CABS Cardiac Syncope Flashcards
The coronary sinus drains into
the right atrium
What is syncope?
transient loss of consciousness secondary to lack of cerebral blood flow
How does syncope differ from seizures
there is no postictal period, and the pts will return fully to baseline when awaking
Presyncope is
the period before the pt might pass out
feels lightheaded, dizzy, tunnel vision, etc
Syncope is m/c d/t
vasovagal event - this is reflex induced and not associated with cardiac or neurologic pathology
no matter the cause, syncope will lead to
decreased cerebral blood flow
What can present with syncope
Acute coronary syndrome (includes unstable angina, NSTEMI, STEMI)
Prolonged QT
Long QT = (for men and women)
if greater than 440ms in men
if greater than 460ms in women
over 500ms increased risk of torsades
Long QT = (for men and women)
if greater than 440ms in men
if greater than 460ms in women
over 500ms increased risk of torsades
(measure in 2 or V5-6)
Long QT syndrome can be either
congenital (increased risk of SCD) or acquired
Wolf Parkinson White syndrome is
abnormal conduction pathway along the bundle of kent directly connecting atria to ventricles and bypasses the AV node, doesn’t allow for ventricles to fill
Wolf Parkinson White syndrome makes the pt prone to
supraventricular tachydysrhythmias
Wolf Parkinson White syndrome presents with
palpitations, dizzy, syncope, CP, SCD, commonly associated with afib
WPW syndrome on ECG
ECG triad:
Delta wave
- slurred upstroke of QRS
short PR <0.12 seconds
Brugada (channelopathy) is
repolarization issue associated with sodium ion channels which can lead to ventricular strain
Brugada on ECG
RBBB with RSR’
down sloping ST depression in V1 and V2
Brugada syndrome presents with
palpitations, syncope, dyspnea
HOCM on ECG
‘dagger-like’ Q wave in lateral leads (1, aVL, V5-6)
Hypertrophic Obstructive Cardiomyopathy (HCOM) is
leads to increased LV thickness which reduces filling and ultimately decreases CO
increased risk of arrhythmias and SCD
Tamponade is
acute or chronic increase in fluid around the heart that can cause pressure on the heart leading to decreased size of chambers of the heart
In tamponade the increased pressure will lead to ______ systemic venous return, _______ CO leading to syncope
decreased
decreased
What is Beck’s Triad
Tamponade (muffled heart sounds, elevated JVP, Hypotension)
Tamponade on ECG
tachycardia
low voltage
electrical alternans (from too much fluid the heart is swinging around)
TX of tamponade
pericardiocentesis or can cut a window for it to drain into the cavity and will be reabsorbed
What is Virchows Triad
stasis
hypercoagulability
endothelial injury
severe pulm HTN increases pulmonary vascular resistance which leads to
right sided HF and decreased CO
Aortic dissection is
separation between layers of the aorta with a false lumen that spreads secondary to pulse and BP - can occlude blood flow to other organs
Cardioversion is
shocking the pt at correct time - synchronized
Defibrillate is
increased J count, not synchronized like cardioversion
Lethal tachyarrhythmias include
Ventricular tachycardia - when the heart is pumping so fast that it can’t fill correctly and will decrease CO
Ventricular fibrillation - nothing being ejected out (low CO)
