausea, Diaphoresis
-Ask for activity pt was doing at the time

-can use tilt table testing

29

If suspecting cariogenic cause, ask

ask for palpitations, SOB any prior episodes

30

Treatment for orthostatic syncope

Avoid dehydration
Encourage oral hydration
Volume expanders – Fludricortisone
Vasoconstrictor – Midodrine