CLINICAL: Palpitations and syncope

Question 1

What is fainting/ syncope?

Answer 1

The self limited loss of consciousness and postural tone
has a relatively rapid onset
underlying mechanism of transient global cerebral hypoperfusion

HISTORY very important

Question 2

What are the different types of syncopy?

Answer 2

Neurally mediated
orthostatic hypotension
cardiac

Question 3

Neurally mediated syncope

Answer 3

• Vasovagal syncope (heart rate drop at blood for example)
• carotid sinus syndrome
• situational (cough, swallow, defecation)

Question 4

Orthostatic

Answer 4

low blood pressures caused by a certain positioning of the body eg

Drug induced- diuretics; vasodilators
Primary or secondary autonomic failure (1- POTS, parkinsons) (2- diabetes, alcohol)

Question 5

How could orthostatic hypotension be treated?

Answer 5

Patient education is optimal, then some hydration therapies and tilt training.
Drug therapies are less used

Question 6

How can cardiac syncope present?

Answer 6

Can be life threatening and might show CV disease

Tachy or brady arrythmias
myocardial ischaemia, aortic dissection/stenosis

Question 7

What is a palpitation

Answer 7

An awareness of a heart rate or rhythm change.
Usually benign and transient.
History important in diagnosis

Question 8

What is long QT syndrome

Answer 8

abnormality of the sodium and or potassium channels

Can be drug induced or genetic (rarer)