Syncope Flashcards
(21 cards)
what is syncope?
a transient, self limited LOC w/ an inability to maintain postural tone that is followed by spontaneous recover
what is pre-sycope?
same sx, but terminates prior to LOC and may include partial loss of postural tone
what are some non-cardiac causes of syncope?
vasovagal
autonomic insufficiency
situational
orthostatic
what are some cardiac causes of syncope?
-vascular dz
-cardiomyopathy
-valvular dysfxn
CHF
-hypotension
-supraventricular tachycardias
-afib/flutter
bradyarrhythmias
adverse medication response
MI
AD
pulmonary embolus
what are exs of SVT causes?
WPW, Brugada, Congenital long QT
vasovagal syncope
-susally in standing position, precipitated by fear, emotional stress, pain
how does vasovagal syncope present?
Nausea, diaphoresis, fading out, epigastric discomfort, light-headedness precede syncope by minutes
what is the mechanism of vasovagal syncope?
efferent vasodepressor reflexes results in decreasedd PVR
situational syncope?
known precipitant, reproducible
what are causes and the mechanism of situational syncope?
micturition, defecation, deglutition, tussive, carotid sinus syncope
Mechanism: precipitants cause autonomic vasodepression which lead to transient cerebral hypoperfusion
orthostatic syncope?
secondary to orthostatic hypotension
what causes orthostatic syncope?
Autonomic failure in neurodegnerative diseases such as: Parkinson’s disease, supranuclear palsy, MSA, dementia, spinal cord injury etc.
Other causes: drugs, volume depletion (dehydration)
what is the BP definition of orthostatic syncope?
Drop of systolic BP of 20mmHg or Diastolic BP of 10mmHG when going from lying to standing position within 3 minutes. Often with pulse increase of >10-20
what are some precipitant factors seen prior to syncope?
Fatigue Sleep/food deprivation Warm temperature ETOH consumption Pain Strong emotions (ie fear) Positions Activities: Exertion Shaving Coughing Voiding Prolonged standing
what are the clinical presentations of syncope?
-rapid onselt LOC that is short in duration with spontaneous complete recover + loss of postural tone
- faintness
- dizziness
- light-headedness
- vertigo
- weakness
- blurred vision
- pallor
- epigastric discomfort
- N
- diaphoresis
what are some lab studies included int he workup of syncope?
Orthostatic Vital Signs: PRIOR TO FLUID RESUSCITATION Glucose level CMP CBC Cardiac Enzymes UA Tox screen if appropriate
what are some diagnostic imagint that can be done in the work up of syncope?
- EKG, ECho
- CXR
- Head CT
- Chest/Abdominal inmaging (aortic dissection/PE)
- MRI/MRA
when do you try carotid sinus massage?
in pts over 40 with syncope of unkonwnetiology
-diagnostic if syncope reproduced with asystole >3 sec or SBP drop > 50 mmHg
cardiac syncope tx
Consider cardiology consult
- Pacer pads if bradyarrythmia suspected
- Stop AV nodal blocking agents
- Eval for pacemaker if > 40 with recurrent syncope with documented asystole. Reduces syncope frequency by > 50%
- Atropine if symptomatic bradycardia and consider pacemaker placement for 2nd degree heart block with symptoms or 3rd degree heart block (asystole)
orthostatic syncope tx?
Elevate head of bed TED stockings Fludrocortisone Midodrine Recommend PO fluid in take
what is midodrine
alpha 1-agonist vasodepressor activity