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INTERNAL MEDICINE > CHAPTER 18 SYNCOPE > Flashcards

CHAPTER 18 SYNCOPE Flashcards

1
Q

it is the transient self limited self conscious due to acute global impairment of cerebral blood flow

A

syncope

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2
Q

onset of syncope

A

rapid duration brief and recovery spontaneous

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3
Q

differential diagnosis for syncope

A

seizures
vertebrobasilar ischemia
hypoxemia
hypoglycemia

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4
Q

what is the typical presyncope (syncopal prodrome)

A 
dizziness
lightheadednes
faintess
weakness
fatigue
visual and auditory distrubances
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5
Q

causes of syncope

A

neurally mediated syncope also called for reflex or vasovagal syncope
orthostatic hypotension
cardiac syncope

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6
Q

type of syncope that comprises heterogenous group of functional disorders that is characterized by transient change in the reflexes responsible for maintaining cardiovascular homeostasis

A

neurally mediate syncope

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7
Q

causes for the temporary failure of blood pressure control

A

episodic vasodilation (loss of vasoconstrictor tone)

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8
Q

cause of orthostatic hypotension

A

autonomic failure where the cardiovascular homeostatic reflexes are chronically impaired

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9
Q

causes of cardiac syncope

A

arrhythmias or structural cardiac disease that can cause a decrease in cardiac output

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10
Q

what is peak incidence of syncope

A

age 10 to 30 years

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11
Q

gender prevalence of syncope

A

females than in males

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12
Q

pathophysiology of syncope

A

standing-pooling of blood in lower extremities-decrease in venous return to the heart-reduced ventricular filling-result to diminished cardiac output and blood pressure

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13
Q

the decreased cardiac output will activate the

A

compensatory reflex response initiated by the baroreceptors in the carotid sinus and aortic arch resulting to increased sympathetic outflow and decreased vagal nerve activity

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14
Q

the reflex will result to:

A

increased peripheral resistance, venous return to the heart, cardiac output thus limits the fall in the blood pressure

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15
Q

if the response fails?

A

chronic: orthostatic hypotension
transient: neurally mediated syncope

leading to cerebral hypoperfusion

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16
Q

responsible for autoregulation of cerebral blood flow

A

myogenic factors
local metabolites
autonomic neurovascular control

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17
Q

how many minutes cessation of blood from the brain will result to loss of consciousness

A

6-8 seconds

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18
Q

bp that will result to syncope

A

a fall in systolic blood pressure of 50 or lower

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19
Q

causes of decreased cardiac output

A 
decreased effective circulating blood
increased thoracic pressure
massive pulmonary embolus
cardiac brady and tachyarrhythmias
valvular heart disease
myocardial dysfunction
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20
Q

what are the two patterns of EEG changes in syncopal subjects

A

slow flat slow pattern followed by sudden flattening of the EEG followed by the return of slow waves and then normal activity

slow pattern characterized by increasing and decreasing slow wave activity

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21
Q

cause of flattening pattern

A

cessation or attenuation of cortical activity

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22
Q

this type of syncope is the final pathway of a complex central and peripheral nervous system reflex arc where is sudden transient change in autonomic efferent activity with increased parasympathetic outflow resulting in bradycardia, vasodilatation and reduced constriction tone

A

neurally mediated syncope

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23
Q

subtypes of neurally mediated syncope based on afferent pathway

A

vasovagal syncope and situational reflex syncope

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24
Q

another term for vasovagal syncope

A

common faint

25
Q

common faint is provoked by

A

intense emotion
pain
orthostatic stress

26
Q

cause of situational reflex syncope

A

specific localized stimuli that provoke the reflex vasodilation and bradycardia that leads to syncope

27
Q

the subtypes of efferent syncope

A

vasodepressor syncope and cardioinhibitory syncope and mixed syncope

28
Q

features of neurally mediated syncope

A 
orthostatic intolerance
dizziness
lightheadedness
fatigue
premonitory features of autonomic activation: pallor, diaphoresis, palpitations, nausea, hyperventilation, and yawning
29
Q

features during the attack

A 
proximal and distal myoclonus- possibility of epilepsy
eyes open and deviate upward
pupils are dilated
roving eye movement 
grunting
moaning
snorting
stertous breathing
urinary incontinence
fecal incontinence
postictal confusio
visual and auditory hallucination
30
Q

predisposing factor of neurally mediated syncope

A 
motionless upward posture
warm ambiance temperature
intravascular volume depletion
alcohol ingestion
hypoxemia 
anemia
pain
sight of blood
venipuncture
intense emotion
31
Q

cornerstone treatment for neurally mediate syncope

A

reassurance
avoidance of proactive stimuli
plasma volume expansion with fluid and salt

