Syncope Types

Question 1

Reflex syncope:

Pathophysiology - 2

3 types of reflex syncope?

Answer 1

Reflex from:

Drop in HR
Peripheral vascular resistance

Vasovagal syncope
Situational syncope
Carotid sinus syncope

Question 2

Reflex syncope - Vasovagal syncope:

What is commonly referred to as?
It’s caused by orthostatic stress. What leads to this? - 3
What may it also be due to?

3 P’s of an uncomplicated faint?

Answer 2

Uncomplicated/simple/common faint

Long standing
Hot weather
Reduced fluid intake

Emotional stress 
Pain 
Emotion 
Blood 
Needles 

Postural - usually after prolonged standing
Provocation - pain/procedure
Prodrome - sweating, nausea, warmth

Question 3

Reflex syncope - Situational syncope:

What makes this different from vasovagal syncope?

Triggers?

Answer 3

Due to specific physical trigger

Cough 
Postprandial 
Post-exercise 
Micturition 
Defecation

Question 4

Reflex syncope - Carotid sinus syncope:

What is wrong with the baroreceptors in the carotid sinuses?

Triggers?

Answer 4

Altered HR and BP due to hypersensitive baroreceptors

Minimal stimulus of the neck - shaving, tight shirt collar etc.

Question 5

Reflex syncope:

Management - 1 thing they need to do?

What should they do if they feel a faint coming on?

What type of reflex syncope doesn’t need to involve the DVLA?

Answer 5

Reassured - avoid triggers

Lie flat with legs in air - on chair or against wall
Put head between legs - protective

Vasovagal syncope - as has a clear trigger and you are usually standing around when it happens

Question 6

Reflex syncope:

Management:

What can be done if recurrent and dangerous?

What can be done for carotid sinus syncope?

Answer 6

Tilt training - supervised prolonged upstanding
Beta-Blockers

Cardiac pacing

Question 7

Cardiogenic syncope - Arrhythmic causes:

What type of SVT can lead to a faint?

What types of heart block leads to a faint?

What can cause sinus bradycardia?

Answer 7

AF

AV block - 2nd degree type II and 3rd degree

Sick sinus syndrome
Beta blockers

Question 8

Cardiogenic syncope - Structural causes:

What type of valve disease?

List a few structural causes?

What extra-cardiac causes? - lungs, aorta

Answer 8

Severe aortic stenosis

MI
Pericardial disease
Congenital HD

PE
Aortic dissection

Question 9

Cardiogenic syncope - Management - 2?

Who should be informed?

Answer 9

Cardiac drugs
Pacemaker

DVLA

Question 10

Orthostatic hypotension:

Define relating to BP

How is it tested for?

Answer 10

Fall in BP >20 systolic or >10 diastolic on standing

Check BP lying or sitting then 1 minute after standing

Question 11

Orthostatic hypotension - Causes:

ANS dysfunction - primary and secondary causes

What meds cause this?

What type of anti-depressant causes this?

Answer 11

Parkinsons Disease - 1
DM - 2

Anti-hypertensives
Diuretics 
Anti-anginas 
Anti-Arrhythmics
Sedatives 

TCA’s - tricyclic antidepressants

Question 12

Orthostatic hypotension - Causes:

What causes hypovolaemia?

What are some acute causes of hypovolaemia? - 2 - preg, aorta

Answer 12

Dehydration
Haemorrhage
Addisons

Ruptured ectopic pregnancy
AAA

Question 13

Orthostatic hypotension:

When is it worse?

What type of pain does it cause and why?

Answer 13

Morning time

Coat hanger pain - due to hypo perfusion of the neck and shoulder muscles

Question 14

Orthostatic hypotension - Management?

Biggest thing!!!

Physical and lifestyle steps

What can you do physically to help venous return

What med can be tried? - 1

Answer 14

Removal causes - drugs
Physical and lifestyle steps - good fluid intakee, raise head of the bed
Leg crossing and arm tensing - helps venous return

Fludrocortisone