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CSI- Winter > Syncope > Flashcards

Syncope Flashcards

1
Q

Syncope

A

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

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2
Q

Syncope is a ______ and NOT a ______

A

Symptom

Diagnosis

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3
Q

Pre-Syncope

A

lightheadedness without LOC

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4
Q

Drop Attack

A

loss of posture without LOC

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5
Q

Seizure

A

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

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6
Q

Vasodepressor Syncope

AKA Vasovagal/Neurocardiogenic

A
  • Most common
  • Pain/Noxious Stimuli
  • Situational (micturation, cough, defecation)
  • Carotid Sinus
  • Hypersensitivity (CSH)
  • Fear
  • Prolonged heat exposure
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7
Q

Cardiovascular Syncope

A
  • Most dangerous
  • Arrhythmia – Tachycardia/Bradycardia
  • Mechanical – Aortic Stenosis, HOCM
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8
Q

Orthostatic Hypotension Syncope

A
  • 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

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9
Q

Neuro / Functional / Psychiatric -

A

Psuedosyncope

TIA or Vertibro-basilar Insufficiency

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10
Q

Vasovagal-

A

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

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11
Q

Vasodepressor Syncope is due to

A

excessive vagal tone

-Vasovagal Hypotension: Initiated by stressful, painful situation

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12
Q

Situational Vasovagal Syncope: Associated with activity that may cause ________

A

increase in vagal tone

Micturation Syncope
After Defecation
Post Prandial (after eating)

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13
Q

Carotid Sinus Hypersensitivity:

A
  • 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
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14
Q

During syncope EKG may show

A

Large pauses (usually old patients)

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15
Q

Orthostatic Syncope

A

Common in Elderly

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

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16
Q

Causes of orthostatic Syncope

A
  • Autonomic Insufficiency, ex: DM Neuropathy

- Hypovolemia: Dehydration (from decreased thirst or infections) or Blood loss, Alpha Blockers, Diuretics

17
Q

Orthostatic BP Measurement:

A
  • Measure same arm
  • Measure while patient laying, sitting and standing
  • Wait 5min between change of position
18
Q

Orthostatic BP Measurement is positive if

A
  • 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
Q

KNOW: Diabetic neuropathy often presents as

A

orthostatic hypotension

20
Q

Mechanical causes of cariogenic syncope

A 
Valvular problems (aortic or pulmonic stenosis)
Structural problems (HOCM, severe cardiomyopathy, myxoma)
21
Q

Arrhythmias that can cause cariogenic syncope

A

Tachycardia (SVT, VT, VF)

Bradycardia (Sinus, AV blocks, AV dissociation)

22
Q

During aortic stenosis, t

A
  • 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
Q

CO=

A

SV x HR

24
Q

Murmur heard with AS

A
  • 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
Q

Hypertrophic Obstructive Cardiomyopathy

A

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
Q

SA/AV node dysfunction will show _____ on EKG

A

long pauses

27
Q

SVT (supraventricular tachycardia) will show ____ on EKG

A

narrow QRS complex

28
Q

Vasodepressor Syncope is usually associated with

A

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

-can use tilt table testing

29
Q

If suspecting cariogenic cause, ask

A

ask for palpitations, SOB any prior episodes

30
Q

Treatment for orthostatic syncope

A

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

31
Q

Bradycardia Tx

A

Adjust medications

Evaluate for Pacemaker placement

32
Q

Tachycardia Tx

A
  • Beta Blocker or Calcium channel blocker

- EP study or ablation if needed

CSI- Winter (44 decks)

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