12. MTB Step 3 - Syncope Evaluation Flashcards
Cards Complete:
SYNCOPE EVALUATION
What are the (3) Criteria that the Management of Syncope is based on?
-
Loss of Consciousness:
- Sudden vs. Gradual
-
Regaining Consciousness:
- Sudden vs. Gradual
-
Cardiovascular Exam:
- Normal vs. Abnormal
*SEE PICTURE FOR FLOWCHART*
SYNCOPE EVALUATION
What are (6) Exams that should be performed on Syncope Evaluation?
- Cardiovascular and Neurological exams
- ECG
- Cardiac Enzymes (Troponins, CK-MB)
- Chemistries (glucose)
- Oximeter
- CBC
SYNCOPE EVALUATION
How should you Manage the Special Circumstance of Syncope + MURMUR?
Echocardiogram
SYNCOPE EVALUATION
How should you Manage the Special Circumstances of Syncope + FOCAL NEUROLOGIC FINDINGS?
CT Scan Head
SYNCOPE EVALUATION
How should you Manage the Special Circumstances of Syncope + HEAD TRAUMA DUE TO SYNCOPE?
CT Scan Head
SYNCOPE EVALUATION
How should you Manage the Special Circumstances of Syncope + HEADACHE?
CT Scan Head
SYNCOPE EVALUATION
How should you Manage the Special Circumstances of Syncope + SEIZURE (described or suspected)?
CT Scan Head
and
EEG
SYNCOPE EVALUATION
What is the Mechanism of Syncope caused by a Brainstem Stroke only?
- The brainstem controls sleep and wake in the brain.
- Only stroke or TIA of the posterior circulation can cause syncope.
- Vertebral/basilar circulation is synonymous with the posterior or brainstem circulation.
- There is no place in the circulation of the middle cerebral artery that can cause syncope.
SYNCOPE EVALUATION
If the Diagnosis is NOT clear after moving the clock forward to obtain the initial results, what are (6) Tests that should be done on Further Management?
- Holter Monitor (outpatients)
- Telemetry (inpatients)
- Repeat CK-MB & Troponins 4 hours after initial
- Urine & Blood Toxicology screens
- TILT TABLE Testing to diagnose Neurocardiogenic (Vasovagal) Syncope
- ELECTROPHYSIOLOGIC Testing
SYNCOPE EVALUATION
What Percentage of Mortality from Syncope is from Cardiac causes?
> 80%
The most important thing to do in Syncope is to EXCLUDE a Cardiac cause (i.e., Arrhythmia)
SYNCOPE EVALUATION
TREATMENT
What is the Treatment if a Ventricular Dysrhythmia is diagnosed as the cause of Syncope?
Implantable Cardioverter/Defibrillator
SYNCOPE EVALUATION
DIAGNOSIS
Which (4) Diagnostic Test should you order for Syncope?
- ECG
- Troponin, CK-MB
- Echocardiogram
- Head CT