Cardiac - Syncope

Question 1

Syncope

Definition

Answer 1

Question 2

Syncope

Ddx of non-syncopal cause of TLOC

Answer 2

Question 3

Cardiogenic syncope

Causes

Answer 3

Question 4

Orthostatic hypotension

Causes

Answer 4

Question 5

Neurogenic/ Neurocardiogenic syncope

Causes

Answer 5

Question 6

Syncope

prodromal symptoms

Answer 6

Question 7

Syncope

Witness signs

Answer 7

Question 8

Syncope

Pathophysiology

Answer 8

1. Cardioinhibitory and vasodepressor response
2. Autonomic dysfunction

Question 9

Syncope

HPI

Answer 9

Question 10

Syncope

Relevant medical/ surgical/ drug/ family history

Answer 10

Question 11

Syncope

P/E
Dynamic Ix

Answer 11

+ assessment of injuries

Question 12

Syncope

Radiological Ix

Answer 12

Question 13

Vasovagal syncope

Treatment

Answer 13

Question 14

Orthostatic hypotension

Treatment

Answer 14

Question 15

4 major categories of cause of TLOC

Answer 15

Head trauma/ traumatic TLOC
Non-traumatic TLOC:

• Syncope
• Epileptic seizures
• Psychogenic

Question 16

Most common causes of syncope in <40, 40-60, and >60 years old pt

Answer 16

<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

Question 17

Typical precipitating/trigger events to neurocardiogenic syncope

Answer 17

Prolong standing

Post-prandial

Being in hot/ crowded places

Head rotation/ pressure on carotid sinus

Long history of recurrent syncope

Question 18

How to distinguish neurocardiogenic syncope from orthostatic hypotension

Answer 18

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

Question 19

leading causes of sudden cardiac death in young athletes?

Answer 19

 Hypertrophic obstructive cardiomyopathy (HOCM)
 Arrhythmogenic right ventricular dysplasia (ARVD)
 Congenital anomalies of coronary arteries
 Atherosclerotic coronary heart disease (probably homozygous familial hyperlipidemia)