cardiac syncope Flashcards
Where do the coronaries branch off of
aortic root
What does the acute marginal artery supply
RV to the apex
What does the posterior descending artery supply
the dominant side of the heart
What does the LAD feed
feeds anterior 2/3 of intraventricular septum
Where is the circumflex artery located
around the AV groove to lateral aspect of LA, lateral wall
Which leads are lateral
1
aVL
V5-V6
Which leads are inferior
2
3
aVF
Which leads are anterior / septal
V1-V4
What is syncope usually caused by
vasovagal event
When does syncope occur
interruption of cerebral flow for 10+ seconds
**usually from decreased CO
What is the prodrome for syncope
sweating
light headedness
nausea
narrowing of vision
What are the differentials for syncope
“PASS OUT”
Pressure
Arrhythmias
Seizures
Sugar
Output / O2
Unusual
TIA/CVA
What is the rule of 15s
15% of PE, AAA, ruptured ectopic, SAH, and ACS all present with syncope
What is the DDX for cardiac syncope
CHESS PIECES
CHF
HCT
ECG abnormality
SOB
SBP
Premature SCD
Ischemic heart disease
EF
Cardiomyopathy
Extertional syncope
Structural heart disease
Which patient population is more likely to present with syncope in ACS
Elderly patient
What are you at risk for with long QT
Torsades
What is an example of a pre-excitation syndrome
WPW
What is WPW
Abnormal conduction pathway along the bundle of Kent directly connecting the atria to ventricles, bypassing the AV node
What are some symptoms of WPW
Palpitations
dizzy
syncope
sudden cardiac death
**commonly associated with afib
What is the ECG triad with WPW
delta wave
short PR
Wibe QRS
What is Brugada syndrome
depolarization issue associated with ion channels which can lead to ventricular strain
What will be seen on ECG with brugada syndrome
RBBB with RSR
downsloping ST depression in V1 & V2
How do you treat brugada syndrome
ICD implant
What does HOCM look like on ECG
Dagger-like Q waves in lateral leads (1, aVL, V5-6)
What is cardiac tamponade
Acute/chronic increase in fluid around the heart that can cause pressure on the heart = decrease CO= syncope
What is Beck’s triad
Hypotension
muffled heart sounds
elevated JVP
What are the classifications of PEs
Massive
Submassive w/ R. heart strain
Submassive w/o R. heart strain
What is virchows triad
stasis
hyper coagulable
endothelial injury
If a patient is at low risk for a PE, how do you work them up
Dimer
If a patient is at high risk for a PE, how do you work them up
CTA
What ECG finding are seen with PE
S wave in lead 1
Q waves in 3
Inverted T waves in 3
What are some causes of pulmonary hypertension
HF
COPD
Vasculitis
Infection
How will a patient present with severe pulmonary hypertension
SOB
CP
Effusion
Edema
What is pulmonary arterial hypertension associated with
Occlusion/constriction of the capillary arterioles within the pulmonary vasculature
What are the common causes of pulmonary arterial HTN
PE
ARDS
COPD
interstitial lung disease
What is pulmonary venous hypertension associated with
left sided heart disease
What are symptoms of as aortic dissection
tearing CP that radiates into back
murmur
syncope
JVD
pulsus paradoxus
pulse / neuro deficit
