24. Different types of blackouts

Question 1

Give me the main classifications of blackouts

Answer 1

• syncope: vasovagal, cardiogenic
• neurological: seizure either provoked or unprovoked
• psychogenic non epileptic attacks (NEAD)

Question 2

what is the main treatment of a NEAD

Answer 2

psychotherapy/ counselling

Question 3

when should you suspect NEAD

Answer 3

• Gradual onset
• Prolonged duration
• Abrupt termination
• Closed eyes +/- resistance to eye opening
• Rapid breathing
• Fluctuating motor activity
• Episodes of motionless or unresponsiveness

patient may have history of mental health problems or personality disorder

Question 4

what is CV syncope

Answer 4

Syncope = loss of consciousness caused by lack of cerebral blood supply

Question 5

what are the risk factors for CV syncope

Answer 5

• ECG abnormality
• HF
• TLoC on exertion
• Family Hx of sudden cardiac death <40yrs
• Family Hx of inherited cardiac condition
• New or unexplained breathlessness
• New murmur

Question 6

what is cardiogenic syncope

Answer 6

• Decrease in cardiac output due to a cardiac arrhythmia or obstructive cardiomyopathy, can be potentially fatal

Question 7

name some arrhythmias which could cause a cardiogenic syncope

Answer 7

	Ventricular arrhythmias 
	AV block
	WPW syndrome 
	AF with ventricular involvement
arrhytmogenic right ventricular cardiomyopathy

Question 8

name some cardiomyopathies that can lead to cardiogenic syncope

Answer 8

 Aortic stenosis
 HOCM
 LV dysfunction

Question 9

when do people with cardiogenic syncope usually get symptoms

Answer 9

during exercise and there is usually no presyncope symptoms

Question 10

what is vasovagal syncope precipitated by

Answer 10

o Decrease in BP precipitated by prolonged standing, dehydration, emotional shock

Question 11

what are the 3p’s which are the prodromal symptoms of vasovagal syncope

Answer 11

- Posture
•	Prolonged standing (syncope after exercise)
- Provoking factors
•	Pain, medical procedures
- Prodromal symptoms 
•	Pre-syncope (light-headedness)
•	Vomiting and nausea 
•	Hot and sweaty 
•	‘closing down’ of vision 

if patient doesn’t have any of these then think cardiogenic syncope

may see brief jerking of the limbs

Question 12

name some situational syncopes

Answer 12

o Micturition syncope

o Cough syncope

Question 13

what causes postural/orthostatic hypotension

Answer 13

• Peripheral vasoconstriction on standing is impaired
• Do a lying and standing BP
o Drop in BP >20/10 mmHg
• TLoC on standing
• Causes:
o Medications (antihypertensives or levodopa)
o Autonomic neuropathies -> diabetes

Question 14

what are the rules with the DVLA and syncope

Answer 14

• Unexplained syncope
o If cause identified and treated = 4 weeks
o No cause identified = 6 months