Cardiac - Syncope Flashcards
Syncope
Definition
Syncope
Ddx of non-syncopal cause of TLOC
Cardiogenic syncope
Causes
Orthostatic hypotension
Causes
Neurogenic/ Neurocardiogenic syncope
Causes
Syncope
prodromal symptoms
Syncope
Witness signs
Syncope
Pathophysiology
- Cardioinhibitory and vasodepressor response
- Autonomic dysfunction
Syncope
HPI
Syncope
Relevant medical/ surgical/ drug/ family history
Syncope
P/E
Dynamic Ix
+ assessment of injuries
Syncope
Radiological Ix
Vasovagal syncope
Treatment
Orthostatic hypotension
Treatment
4 major categories of cause of TLOC
Head trauma/ traumatic TLOC
Non-traumatic TLOC:
- Syncope
- Epileptic seizures
- Psychogenic
Most common causes of syncope in <40, 40-60, and >60 years old pt
<40 = neural -mediated syncope/ neurocardiogenic (situational, vasovagal, carotid sinus hypersensitivity)
40-60 = 10% orthostatic hypotension, 10% cardiac syncope, 80% NMS
> 60: 25% cardiac syncope, 25% orthostatic, 50% NMS
Cardiac syncope associated with highest mortality
Typical precipitating/trigger events to neurocardiogenic syncope
Prolong standing
Post-prandial
Being in hot/ crowded places
Head rotation/ pressure on carotid sinus
Long history of recurrent syncope
How to distinguish neurocardiogenic syncope from orthostatic hypotension
Tilt table test: tilt table that raises to 70o above supine
Sudden significant fall in BP or HR with loss of consciousness or the inability to maintain posture = Positive for vasovagal syncope
Progressive orthostatic hypotension with or without symptoms = Orthostatic hypotension
leading causes of sudden cardiac death in young athletes?
Hypertrophic obstructive cardiomyopathy (HOCM)
Arrhythmogenic right ventricular dysplasia (ARVD)
Congenital anomalies of coronary arteries
Atherosclerotic coronary heart disease (probably homozygous familial hyperlipidemia)
