Syncope

Question 1

What is syncope attributed to?

Answer 1

Cerebral Hypotension

Question 2

What is Syncope?

Answer 2

Sudden loss of consciousness and posture with spontaneous recovery

Question 3

How is Orthostatic BP taken for someone experiencing syncope?

Answer 3

Check BP supine, sitting and standing after 3 min

Postitive if:

1. SBP drops >20
2. DBP drops >10

Question 4

What are the cardiac signs that can indicated syncope?

Answer 4

1. Abnormal heart rhythm/murmurs/
2. PMI
3. Carotid bruits

Question 5

What labs would you order for syncope?

Answer 5

1. CBC
2. BMP
3. Troponin

Question 6

What additional diagnostic tests can you give to someone with abnormal HR or arrhythmia

Answer 6

1. EKG
2. Holter/Diary 24-72 hr
3. External loop recorder
4. External patch

Question 7

What is the Tilt table and who is this reserved for?

Answer 7

1. Reserved for ppl experiencing recurrent, unexplained syncope
2. Tests for vasovagal syncope

Question 8

What is the benefit behind using the Tilt table?

Answer 8

Can be helpful in teaching patients to recognized symptoms (dizziness, lightheadedness)

Question 9

What are the three types of Neurally-Mediated Syncopes?

Answer 9

1. Vasovagal Syncope
2. Situation syncope
3. Carotid Sinus syncope?

Question 10

What is the most common type of syncope?

Answer 10

Vasovagal Syncope

Question 11

What are some common triggers of Vasovagal syncope?

Answer 11

Heat exposure
Prolonged standing
Physical exertion

Question 12

What are some examples of Situational syncope?

Answer 12

Micturition
Cough
Swallow

Question 13

How is Vasovagal Syncope usually treated?

Answer 13

1. Avoid triggers
2. Educate with counter pressure maneuvers (tilt training)
3. Avoid salt and watch water intake

Question 14

What are the causes associated with Carodit Sinus Syndrome

Answer 14

1. Shaving
2. Tight neck collar
3. Prior head and neck surgery

Question 15

What is Carotid Sinus Syndrome characterized as?

Answer 15

Drop in BP by 50 mmHg or more

        OR Sinus pause of more than 3 seconds

Question 16

Treatment for Carotid Sinus syndrome

Answer 16

Avoid triggers and consider pacing to relax

Question 17

What is the Classic definition of Orthostatic Syncope?

Answer 17

Measure of BP 3 min after supine to standing

Drop in SBP of 20mmHg or more
OR
Drop in DB of 10 mmHg or more

Question 18

What are the causes of Orthostatic Syncope?

Answer 18

1. Hypovolemia
2. Medications
3. Autonomic Dysfunction

Question 19

What are some treatments for Orthostatic Syncope?

Answer 19

1. If due to dehydration give IV fluids and watch salt intake
2. If drug related, remove drug
3. Tilt training

Question 20

What are the most common causes of Obstructive Cardiovascular Syncope?

Answer 20

1. Aortic Stenosis (most common)
2. Aortic dissection
3. Hypertrophic cardiomyopathy
4. PE
5. Cardiac tamponade

Question 21

What is the treatment plan for Cardiovascular Syncope?

Answer 21

1. Possible pacemaker to fix arrhythmias

2. Anti-arrhythmics

Question 22

What are some signs that would signify a seizure more than syncope?

Answer 22

1. Lateral tongue bitting
2. Head turning
3. Hypersalivation

Question 23

What is one useful test to determine Psedo syncope?

Answer 23

Arm drop test

Question 24

Which type of syncope is considered the most dangerous with the highest mortality rate?

Answer 24

Cardiovascular syncope