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Flashcards in Syncope Deck (23)
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1
Q

Why isn’t hypoglycemia a good explanation for true syncope?

A
  1. True syncope is caused by complete ischemia to bilateral hemispheres or focal ischemia to RAS
  2. Hypoglycemia will have other symptoms. It is not a sudden loss of consciousness with a instant return to baseline
2
Q

Lateral tongue biting is how specific for seizure?

A

Not sensitive but 97% specific

3
Q

What is the most useful indicator to differentiate syncope from seizure?

A

Rapid return to consciousness

4
Q

Syncope + CP could be what?

A
  1. ACS
  2. PE
  3. Dissection
5
Q

Syncope + abdominal pain could be what?

A
  1. AAA

2. Ectopic

6
Q

Syncope + pregnancy could be what?

A
  1. Normal physiology of pregnancy (CV changes)
  2. Dehydration
  3. Ectopic
7
Q

Syncope + headache could be what?

A
  1. SAH

2. Basilar migraine

8
Q

Syncope + focal neuro symptoms could what?

A
  1. Strokes (but syncope is RARE in strokes–remember, we really need hypoperfusion of both hemispheres)
  2. Vertebrobasilar TIA (vertigo, ataxia, diplopia–this can hit RAS)
9
Q

Who needs a head CT for syncope + neuro symptoms?

A

These are VERY low yield if they don’t have focal findings on their exam

10
Q

Syncope + orthostasis could be caused by what?

A
  1. Hypovolemia
  2. Medications
  3. Primary autonomic failure
11
Q

Why do you have to be careful about checking orthostatics on all elderly patients with syncope?

A

The prevalence in the general elderly population is 55%, so you could miss something if you just focus on this

12
Q

What are the two main causes of isolated syncope?

A
  1. Neurocardiogenic

2. Cardiac

13
Q

What is the most common cause of syncope?

A

Neurocardiogenic (this is a benign process)

**vasovagal syncope

14
Q

What are some provoking factors for neurocardiogenic syncope?

A
  1. Fear, stress, pain, standing

2. Micturition, defacation, standing

15
Q

If history and physical aren’t enough, how can neurocardiogenic syncope be made?

A

Tilt-table test

16
Q

What are some pharmacologic agents that can be used for neurocardiogenic syncope?

A
  1. Midodrine
  2. SSRIs
  3. Fludrocortisone
  4. B-blockers
17
Q

What EKG findings will be seen in Bruggada syndrome?

A

RBBB and ST elevation in V1 and V2

18
Q

What symptoms are commonly associated with syncope caused by orthostatic hypotension?

A
  1. Diaphoresis
  2. Light-headedness
  3. Graying of vision
19
Q

What three rules can be used to help risk stratify syncope patients?

A
  1. San Francisco Syncope Rule
  2. OESIL
  3. ROSE
20
Q

What are parts of San Francisco Syncope Rule?

A
  1. CHF
  2. Abnormal EKG
  3. Hematocrit
21
Q

What are parts of ROSE rules?

A
  1. BNP > 300
    • fecal occult blood
  2. Hgb
22
Q

In what groups should near-syncope be evaluated as syncope?

A

High risk groups

23
Q

What are generally accepted rules regarding prognosis in syncope patients?

A
  1. CHF
  2. Structural or coronary heart disease
  3. Abnormal EKG

All indicate poor prognosis