Clinical: Syncope Flashcards
What age groups have a high incidence of syncope?
- 10 to 30 year-olds
- Incidence also increases after age 70
- What must occur to the brain for a patient to have syncope?
Describe the criteria for BP levels for syncope
Neurally Mediated [Reflex] Syncope
- All the disorders in this group have a common final pathway characterized by what 3 conditions?
Neurally Mediated [Reflex] Syncope
- What happens to parasympathetic tone?
- What “reflex” is involved?
- What kind of vessel control is involved?
- How worried are most doctors about this form of syncope?
These strips are from a patient who was induced to have a fainting episode
- What is a “jerk” associated with?
- Where is the vasovagal response occurring?
- What is the asystole associated with?
- Jerk
- Syncope + not being able to lay horizontally when passed out
- Vasovagal = Red
- Asystole (Blue)
- Drop in blood pressure
Neurally Mediated [Reflex] Syncope: Vasovagal Syncope
- What is notable about this type of syncope in term of incidence?
- What 2 conditions is it associated with?
- How deadly is this type of syncope?
- What are some of the prodromal symptoms associated with it?
Carotid Sinus Hypersensitivity
- What type of syncope does this fall under?
- What is the cause of this physiological cause of this condition?
- What activities can bring about an episode of this type of syncope?
- What category of syncope do these all fall under?
- Do we consider them risky or mostly benign?
Benign
- What type of syncope is associated with a drop in systolic BP?
- What population usually has this type, and why?
- What medications can produce this syncope, and what type of conditions can produce it?
Orthostatic Hypotension
- What are the BP criteria for this type of syncope?
- How do you test for it?
Cardiac Syncope
- What are the main categories of cardiac syncope?
- What conditions make up the “other” category?
- Why do we consider these forms on syncope serious/risky?
- Arrhythmias
- Structural/Valve Disease
- “Other”
What type of syncope are is the following associated with?
Cardiac Syncope: Bradyarrhythmias
What is a Stokes-Adams Attack?
Syncope due to a heart block
What makes you believe that this patient suffered a Stokes-Adams attack?
The heart block lasts between 2 and 2.5 seconds, which can lead to syncope
Which type of syncope is the following associated with?
Cardiac Syncope: Bradyarrhythmias
Which type of syncope is the following associated with?
How do you treat it?
Cardiac Syncope: Bradyarrhythmias
Cardiac Syncope: Tachyarrhythmias
- What criteria for heart rate can cause this form of syncope?
- How is this syncope related to
- Diastole
- Blood Pressure
- Blood Perfusion
- What general type of cardiac disease is this common in?
Cardiac Syncope: Tachyarrhythmias
- What type of heart rhythm is most concerning?
Cardiac Syncope: Tachyarrhythmias
- What conditions/disease put PTs at high risk of ventricular arrhythmia?
- Which condition is associated with sudden death particularly in Asian males?
Cardiac Syncope: Tachyarrhythmias and Ischemic Heart Disease
- How often do MI patients present with syncope as a major symptom?
- Why would a patient with a previous MI present with a ventricular arrhythmia?
Cardiac Syncope: Tachyarrhythmias and Prolonged QT [Hereditary]
- What is the general mechanism behind this?
- What type of rhythm can this develop into?
- Describe Jervell and Lange-Nielsen syndrome
- Describe Romano-Ward syndrome
Cardiac Syncope: Tachyarrhythmias and Prolonged QT [Non-Hereditary]
- What could cause this type of syncope?
Cardiac Syncope: Tachyarrhythmias
- What type of condition is associated with a bypass tract and an increased risk to develop A-Fib?
Cardiac Syncope: Tachyarrhythmias and Wolff Parkinson White
- What electrophysical pathology is this associated with?
- What type of heart condition can patients develop, and what does this present in terms of heart rate?
- What kind molecules are increased in this condition, and what are the conditions associated with this increase?
Cardiac Syncope: Tachyarrhythmias and Hypertrophic Cardiomyopathy
- Why is this condition significant in terms of death and young people?
- What kind of genetic inheritance is this condition associated with? What sex gets this condition at lower rates?
- Pathology
- What are the hallmarks of this condition?
- What structure is most commonly involved?
- What happens to the outflow from the LV?
- What to most patients have trouble with and why?
Cardiac Syncope: Tachyarrhythmias and Hypertrophic Cardiomyopathy
- What would you see on an ECG?
- Where can a murmur be heard, and is this murmur diastolic or systolic?
- What do you see when looking at MRI and Ultrasound imaging for this?
Cardiac Syncope: Tachyarrhythmias and Hypertrophic Cardiomyopathy
- When do these patients get syncope? How does this relate to cardiac output?
- Why do these patients have angina, and what does this increase the risk for?
Cardiac Syncope: Tachyarrhythmias and Hypertrophic Cardiomyopathy
- Treatment
- What are the typical treatments for these patients?
- What therapy is considered for high-risk patients?
Cardiac Syncope: Aortic Stenosis
- How often does severe aortic stenosis present with syncope?
- What happens to cardiac output?
- How do A-Fib and V-Fib relate to this?
Cardiac Syncope: Heart Failure
- Relate Syncope due to heart failure to ejection fraction
- What type of dysrhythmias do these have patients have increased risk for?
- What is considered the treatment for this?
Evaluation of Syncope
- When you have a Pt with syncope, what do you consider/need to do when assessing why they have syncope?
List some of the criteria that would make a patient a high risk syncope patient
- Name some of the additional testings you would do on the patient once you receive their ECG
