CARDS III Flashcards
What is True Syncope
True syncope: Transient loss of consciousness and or postural tone due to a self terminating loss of nutrient flow to brain, followed by complete and usually rapid spontaneous recovery
Most common cause: Vasovagal
What is the MC cause and 2nd MC Cause of True Syncope
Most common cause: Vasovagal
Second most common cause: Cardiac (structural or dysrrhythmia)
Less frequent but common: Reflex mediated causes
Define pre-syncope
Pre-syncope (near syncope): Conditions where the patient feels like they will lose consciousness but do not.
Usually lasts only seconds
Can manifest as lightheadedness, feeling unstable in upright position, nausea or feeling hot or cold, “feeling like I am blacked out”
What are the four groups of True Syncope
A. Reflex Mediated
Vasovagal
Situational = Cough or Sucking
Carotid Sinus Hypersensitivity
B. Orthostatic Hypotension (OH) Neurogenic - baroreflex dysfunction Autonomic Dysfunction = PD, DLB, PAF Neuropathies = DM, Amyloidosis, PAN Age related ↓ baroreceptor sensitivity Acute Intravascular Depletion Medications Arenal Insufficiency / Addisons Disease
C. Cardiac Arrhythmias Bradycardia = SSS, AVB Tachycardia AF RVR, SVT, VT Pacemaker failure
D. Cardiopulmonary Structure Exertional LVOO = HOCM, AS, MS, Myxoma, PV RVOO = PS, TS, PHTN, PE Non-exertional NYHA Class 4 Heart Failure Carbon Monoxide COPD Exacerbation
What is the MOA of reflex mediated Syncope
Reflex Mediated = Conditional episodic impairment of sympathetic withdrawal with paradoxical conditional activation of the parasympathetic efferent
Response: ↓BP ↓HR
Define orthostatic HOTN
Drop in SBP greater than 20
Or DBP greater than 10
From supine, to sitting, to standing
Seperated by 5 min
What is the QT elongation cutoffs in QTC prologation
Men greater than 440 msecs
Women greater than 460 msec
What effect do Azithromycin and Ondansetron have on the QTi
Prolong and can cause Torsades
Create scenarios from slide 47 of syncope Pts
What are the 6 steps to doing an accuratae BP
Prepare the patient
(5 min at rest in chair; avoid stimulants prior; empty bladder; no talking; cuff on skin)
Proper technique (Calibrated / validated device; arm is rested at level of right atrium; correct cuff size-80%)
Proper measurements (Assess both arms 1st; reassess higher arm every 1-2 min; estimate SBP by radial pulse obliteration; then inflate 30 mmHg above and deflate 2mmHg / sec for ausculatory reading)
Record BP: SBP at 1st Korotkoff sound, DBP at disappearance of all sounds, and time of last antihypertensive med
Estimate patient BP with an average ≥ 2 readings obtained on ≥ 2 occasions to
Communicate the SBP/DBP to the patient, both verbally and in writing.
Define Stage 1 HTN
130-139/ 80-89
Define stage 2 HTN
Greater than 140/90
Defined elevated BP
120-129/ 80
What are the three key feautres of Primary HTN
Elevated DBP
Elevated SBP
Low Renin State
What is the most common cause of death from HTN
CAD
