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Flashcards in syncope and sudden death Deck (17):
1

def. syncope

loss of cons. due to insuff. bloodflow to the brain

2

what are the 2 questions to ask self

1. did the patient faint?
2. why did the patient faint?

3

4 most common causes from most to least

1. neurally mediated - vasovagal
2. orthostatic - drugs, ANS failure
3. cardiac arrythmia - can be fatal
4. structural cardio-pulmonary
- acute MI, aortic stenosis, pulm HT

4

most important part of syncope evaluation

HX

5

what are Hx signs of neurogenic

- nausea, pallor, fatigue before or after
- Phx or emotional stress, hedydration
- long Hx of them, that began before 3

6

other Hx things and what they might mean

abrupt, severe, quick recovery - VT
syncope DURING effort - stenosis, ischemia, HCM
family history of sudden death - long QT

7

4 major parts of Hx

1. circumstances of most recent event
2. more remote events
3. other disease, esp cardiac
4. fam. Hx

8

KEY part of Hx

GO back and ask eye-witnesses

9

most important question

was it vasopressor or arrhythmia

10

what is neurally mediated

- simple faint
- hot/crowded, ETOH, dehydrated, stress
- postdrome frequent - minutes to hours fatigue

11

what are 4 parts of diagnostic plan

1. intial exam - easy and cheap
- Hx
- ECG
- Phx
2. montitoring
- holter - not useful
- event - if have Sx 2x weeks
- insertable loop - invasive and expensive
3. imaging
- look for stuctural
4. special tests

12

6 times should be worried

1. >65
2. with injury
3. DURING excercise
4. sitting or lying down
5. with little or no warning
6. family Hx of sudden death

13

what is an ECG that should make you act now

not a normal ECG
- lots of things can be wrong with it

14

use of neuro imaging

useless

15

what is sudden death

unexpected death due to cardiac causes occuring in ashort period of time
- ususally due to arrhythmias
- half of all cardiac deaths

16

what is cardiac arrest

- most often due to VT or VF
- usually in the prescence of CAD
- may be due to ischemia or infarction

17

causes of VT/VF other than CAD

non-structural heart disease
- chanelopathies- long QT
- esp. young people

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