Collapse

Question 1

Is a fall with or without facial injury more concerning?

Answer 1

With - no aura/warning prior to collapse

Question 2

What condiitons are no tsyncope but should be ruled out in an initial hisotry

Answer 2

• Seizure
• Stroke
• Head injury
• Cardaic syncope
• Blood loss
• PE
• Subarrachnoid haemorrhage

Question 3

List as many life threatening causes of syncope as you can

Answer 3

CVS
-Arrhytmia - VT, Long QT syndrome, Brugada syndrome, Bradycardya - Mobitz type II or 3rd degree HB, significatn sinus pause over 3 seconds
Ischaemia - ACS, MI
Structural - Aortic or mitral stenosis, Cardiomyopathy, atrial myxoma, cardiac tamponade, aortic dissection
Significant haemorrhage - tissue rupture: aortic aneurysm, spleen, ovarian cyst, ectopic pregnancy, retroperitoneal hameorrhage
PE - saddle embolus -> outflow obstruction or severe hypoxia
Subarrachnoid haemarrhage

Carotid sinus hypersensitivity - turning head, shaving, circumferential neck compression eg tie

Question 4

How can PE cause collapse

Answer 4

Saddleembolus -> outflow tract obstruction or severe hypozia

Question 5

List causes of neurocardiogenic syncope

Answer 5

Micturition
Defecation
Cough mediated
Deglutiiton
Glossopharyngeal nerve
Situational

Question 6

What can cause orthostatic syncope?

Answer 6

Volume loss
Autonomic duysfunction
Deconditioning, prolonged bed rest

Question 7

Mediation realted syncope causes list

Answer 7

Vaso active medications
meds affecting conduction
Meds affecting QT interval
diuretics

Question 8

What medications are vasoactive

Answer 8

Alpha dn beta blockers
CCBs
Nitrates
AntiHPTN
Diuretics
Erectily dysfunction - PDE 5 inhibitors

Question 9

Mediations affecting conduction

Answer 9

Antiarrhtymics
CCBs
Digoxin

Question 10

List neural mediated syncope clinical features that suggest a ccause

Answer 10

Absence of heart disease
Long istory of recurrent
Sudden unexpected unpleasant stimulus
Prolonged stand, hot, cold
N+V ass
During or after meal - postprandial
With head rotation or pressure in carotid sunis
After exertion

Question 11

What clinical features suggest an orthastatic hypotensive cause?

Answer 11

AFTER standing
Temporal relationshup with start or change in vasopressive druggs -> hypotnesion
Prolonged stan
Presence autonomic neuropathy or parkinsons
Stand after exertion

Question 12

Clinical features suggesting a CVS cause of syncope

Answer 12

Presence of structural HD
FH unexplained sudden death or channelopathy
Exertion or supine
Abnormal ECG
Palpitations before
ECG findings -> arrhytmic syncope

Question 13

What does Brugada syndrome look like on ECG?

Answer 13

RBBB pattern with ST elevation in leads VI to V3

Question 14

ECG findings arrhytmias that can cause syncope

Answer 14

Bufasicular block eg LBBB or RBBB WITH L anterior or posterior fascicular block
QRS over 0.12 s (Intraventricular abnormal conduction)
Mobitz I second degree HB
Asymptomatic innapropraite bradycardia <50bpm, sinoatrial block or sinus pause over 3s in absense of negatively chronotropic meds
Nonsustained VT
Presxcited QRS complexes
Long or short QT intervals
Early repolarisation
Brugada syndrome
Negative T waves in R precordial lead, epsilon waves and V late potenitals - suggestive of ARVC
pATHOLOGICAL q WAVES

Question 15

What is fascicular block?

Answer 15

Interference with a fascicle of a branch of the bundle of His in the left

Question 16

What does fascicular block cause

Answer 16

Left vntricle to pumo later than rght

Question 17

What is ARVC and how can it cause syncope

Answer 17

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease of the heart muscle. In this disease, fatty fibrous tissue replaces normal heart muscle. This interrupts normal electrical signals in the heart and may cause irregular and potentially life-threatening heart rhythms.

Question 18

How do you rule out a PE as a cause of syncope

Answer 18

Wells score - under 4 = PE unlikely
D-dimer - negative