Blackouts

Question 1

What is syncope?

Answer 1

syncope is a transient loss of consciousness due to global cerebral hypoperfusion w/ 1) rapid onset 2) short duration 3) spontaneous complete recovery [this definition excludes other causes of collapse e.g . epilepsy]

Question 2

What are the 3 different types of syncope?

Answer 2

• reflex
• orthostatic
• cardiac

Question 3

What type of syncope are vasovagal, situational and carotid sinus?

Answer 3

reflex syncope

Question 4

what type of syncope are primary autonomic, secondary autonomic, drug induced, volume depletion?

Answer 4

orthostatic syncope

Question 5

what type of syncope is arrhythmias and structual?

Answer 5

cardiac syncope

Question 6

which is the most common syncope type in all age groups?

Answer 6

reflex syncope is the most common cause in all age groups

although orthostatic and cardiac causes become progressively more common in older patients.

Question 7

what type of syncope does this describe?

reflex bradycardia +/- peripheral vasodilation provoked by emotion, pain, fear/stress or standing too long.

Answer 7

vasovagal

often reffered to as “fainting”

Question 8

What type of syncope does this describe?

triggered syncope on cough, micturition, GI

Answer 8

situational syncope

(a reflex syncope - these are neurally mediated)

Question 9

What type of syncope does this describe?

hypersensitive baroreceptors causing excessive reflex bradycardia on minimal stimulation

Answer 9

carotid sinus syncope

(a type of neurally mediated/ reflex syncope)

Question 10

What type of syncope does this describe?

Parkinson’s disease, Lewy body dementia

Answer 10

primary autonomic failure e.g orthostatic syncope

Question 11

What types of syncope do these conditions give?

Diabetic neuropathy, amyloidosis, uraemia

Answer 11

secondary autonomic failure

e.g. orthostatic syncope e.g. postural decrease in BP

Question 12

What type of syncope do diuretic, alcohol and vasodilators give?

Answer 12

drug induced - orthostatic syncope (postural decrease in blood pressure)

Question 13

What type of syncope does haemorrhage, diarhoea & POTS (postural orthostatic tachycardia syndrome) give?

Answer 13

volume depletion e.g. orthostatic syncope - postural decrease in BP

Question 14

what type of syncope is can happen on standing; elderly, autonomic neuropathy, anti-hypertensives, over diuresis, MSA, Addison’s ?

Answer 14

orthostatic syncope

Question 15

What type of syncope does this describe?

bradycardias (sinus node dysfunction, AV conduction disorders) or tachycardias (supraventricular, ventricular)

transient arrhythmias e.g. bradycardia due to complete heart block causing decreased CO & LOC

-> pt falls to ground, pale, slow/absent pulse, recovery in seconds

Answer 15

Stokes adams attacks

aka arrhythmias

= cardiac syncope

Question 16

What type of syncope does this describe?

valvular, MI, hypertrophic obstructive cardiomyopathy

Answer 16

structural e.g. cardiac syncope

Question 17

What does this describe?

tremor, hunger, sweaty, light-headedness, LOC

Answer 17

hypoglycaemia – a type of cardiac syncope

Question 18

what does this describe?

sudden weakness of the legs causes the patient

(usually an older woman)

to drop to the ground, no warning, no LOC, no confusion;

benign spontaneously resolving condition (could also be hydrocephalus, cataplexy)

Answer 18

drop attack

Question 19

What does this describe?

hyperventilation, tremor, sweating, tachycardia, paraesthesia, light-headedness, no LOC -

Answer 19

anxiety

–> panic attack

Question 20

What investigations can be done into syncope?

Answer 20

1. cardiovascular examination
2. postural BP readings:
3. ECG +/- 24hr ECG
4. Bloods - FBC, U&E, glucose
5. carotid sinus massage
6. tilt table test
7. EEG
8. Echo
9. CTH/MRI

Question 21

What postural blood pressure reading changes are significant/diagnostic?

Answer 21

• a symptomatic fall in systolic BP > 20 mmHg
• or diastolic BP > 10 mmHg or
• decrease in systolic BP < 90 mmHg is considered diagnostic

Question 22

What type of syncope does PE cause?

Answer 22

Cardiac syncope