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Y4 Extra teaching notes > Syncope/Collapsed patient > Flashcards

Syncope/Collapsed patient Flashcards

1
Q

Vasovagal syncope

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope)

A
  • Trigger: emotional distress/ orthostatic distress
  • Prodromal symptoms: lightheadedness, visual disturbances, nausea, vomiting
  • Time: seconds
  • After syncope: no incontinence, may appear pale, full recovery
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2
Q

Situational syncope

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: cough, sneeze, post micturition
  • Prodromal symptoms: none
  • Time: seconds, appears pale
  • After syncope: no symptoms
  • PMH: previous episodes like that
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3
Q

Carotid sinus syncope

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: shaving, tightening of a collar, head turning
  • Prodromal symptoms: none
  • Time: seconds
  • After syncope: no symptoms
  • PMH: previous histories of such episodes
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4
Q

Stroke

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: none
  • Prodromal symptoms: visual disturbances, tingling
  • Time: seconds
  • After syncope: may have focal neurological deficits
  • PMH: TIAs, HTN, T2DM, smoking, alcohol excess
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5
Q

Seizures

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: variable
  • Prodromal symptoms: eye deviation, aura
  • Features: tonic-clonic activity before rhythmic clonic activity, tongue biting, bladder/bowel incontinence
  • Time: seconds - minutes
  • After onset: prolonged ictal phase, maybe confused and disorientated
  • PMH: epilepsy
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6
Q

Cardiac causes of (6) a syncope

A
  • arrhythmia
  • hypertrophic cardiomyopathy
  • MI
  • aortic stenosis
  • PE
  • postural hypotension
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7
Q

Neurological causes of syncope (5)

A
  • vasovagal syncope
  • situational syncope
  • carotid sinus
  • stroke
  • seizure
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8
Q

Arrhythmia (syncope)

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, FHx)

A
  • Trigger: exertion
  • Prodromal symptoms: none/palpitations
  • Time: sudden onset, lasting seconds
  • After syncope: no residual symptoms, rapid full recovery
  • FHx: sudden death
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9
Q

Hypertrophic cardiomyopathy

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: exertion
  • Prodromal symptoms: dyspnoea, palpitations, angina
  • Time: sudden onset, lasting seconds
  • After syncope: rapid full recovery
  • FHx: sudden death at young age
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10
Q

Cardiac stenosis

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope)

A
  • Trigger: syncope on exercise
  • Prodromal symptoms: dyspnoea, chest pain
  • Time: sudden onset
  • After syncope: rapid full recovery
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11
Q

PE

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: none, risk factors (travel, immobility, malignancy etc), exercise (when syncope occurs)
  • Prodromal symptoms: dyspnoea, chest pain
  • Time: sudden onset
  • After syncope: variable symptoms
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12
Q

MI

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: variable
  • Prodromal sympotms: chest pain, dyspnoea
  • Time: sudden onset
  • After syncope: variable
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13
Q

Postural Hypotension

Clues in the history that may point out the diagnosis

(trigger, prodromal symptoms, time, after syncope, PMH)

A
  • Trigger: standing up from sitting position
  • Prodromal symptoms: blackout
  • Time: acute onset lasting seconds
  • After syncope: none
  • PMH: HTN (maybe drug doses need to be reduced)
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14
Q

Vasovagal syncope - diagnosis

Examination clues

Investigations

Management

A

Examination: none

Investigations: none

Management: reasurre

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15
Q

Situational syncope - diagnosis

  • Examination clues
  • Investigations
  • Management
A
  • Examination clues: none
  • Investigations: none
  • Management: reasurre
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16
Q

Carotid sinus syncope - diagnosis

  • Examination clues
  • Investigations
  • Management
A
  • Examination: none
  • Investigations: carotid doppler
  • Management: Aspirin; surgery if >70% stenosis
17
Q

Stroke - diagnosis

  • Examination clues
  • Investigations
  • Management
A

Examination: focal neurological deficit (depends on the side of the lesion)

Investigation: CT head (may show haemorrhage or infarct)

Management: conservative; thrombolysis; thrombectomy

18
Q

Seizures - diagnosis

  • Examination clues
  • Investigations
  • Management
A

Examination: post-ictal phase

Investigations: EEG, CT head

Management: treat the cause; anti-epileptic

19
Q

Arrhytmia - diagnosis

Examination clues

Investigations

Management

A
  • Examination: no significant clue if a patient is haemodynamically stable
  • Ix: 24 hour ECG
  • Mx: Temporary/permanent pacemaker
20
Q

Hypertrophic cardiomyopathy - diagnosis

  • Examination clues
  • Investigations
  • Management
A
  • Examination: CVS exam → systolic crescendo - decrescendo murmur; S4 gallop
  • Ix: Echo → asymmetrically thickened septum and dynamic obstruction of a blood flow
  • Mx: implantable cardioverter-defibrillator (ICD), beta-blockers, aspirin, specialist centre (probable ablation; myomctomy)
21
Q

Aortic stenosis- diagnosis

  • Examination clues
  • Investigations
  • Management
A
  • Exam: slow rising pulse, mild crescendo-decrescendo murmur, soft S2
  • Ix: ECG → left ventricular hypertrophy; ECHO → stenosed valve
  • Mx: valve replacement; balloon valvuloplasty
22
Q

Pulmonary Embolism - diagnosis

  • Examination clues
A

Examination:

  • chest clear
  • tachypnoea
  • low BP
  • tachycardia
23
Q

PE - diagnosis

  • Investigations
  • Management
A

Investigations:

ECG → may show R heart strain

D-dimer → high

CTPA → shows PE

Management:

Treatment dose Dalteparin

Thrombolysis

24
Q

Situational syncope - diagnosis

  • Examination clues
A

Examination findings:

None - in a haemodynamically stable patient

25
Q

Situational syncope - diagnosis

  • Investigations
  • Management
A

Investigations:

ECG shows ST-elevation

Raised troponins

Management:

STEMI → PCI

Non-STEMI → medical treatment

26
Q

Postural hypotension - diagnosis

  • Examination clues
  • Investigations
A

Examination:

Lying/standing BP → shows a drop of at least 20 mmHg

Investigations:

electrolytes

cortisol level

27
Q

Management of postural hypotension

A
  • review medication (especially anti-HTN)
  • Meds to Mx: fludrocortisone/ midodrine PO

*Midodrine → agonist of alpha1 adrenergic receptors in arterioles/vasculature → increased vasoconstriction → increase pressure

28
Q

Neurological causes of syncope

(all - handout)

A
29
Q

Cardiovascular causes of syncope

(all - handout)

A
30
Q

Postural hypotension as a cause of syncope

(houndout)

A

Y4 Extra teaching notes (5 decks)

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