Syncope/Collapsed patient Flashcards
(30 cards)
Vasovagal syncope
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope)
- Trigger: emotional distress/ orthostatic distress
- Prodromal symptoms: lightheadedness, visual disturbances, nausea, vomiting
- Time: seconds
- After syncope: no incontinence, may appear pale, full recovery
Situational syncope
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- Trigger: cough, sneeze, post micturition
- Prodromal symptoms: none
- Time: seconds, appears pale
- After syncope: no symptoms
- PMH: previous episodes like that
Carotid sinus syncope
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- Trigger: shaving, tightening of a collar, head turning
- Prodromal symptoms: none
- Time: seconds
- After syncope: no symptoms
- PMH: previous histories of such episodes
Stroke
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- Trigger: none
- Prodromal symptoms: visual disturbances, tingling
- Time: seconds
- After syncope: may have focal neurological deficits
- PMH: TIAs, HTN, T2DM, smoking, alcohol excess
Seizures
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- 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
Cardiac causes of (6) a syncope
- arrhythmia
- hypertrophic cardiomyopathy
- MI
- aortic stenosis
- PE
- postural hypotension
Neurological causes of syncope (5)
- vasovagal syncope
- situational syncope
- carotid sinus
- stroke
- seizure
Arrhythmia (syncope)
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, FHx)
- Trigger: exertion
- Prodromal symptoms: none/palpitations
- Time: sudden onset, lasting seconds
- After syncope: no residual symptoms, rapid full recovery
- FHx: sudden death
Hypertrophic cardiomyopathy
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- Trigger: exertion
- Prodromal symptoms: dyspnoea, palpitations, angina
- Time: sudden onset, lasting seconds
- After syncope: rapid full recovery
- FHx: sudden death at young age
Cardiac stenosis
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope)
- Trigger: syncope on exercise
- Prodromal symptoms: dyspnoea, chest pain
- Time: sudden onset
- After syncope: rapid full recovery
PE
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- Trigger: none, risk factors (travel, immobility, malignancy etc), exercise (when syncope occurs)
- Prodromal symptoms: dyspnoea, chest pain
- Time: sudden onset
- After syncope: variable symptoms
MI
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- Trigger: variable
- Prodromal sympotms: chest pain, dyspnoea
- Time: sudden onset
- After syncope: variable
Postural Hypotension
Clues in the history that may point out the diagnosis
(trigger, prodromal symptoms, time, after syncope, PMH)
- 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)
Vasovagal syncope - diagnosis
Examination clues
Investigations
Management
Examination: none
Investigations: none
Management: reasurre
Situational syncope - diagnosis
- Examination clues
- Investigations
- Management
- Examination clues: none
- Investigations: none
- Management: reasurre
Carotid sinus syncope - diagnosis
- Examination clues
- Investigations
- Management
- Examination: none
- Investigations: carotid doppler
- Management: Aspirin; surgery if >70% stenosis
Stroke - diagnosis
- Examination clues
- Investigations
- Management
Examination: focal neurological deficit (depends on the side of the lesion)
Investigation: CT head (may show haemorrhage or infarct)
Management: conservative; thrombolysis; thrombectomy
Seizures - diagnosis
- Examination clues
- Investigations
- Management
Examination: post-ictal phase
Investigations: EEG, CT head
Management: treat the cause; anti-epileptic
Arrhytmia - diagnosis
Examination clues
Investigations
Management
- Examination: no significant clue if a patient is haemodynamically stable
- Ix: 24 hour ECG
- Mx: Temporary/permanent pacemaker
Hypertrophic cardiomyopathy - diagnosis
- Examination clues
- Investigations
- Management
- 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)
Aortic stenosis- diagnosis
- Examination clues
- Investigations
- Management
- Exam: slow rising pulse, mild crescendo-decrescendo murmur, soft S2
- Ix: ECG → left ventricular hypertrophy; ECHO → stenosed valve
- Mx: valve replacement; balloon valvuloplasty
Pulmonary Embolism - diagnosis
- Examination clues
Examination:
- chest clear
- tachypnoea
- low BP
- tachycardia
PE - diagnosis
- Investigations
- Management
Investigations:
ECG → may show R heart strain
D-dimer → high
CTPA → shows PE
Management:
Treatment dose Dalteparin
Thrombolysis
Situational syncope - diagnosis
- Examination clues
Examination findings:
None - in a haemodynamically stable patient
