Foundations II (Cholley) > Syncope > Flashcards

Syncope Flashcards

(39 cards)

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1
Q

Define: Syncope

A

Sudden, transient, complete loss of consciousness & postural tone w/ spontaneous recovery

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2
Q

What are some characteristics of syncope?

A
  • Self-limited, rapid onset
  • Variable warning symptoms
  • Spontaneous, complete, & prompt recovery w/out meds/surgical intervention
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3
Q

What is syncope attributed to?

A

Cerebral hypoperfusion

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4
Q

What are “pre-syncopal” sx?

A
  • Lightheadedness/dizziness
  • Tunnel vision
  • “Graying-out”
  • Altered consciousness
  • Palpitations
  • Weakness
  • Tremulousness
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5
Q

What are the causes of true syncope?

A
  • Neurally-mediated
  • Orthostatic
  • Arrhythmia (brady, tachy)
  • Cardiopulmonary
  • *Unexplained in 1/3
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6
Q

What is #1 on your DDx?

A

Somatization disorder (psychogenic pseudo-syncope)

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7
Q

What sx are consistent w/ vasovagal syncope?

A
  • Lightheaded
  • Facial pallor
  • Diaphoresis
  • Nausea
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8
Q

What is the tilt table?

A

A provocative test for vasovagal syncope

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9
Q

What does the tilt table measure?

A
  • Vasodepressor response

- Pauses

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10
Q

Describe how the tilt table is performed. What is it helpful for?

A

Pt tilted upright by 60-90 degrees

*Teaches pts how to recognize prodromal sx

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11
Q

Tilt table: What are normal vs abnormal findings?

A
  • Normal: minimal drop in BP & increase in HR

- Abnormal: exaggerated drop in BP w/ or w/out drop in HR (associated w/ dizziness & lightheadedness)

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12
Q

When is a tilt table test indicated?

A

After recurrent episodes of unexplained syncope

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13
Q

What is the most common type of syncope?

A

Vasovagal syncope

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14
Q

What triggers vasovagal syncope?

A
  • Heat
  • Standing
  • Exertion
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15
Q

Define: Orthostatic BP

A

≥ 20 drop in SBP or ≥ 10 drop in DBP (measured 3 minutes after supine to standing)

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16
Q

Which type of syncope has a higher risk of recurrent syncope?

17
Q

Which type of syncope has lower survival rates?

18
Q

Define: Sinus node dysfunction (type of bradyarrhythmia)

Study These Flashcards
A

Intermittent pauses w/ alternating bradycardia & tachycardia (tachy-brady syndrome)

19
Q

Define: AV block (type of bradyarrhythmia)

Study These Flashcards
A
  • 2nd degree, type II (Mobitz II)

- Complete heart block

20
Q

What are types of tachyarrhythmias?

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A
  • SVT
  • WPW
  • AF/flutter w/ RVR
  • Ventricular tachycardias
21
Q

Psychogenic causes of syncope

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A
  • Not true syncope!
  • Conversion disorder
  • Pseudo syncope
  • Pseudo-seizures
22
Q

The San Francisco Syncope Rule identifies…

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A

Low-risk pts for short-term serious outcomes who are unlikely to benefit from hospital admission
- Uses “CHESS” Criteria

23
Q

What is the “CHESS” Criteria?

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A
  • CHF hx
  • Hematocrit > 30%
  • ECG abnormal
  • SOB
  • Systolic BP < 90
  • If any of the above –> higher risk (consider hospital admission)
24
Q

What is the goal of the Canadian Syncope Arrhythmia Risk Score?

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A

Identify small subset of pts who suffer arrhythmia or death within 30 days of ED visit for syncope

25
Canadian Syncope Arrhythmia Risk Score: What are the 8 criteria scored?
- Vasovagal predisposition - Hx of HD - Any ED systolic BP <90 or > 180 - Troponin elevated - QRS duration > 130 - Corrected QT interval >480 - ED dx of vasovagal syncope or cardiac syncope
26
What is the risk of arrhythmia in pts w/ a score of ≤ 0?
< 1%
27
What is the risk of arrhythmia in pts w/ a score of 1-3?
1.9-7.5%
28
What is the risk of arrhythmia in pts w/ a score of 4-8?
14.3-22.2%
29
In a young pt, what red flags might indicate he/she has VVS?
- Family hx of sudden death or early cardiac disease - EKG abnormalities - Exertional syncope
30
If the syncope has a long duration, what etiology might you think of?
Seizure!
31
Does a normal ECG rule out an arrhythmia cause?
No no no no no! | *May need to monitor on telemetry or wear an event monitor
32
Who should be admitted as inpatient?
Serious underlying conditions
33
Who should be admitted for observation?
"Intermediate-risk" pts
34
Who should be admitted for outpatient management?
Reflex-mediated syncope | *Prompt f/u necessary
35
What are life-threatening causes of syncope?
- Cardiac - Acute severe hemorrhage - Pulmonary embolism - Subarachnoid hemorrhage - Stroke, seizure, head injury
36
What is considered a "dx of exclusion"?
Orthostatic hypotension
37
What meds can cause syncope?
- Vasodilatory - Cardiotoxic - QT prolonging
38
What diagnostic tests should you perform for syncope?
- CBC, CMP, troponin - ECG (holter/event monitor) - Echo
39
If there is a cardiovascular abnormality, what additional dx tests should you perform?
- External loop recorder (2-6 wks) - External patch (2-14 days) - Outpatient telemetry (30 days) - ICG - EP study - Carotid u/s - Stress testing - Chest imaging - Neuro tests (MRI, EEG to r/o seizure) - Tilt table
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