Week 3 - Syncope / Weakness / Dizziness Flashcards
(47 cards)
Syncope
Syncope definition
Can they seize?
What is the pt like after the syncope?
Temporary/transient loss of consciousness associated with loss of postural tone, insufficient blood flow to the brain.
Also called fainting or “passing out” - usually occurs due to hypotension
They can have BRIEF seizure activity
The pt is NOT altered or post-ictal afterwards
Weakness
What does weakness infer?
A decrease in physical strength or energy
Many different symptoms and presentations
May represent neuromuscular weakness, fatigue, malaise, or pressyncope
Hx and physical exam is key to help narrow the differential
It’s often mutlifocal
Dizzy/Vertigo
What words/phrases would a pt use to describe their experience?
You should use
Vertigo (the illusionary sense of movement)
Weakness/fainting
Lightheadedness
Unsteadyness
OPQRST
CABG
Coronary, Artery, Bypass, Graft
Syncope
What are the key findings?
Generalized loss of blood flow to the brain (not focal)
Sudden
Brief
Transient
Fully resolved
Returns to normal neurological status
Faint Score
Memory Aid - BLOOD
4 Pre’s
2 Dx
3 Q’s
Previous hx of heart disease predisposition i.e. blood pressure LESS then 90 over LESS than 180 = high troponin
Dx of cardiac syncope
Dx of vasovagal syncope
Abnormal QRS axis = duration of GREATER then 130ms and/or QT is GREATER then 480ms
CHESS Mnemonic
San Francisco Syncope Rule
Syncope - 3 P’s
What are the 3 P’s?
What are the red flags of cardiac syncope?
Posture e.e prolonged standing
Provoking factors e.g. medical procedure
Prodomal symptoms e.g. sweating
ECG changes
SOB
Murmer
Syncope on exertion
Sudden death in the family
Age GREATER then 65y old with absent 3P’s
Syncope
What are the causes?
Syncope - ECG changes
What are the ECG changes that might present during syncope?
Syncope
What other conditions may present with syncope?
Myocardial Infarction
Dysrhythmias
Hypertrophic Cardiomyopathy
Pericardial Tamponade
Stroke
Subarachnoid Hemorrhage
Aortic Stenosis
Thoracic Aortic Dissection
Pulmonary Embolism
Abdominal Aortic Aneurysm
Gastrointestinal bleeding/Shock/Hypovolemia
Ectopic Pregnancy
Toxicological
Sepsis
Syncope Expected Findings
What could be the causes?
What is hypertrophic cardiomyopathy? What would the ECG have?
Insufficient blood supply to the brain
Change in vasomotor tone
Transient change in HR
Transient change in BP
Transient reduction in blood flow to the brain
May appear pale and diaphoretic
Witnessess may report a fainting
a disease in which the heart muscle becomes thickened (hypertrophied) - comes with few if any symptoms
dagger-like Q waves in inferior and lateral leads
What is aortic stenosis?
What are some symptoms?
a type of heart valve disease (valvular heart disease) in which the one between the left ventricle and the body’s main artery (aorta) is narrowed and doesn’t open fully thus restricting bloodflow from the heart to the rest of the body.
Chest pain
Fatigue
SOB
Fainting/lightheadedness
Heat murmur
Heart palpitations
WPW-Wolf Parkinson White Syndrome
What is it and what does it commonly cause in infants/children?
What kind of waves are created on an ECG?
What are the common symptoms AND rates?
a syndrome describing an additional electrical pathway in the heart that leads to periods of rapid HR
Causes tachycardia
Delta waves
160-220-300
Chest pain or tightness
Dizziness
Lightheadedness
Syncope
Palpitations
SOB
Brugada Syndrome
What is the disorder and it’s effects?
a genetic disorder that can cause a dangerous irregular heartbeat
the ventricles beat fast and irregularly - preventing blood from circulating correctly in your body
Vertebrobasilar Artery Disease/Insuffciency
What is it?
What does atherosclerosis = ?
What are plaques made of? What are their complications?
a condition characterized by poor blood flow to the posterior (back) portion of the brain, which is fed by two vertebral arteries that join to become the basilar artery
(fainting or syncope can occur)
reduced blood flow
deposits of cholesterol, calcium, and other cellular components
block the flow of blood to the brain
Vagus Nerve is the ? cranial nerve also called ? that interfaces with the ? control of the heart, lungs, and digestive tract
Comprsises what kind of fibers?
10th cranial nerve
pneumogastric nerve
parasympathetic NS
sensory and motor
By what is the heart parasympathetically controlled by?
Which side innervates the sinoatrial node?
When hyperstimulated what happens?
Vagus nerve
AND
Thoracic ganglia
the right vagus branch
the left vagal branch predisposes the heart to conduction block at atrioventricular node
Vaso-vagal Syncope
Who does it affect?
What could it lead to?
Young children and women more than other groups
temporary loss of bladder control under moments of extreme fear
Vaso-vagal Syncope
What happens?
you syncope due to extreme emotional distress - called neurocardiogenic syncope
Your HR and BP drop suddenly (your brain obviously loses enough oxygen to keep you conscious)
Atropine
What is it used for?
Classification and mechanism of action?
Bradycardia
muscarinic receptor antagonist that is used to inhibit the effects of excessive vagal activation on the heart, which is manifested as sinus bradycardia and AV nodal block
Micturition Syncope
Explain it to me
What’s the rare cause?
one strains to increase the flow of urine, it stimulates the vagus nerve - decreasing HR and thus BP
(usually more pronounced in elderly men with large prostates)
Paraprostatic pheochromocytoma