Taylor-Syncope

Question 1

why I don’t passout when I stand up

Answer 1

my baroreceptor reflex acts instantly to make sure brain is still perfused; sympathetics fire

Question 2

besides sympathetics, what other way can we ensure we don’t pass out when standing up

Answer 2

muscle compression that compresses veins and pushes venous return to heart

Question 3

acute response to standing up maintains what

Answer 3

maintains arterial pressure

Question 4

has transient corrections of BP (when there is a change in pressure or blood volume)

Answer 4

baroreceptor reflex

Question 5

has sustained management of BP and blood volume

Answer 5

kidneys

Question 6

4 main variables in the normal orthostatic response

Answer 6

1. total blood volume
2. drugs/alcohol
3. temperature
4. recent meal

Question 7

ways that a patient can lose blood volume and make orthostatic response slow

Answer 7

dehydration
hemorrhage
laying down too long

Question 8

drugs that can cause orthostatic response to be sluggish

Answer 8

diuretics, B blockers and vasodilators, SSRI’s

Question 9

what makes orthostatic response sluggish in regards to temp.

Answer 9

heat–vasodilates blood vessels

Question 10

main thing to check first if someone experiences syncope

Answer 10

make sure it is not cardiac related (order ecg and labs)

Question 11

transient loss of consciousness (fainting) w/ spontaneous recovery (20 sec)

Answer 11

Syncope

Question 12

most common cause of syncope

Answer 12

inadequate perfusion of brain

Question 13

labs to order to see if syncope is due to a metabolic issue

Answer 13

glucose levels (hypoglycemia)
CBC (anemia)

Question 14

blowing off too much CO2 and blood vessels constrict causing what

Answer 14

loss of consciousness

Question 15

most important cause of syncope to recognize even though it is only 10% of all cases

Answer 15

cardiac

Question 16

if you identified patient did not pass out due to cardiac pathology, then what do you check for

Answer 16

Dysautonomia

Question 17

autonomic dysfunction due to essential failure or delay of sympathetic activation +/or response

Answer 17

Dysautonomia

Question 18

2 main types of cardiac causes of syncope

Answer 18

Arrhythmia
Long QT syndrome

Question 19

hypotension when standing; dizziness or fainting when standing

Answer 19

Orthostatic Intolerance

Question 20

how to measure Orthostatic or Postural Hypotension

Answer 20

a decrease in systolic BP by 20 mmHg or a decrease in diastolic BP of 10 mmHg w/in 3 minutes of standing

Question 21

4 main types of Dysautonomia

Answer 21

1. Vasovagal syncope
2. Carotid sinus hypersensitivity
3. pure autonomic failure
4. PoTS

Question 22

common faint reflex (multiple triggers); 70-80% of syncope cases

Answer 22

Vasovagal syncope

Question 23

enhanced baroreflex in response to neck pressure

Answer 23

Carotid sinus hypersensitivity

Question 24

entire autonomic system and cardiovascular system damaged; due to brain neurodegenerative disease

Answer 24

Primary autonomic failure

Question 25

sustained rapid heart rate when standing

Answer 25

PoTS (postural tachycardia syndrome)

Question 26

characterized by rapid bradycardia and hypotension (withdrawal of sympathetic tone and increased vagal firing)

Answer 26

Vasovagal syncope

Question 27

specific degeneration of autonomic functions; inability to maintain bp when standing

Answer 27

Pure Autonomic Failure (PAF)

Question 28

increased HR within first 10 minutes of standing due to unstable BP and low cerebral perfusion

Answer 28

PoTS (postural tachycardia syndrome)

Question 29

seen recently after someone who has had COVID

Answer 29

PoTS

Question 30

how to assess for dysautonomia

Answer 30

Head Upright Tilt test (HUT)

Question 31

HUT test

Answer 31

check HR and BP of patient on tilted table w/out involvement of m. contraction

Question 32

after HUT test, both BP and HR fall

Answer 32

Vasovagal response

Question 33

after HUT test, only BP falls

Answer 33

Pure autonomic failure

Question 34

after HUT test, HR increases and remains elevated; BP unstable

Answer 34

PoTS

Question 35

top, middle, bottom represent what

Answer 35

top-normal middle-PAF bottom- PoTS

Question 36

to treat and manage syncope

Answer 36

ecg and labs and FH

Question 37

non-pharmacologic ways to treat syncope

Answer 37

1. avoid triggers 2. hydrate 3. exercise (volume expansion)

Question 38

pharmacologic ways to treat syncope:

Answer 38

basically drugs that will increase sympathetics

Question 39

a1 receptor agonist used to treat syncope

Answer 39

Midodrine

Question 40

drug that increases Na+ and fluid retention (volume expansion) used to treat syncope

Answer 40

Fludrocortisone

Question 41

anticholinergic drugs that oppose parasympathetic effects and used to treat syncope

Answer 41

Atropine Disopyramide

Question 42

drugs that act like accessory catecholamines to treat syncope

Answer 42

Ephedrine/Pseuodophedrine

Question 43

reduces serotonin reuptake drug used to treat syncope

Answer 43

SSRI's

Question 44

drug that will keep NE and Epi in synapse longer; used to treat syncope

Answer 44

Ritalin

Question 45

a way to assess autonomic response and assess valve issues in heart

Answer 45

Valsalva maneuver

Question 46

triggered by immersing face in water (CN V)

Answer 46

dive reflex

Question 47

Involves parasympathetic mediated bradycardia; w/ sympathetic vasoconstriction in vasculature

Answer 47

dive reflex

Question 48

2 ways to quickly lower HR on your own

Answer 48

splash your face with water rub one carotid