3.3.3. Syncope Flashcards
Standing in line for a long period of time can predispose to venous pooling, leading to … what?
Standing in line for a long period of time can predispose to venous pooling, leading to vasovagal syncope
CAD is the leading risk factor for …
CAD is the leading risk factor for ventricular tachycardia
Major injury = think _________ causes of syncope (except with elderly patients)
Major injury = think cardiovascular causes of syncope (except with elderly patients)
_______ = postictal confusion, tongue biting, bladder AND/OR bowel incontinence, family history of epilepsy, or repetitive tonic-clonic movements
Seizure = postictal confusion, tongue biting, bladder AND/OR bowel incontinence, family history of epilepsy, or repetitive tonic-clonic movements
History of MI = _________ ________
History of MI = ventricular tachycardia
Syncope during exercise or family history of sudden death = what (2 options)
Syncope during exercise or family history of sudden death = LQTS or HCM (long QT syndrome or hypertrophic cardiomyopathy)
Newly prescribed medications = ______ ________
Newly prescribed medications = orthostatic hypotension
>20 mmHg drop in systolic or >10 mmHg drop in diastolic blood pressure after standing for 3 minutes confirms this type of hypotension
Orthostatic
Valvular aortic stenosis is most common in the elderly and, when associated with syncope, may indicate a very high risk for what?
Valvular aortic stenosis is most common in the elderly and, when associated with syncope, may indicate a very high risk for sudden cardiac death
LOC when rising from a squatting position or after exertion (dehydration) = _____ ______ ______
LOC when rising from a squatting position or after exertion (dehydration) = neurally mediated syncope
The following is a description of events following which kind of syncope?
Before event: nausea and progressive loss of vision = autonomic activation
After event: fatigue, nausea, and the desire to void = autonomic activation
However, the absence of premonitory or post-dromal symptoms is fairly common in the elderly
Neuronally mediated syncope
Chest pain or LOC while walking = ______ _____
Chest pain or LOC while walking = cardiovascular syncope
Most common causes of cardiac syncope in children are … (2 causes)
Most common causes of cardiac syncope in children are LQTS and HCM
On ECG look for prolonged QT and/or left ventricular hypertrophy
If syncope occurs during exercise, then it is cardiovascular until proven otherwise
The most common cause of syncope in children = what?
What subset of children is this most common in?
The most common cause of syncope in children = vasovagal episode
Especially among adolescent females
In syncope patients, what are you looking for in the general inspection of the chest?
General Inspection of Chest (shirt off)
Look for shortness of breath and surgical scars
What are you looking for when you inspect a syncopal patient’s hands?
- Inspect the Hands
- Symmetrically warm; no sign of tar staining on the fingernails; no splinter hemorrhages; no sign of finger clubbing
- Pallor (unhealthy pale appearance) = sign of anemia
- Assess pulse rate (one side) and then check for bilateral pulse rate
- Radial-Radial delay = aortic coarctation
- Check pulse while lifting arm up in the air
- Collapsing pulse = aortic regurgitation
When recording blood pressure for syncopal patients, what is one special thing you must do?
Record Blood Pressure [note any difference b/w sitting and standing]
Allow 3 minutes of standing to assess orthostatic pressure
In syncopal patients, what are you looking for in their jugular venous pulse?
Assess Jugular Venous Pressure
Palpate carotid pulse (lean head back gently) (only after checking for bruits!)
Looking for “normal character and good volume”
Along with the general inspection of the chest, what are you looking for in the patient’s face?
- Inspect the Face
- Xanthelasma = hypercholesterolaemia; corneal arcus = hyperlipidaemia; conjunctival pallor (peal down eyelid) = anemia
- Malar flush (cheeks) = mitral stenosis
- Poor dental hygiene = infectious endocarditis
When looking (and palpating) closer at the patient’s chest, what might you find?
- Close Inspection of the Chest
- Visible pulsations at the apex of the heart = ventricular hypertrophy
- Palpation
- Apex beat (5th Intercostal space, Midclavicular line)
- Feel for heaves and thrills (mitral/tricuspid areas, aortic/pulmonic areas)
- Thrills = palpable murmurs
- Heaves = ventricular hypertrophy
For auscultation, what are a couple of special maneuvers to check for certain heart murmurs?
- Auscultation
- Apex (feel carotid pulse to identify the 1st and 2nd heart sounds)
- Mitral; Tricuspid; Pulmonary; Aortic
- Listen for carotid bruits (head back and hold breath)
- Palpate carotid pulses individually if no bruits
- Lean forward, deep breath in and exhale all the way out
- Aortic regurgitation [listen w/ diaphragm in aortic/pulmonic areas]
- Check for mitral stenosis by asking the patients to lay on their L side & auscultating at the apex with the bell of your stethoscope
- Auscultate lung bases
- Apex (feel carotid pulse to identify the 1st and 2nd heart sounds)
Basal crackles = heart failure
Where do we look for edemas and what might they indicate?
Feel for sacral edema (heart failure) and pedal edema
What is syncope and what may cause it?
- Syncope is sudden loss of consciousness and postural tone not due to epileptic seizures or trauma with spontaneous recovery
- Usually due to a brief interruption of blood flow to the brain followed by immediate restoration of flow
- Transient fall in cardiac output or loss of vascular tone
What kind of patients undergo syncope and what are some mortalities related to cardiovascular related syncope and unkown origin syncope?
Patients with syncope range from perfectly healthy to those at risk for immediate sudden cardiac death
Syncope due to cardiovascular disease = one-year mortality of 20-30%
Unknown or noncardiovascular syncope = 5% one-year mortality