Blackouts or

Question 1

acronym for causes of blackouts

Answer 1

CRASH
Cardiac
Reflexes
Arterial
Systemic
Head

Question 2

Cardiac causes of blackouts

Answer 2

Stokes-Adams Attacks
Brady - heart block, sick sinus, long-QT
Tachy - SVT, VT
Structural - weak hear (LVF, tamponade), block (AS, HCM, PE)

Question 3

Reflex causes of blackouts

Answer 3

1. Vagal overactivity
   - vasovagal syncope
   - situational (cough, effort, micturition)
2. sympathetic underactivity = postural hypotension
   - Salt deficiency (hypovolaemia, Addisons)
   - Toxins (Cardiac - ACEi, diuretics, nitrates) (Neuro - TCAs, benzos, antipsychotics, L-DOPA)
   - Autonomic Neuropathy (DM, Parkinson’s, GBS)
   - Dialysis
   - Unwell (chronic bed rest)
   - Pooling (venous, varicose veins, prolonged standing)

Question 4

Acronym for sympathetic underactivity causes of blackouts

Answer 4

STANDUP

Question 5

arterial causes of blackouts

Answer 5

• Vertebrobasilar insufficiency: migraine, TIA, CVA,
  subclavian steal
• Shock
• Hypertension: phaeochromocytoma

Question 6

systemic causes of blackouts

Answer 6

• Metabolic: ↓glucose
• Resp: hypoxia, hypercapnoea (e.g. anxiety)
• Blood: anaemia, hyperviscosity

Question 7

head causes of blackouts

Answer 7

• epilepsy

- drop attacks

Question 8

general investigations for blackouts

Answer 8

1. lying and standing BP (>20/10 difference after 3 min → postural hypotension)
2. ECG ± 24hr ECG
3. U+E, FBC, Glucose
4. Tilt table
5. EEG, sleep EEG
6. Echo, CT, MRI brain

Question 9

Triggers for cardiogenic syncope

Answer 9

exertion, drugs, unknown

Question 10

symptoms before cardiogenic syncope

Answer 10

palpitations, chest pain, dyspnoea

Question 11

symptoms during cardiogenic syncope

Answer 11

pale, slow/absent pulse, clonic jerks may occur

Question 12

symptoms after cardiogenic syncope

Answer 12

rapid recovery

Question 13

investigations for cardiogenic syncope

Answer 13

• ECG
• 24hr ECG
• Echo

Question 14

triggers for vasovagal syncope

Answer 14

prolonged standing
heat
fatigue
stress

Question 15

symptoms before vasovagal syncope or postural hypotension

Answer 15

• Gradual onset: secs→mins
• Nausea, pallor, sweating, tunnel vision, tinnitus
• Cannot occur lying down

Question 16

symptoms during vasovagal syncope or postural hypotension

Answer 16

• Pale, grey, clammy, brady

- Clonic jerks and incontinence can occur, but no tongue biting

Question 17

symptoms after vasovagal syncope or postural hypotension

Answer 17

rapid recovery

Question 18

investigations for vasovagal syncope or postural hypotension

Answer 18

tilt-table testing

Question 19

triggers for postural hypotension

Answer 19

standing up

Question 20

triggers for arterial causes of blackout

Answer 20

• arm elevation (subclavian steal)

- migraine

Question 21

symptoms of arterial blackout

Answer 21

same as vasovagal

+ diplopia, nausea, dysarthria

Question 22

investigations for arterial blackout

Answer 22

• MRA

- duplex vertebrobasilar circulation

Question 23

symptoms of hypoglycaemic syncope

Answer 23

tremor, hunger, sweating, lightheadedness

→ LOC

Question 24

triggers for epileptic causes of blackout

Answer 24

flashing lights
fatigue
fasting

Question 25

symptoms before epileptic blackout

Answer 25

e.g. aura in complex partial seizures – feeling
strange, epigastric rising, deja/jamias vu, smells, lights,
automatisms

Question 26

symptoms during epileptic blackout

Answer 26

Tongue biting, 
incontinence, 
stiffness→jerking,
eyes open, 
cyanosis, 
↓SpO2

Question 27

symptoms after epileptic blackout

Answer 27

headache,
confusion,
sleeps,
Todd’s palsy

Question 28

investigations for epileptic blackout

Answer 28

EEG

↑ se prolactin at 10-20min

Question 29

triggers for drop attacks

Answer 29

nil

Question 30

symptoms before drop attacks

Answer 30

no warning

Question 31

symptoms during drop attacks

Answer 31

sudden weakness of legs causes older woman

to fall to the ground.

Question 32

symptoms after drop attacks

Answer 32

no post-ictal phase