32
Q

how to raise blood pressure by increasing blood central volume and cardiac output

A

isometric counterpressure maneuvers of limbs such as leg crossing or handgrip and arm tensing

33
Q

pharmacotherapy for neurally mediated syncope

A

fludrocortisone
vasoconstricting agents
beta adrenenoreceptor antagonist

34
Q

when is cardiac pacemaker used

A

older px >40 years old in which the syncope is associated with asystole or severe bradycardia and in patients with prominent cardioinhibition due to carotid sinus syndrome

35
Q

type of syncope that is defined as reduction in systolic blood pressure of at least 20mmHg or diastolic blood pressure of at least 10 mmHg within 3 minutes of standing or head tilt up

A

orthostatic hypotension

36
Q

variant of orthostatic syncope that hypotension is delayed which occurs beyond 3 mins of standing

A

mild or early form of sympathetic adrenergic dysfunction

37
Q

a variant of orthostatic syncope where hypotension occurs within 15 seconds of standing that reflect a transient mismatch between cardiac output and peripheral vascular resistance and it does not represent autonomic failure

A

initial orthostatic hypotension

38
Q

features of orthostatic hypotension

A 
light headedness
dizziness
presyncope (near faintness)
nonspecific: general weakness, fatigue, cognitive slowing, leg buckling or headache
visual blurring 
neck pain
dyspnea
angina
39
Q

cause of visual disturbance

A

retinal and occipital lobe ischemia

40
Q

location of neck pain

A

suboccipital
posterior cervical
shoulder region (the coat hanger headache)

41
Q

cause of dyspnea

A

ventilation-perfusion mismatch due to inadequate perfusion of ventilated lung apicess

42
Q

cause of agina

A

impaired myocardial perfusion even with normal coronary arteries

43
Q

aggravating factors for symptoms

A

exertion
prolonged standing
increased ambient temperature or meals

44
Q

causes of neurogenic orthostatic hypotension

A

central and peripheral autonomic nervous system dysfunction

45
Q

drugs that can cause orthostatic hypotension

A 
alpha adrenoreceptor antagonists
antihypertensive
nitrates 
vasodilators
tricyclic agents
phenothiazines
46
Q

first step of treatment for orthostatic hypotension

A

remove the reversible causes such as vasoactive medications

47
Q

second step in treatment of orthostatic hypotension

A

nonpharmacologic interventions such as patient education regarding staged moves from supine to upright
warnings about the hypotensive effects of large meals

48
Q

pharmacologic intervention for orthostatic hypotension

A

fludrocortisone acetate

vasoconstricting agents

49
Q

cause of cardiac syncope

A

arrhythmias and structural heart disease

50
Q

bradyarrhythmias that can cause syncope includes

A

sinus node dysfunction such as sinus arrest or sinoatrial block
atrioventricular block

51
Q

most common association of bradyarrhythmias due to sinus node dysfuction

A

atrial tacyarrhythmia known as tachycardia-bradycardia syndrome

52
Q

syncope due to bradycardia or asytole is referred as

A

strokes-adams attack

53
Q

cause of the compromised hemodynamic function during ventricular tachycardia

A

infective ventricular contraction

54
Q

the long QT syndrome that is associated with prolonged cardiac repolarization and a predisposition to ventricular arrhythmias

A

torsades de pointes

55
Q

it is a inherited associated with exercise stress induced ventricular arrhythmias syncope or sudden death

A

catecholaminergic polymorphic tachycardia

56
Q

treatmen for cardiac syncope caused by arrythmias

A

cardiac pacing for sinus node

AV block and ablation-antiarrhytmic drugs and cardioverter defibrillators

57
Q

type of seizure present in syncope

A

myoclonic-generalized or multifocal

58
Q

reorientation from drowsiness in syncope

A

occurs immediately after the syncopal event

59
Q

syncope are provoked by emotions unlike seizures

A

true

INTERNAL MEDICINE (12 decks)

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