Blackout hx Flashcards
Key question
Did anyone see you fall?
Types of falls
Mechanical
Cardiovascular
Cerebrovascular (Neuro)
What questions would you ask?
What shoes were you wearing?
Cardio causes of falls
AF/arrhythmias
Postural hypotension (new BP bloods)
Mitral valve regurg
HF
Symptoms of cardio falls
Palpitations SOB Dizziness/light headed Nausea Chest pain
Main cause of neuro falls?
Epilepsy
If they have epilepsy, is the patient conscious?
No! Hence collateral history
What would you ask for neurogenic seizure focussed fall?
Did you feel funny before you fell? (prodromal auras)
During - ask for collateral history
Was your tongue bleeding? (tongue biting)
Did you notice that you had weed yourself? (epilepsy)
How would you diagnose epilepsy?
Requires two seizures
Only consultant neurologists can diagnose
Describe what symptoms a patient with TIA and visual disturbance would cause
Sudden or curtain drop?
What three questions would you ask about what happened BEFORE the blackout?
Was there any warning?
Were there precipitating factors?
Was there any recent head trauma?
Which conditions have warning signs?
Partial seizures
Vasovagal
NOTE: usually cardiac causes do not have warning signs
What warning sign would be present in partial seizures?
Auras
Precipitating factors (triggers) for MI causes
Exercise
Short lived syncope causes with spontaneous recovery
Cardiac
vasovagal causes
What three questions would you ask about what happened DURING the blackout?
How long was the patient unconscious? Minutes? Seconds?
Did they bit their tongue/move limbs/ were incontinent
Which causes of syncope would cause tongue biting / limb movemnet
Vasovagal (parasympathetic loss of tone)
Seizures
What three questions would you ask about what happened AFTER the blackout?
Did they recover spontaneously?
How long did it take to recover?
Were they confused after recovery?
Give examples of ‘vagal’ symptoms
Clammy
sensation in stomach
Nausea
What is the classic triad of aortic stenosis?
Dypsnoea
Chest pain
Syncope
Systems questions????????
Chest pain, palpitations?
Resp: dyspnoea, cough, sputum, wheeze, haemoptysis, pleurtiic chest pain
GI: dyspepsia, nausea, voimiting, dyspahgia, abdo pain
Genitourinary: oliguria, polyuria, dysuria
Relevant pre existing conditions
Epilepsy/seizures Diabetes Cardiac illness e.g: congenital bicuspid aortic valve Heart disease MI Aortic stenosis Hypertrophic obstructive cardiomyopathy
Anaemia
Psych conditions e.g. depression/anxiety
Relevant drug hx
Insulin
AntiHTN
Vasodilators
Relevant drug hx
Insulin
AntiHTN
Vasodilators
Anything that prolongs the QT interval
