Collapse, Weakness, Exercise Intolerance Flashcards
What is the problem with a ‘collapsing’ patient?
What is important for you to spend enough time doing?
- Patient is often “normal” at presentation.
- Differential diagnosis list is huge -collapse, weakness, syncope, fainting, fits, seizures, funny turns etc,etc,etc.
- SIGNALMENT.
- HISTORY AND OWNER’S DESCRIPTION OF THE EVENTS IS VITAL, TAKE YOUR TIME.
- FULL GENERAL HISTORY –OFTEN BEST LEFT UNTIL AFTER DESCRIPTION OF THE EVENT.
What kind of information do you want to get from a history?
- Full general history –do first?
- Then full description of episode(s)
- History –should identify episode as:
- Syncope (faint)
- Seizure
- Episodic weakness
- Number of events
- Age at onset
- Duration
- Time of day
- Association with:
- Exercise/excitement - If after exercise –more likely cardiorespiratory disease
- Feeding
- Rest/waking If after just woken up, far more likely to consider seizure
If collapse is associated woth exercise/excitement - which body system is most likely to be affected?
More likely to be cardiorespiratory
If collapse is associated with rest/waking - which body system is most likely to be affected?
If after has just woken up, far more likely to consider seizure
What are some more specific things you should ask about the history with a collapsing patient?
- All the same –specific, predictable?
- Prodrome/post ictalbehaviour
- Tonic/clonic or flaccid
- Autonomic signs –Has it lost control of bladder or defecate at the time?
- Consciousness lost?
- MM pallor/cyanosis
- Heart rate
- Normal between episodes –e.g. ex tolerance
- Medication –any response/cause of episode
- Toxin/drug access
What are some significant findings you are looking for in a patient that has collapsed previously?
- Significant findings??
- MM pallor
- Dysrhythmia
- Heart murmur
- Neurological abnormality
- Musculoskeletal abnormality
Significant findings may not always be relevant to the epidoes its having
After physical exam and moving onto diagnostic tests in a collpasing patient, what is done next?
What is done next is determined by:
- Findings on physical examination
- Pursue clinical abnormalities
- Pursue breed-specific abnormalities?
- RISK –breed associated disease?
- Severity and/or frequency of episodes
- Financial constraints
Define syncope
- Sudden, short-lived loss of consciousness
- Temporary failure of delivery of energy substrate to CNS - Oxygen and glucose in the blood, failure to thebrain
- Typically failure of perfusion
- ?? 6 seconds+
What are some clinical signs of syncope?
- Sudden onset
- Generalised weakness/ataxia
- Flaccid collapse -motionless
- Consciousness lost
- Maybe autonomic signs
- Maybe generalised mm activity
What are some differential diagnoses for syncope relating to inappropriate vascular reflexes?
- Inappropriate vascular reflexes –will be clinically quite normal!
- Vasovagal
- Carotid sinus
- Situational e.g. tussive
- BP falls
- perfusion fails
- Clinically normal?
- Lots of boxers faint
- Often associated with excitement
What are some cardiac differential diagnoses for syncope?
Cardiac
- Dysrhythmia
- Flow obstruction
- Pump failure
- Tamponade/preload failure
- Effusion can cause tamponade
- Perfusion fails
- Clinical abnormality likely
- Exertional?
What are some non-cardiac differential diagnoses for syncope?
Non-cardiac
- Metabolic
- Non-motorseizure so no obvious tonic clonic signs
- Central neurological
- Clinical abnormality?
What are some diagnostic tests you can perform when you have suspected syncope in a patient?
The underlined ones are the highest yield tests, especially if the animal is clinicallynormal
- Haematology and clinical biochemistry
-
ECG
- 24 hour/event recorder/monitor
- Thoracic/abdominal radiography
- Echo
What is wrong with this ECG? Patient presented with syncope
Is this animal going to collapse?
Ventricular tachycardia, almost ventricular flutter
is this animal going to collapse? YES - heart will be going so fast it will not be able to fill properly
Describe findings on this ECG of a patient that presented with syncope
Why does the ECG go off the paper at one point?
- Normal sinus rhythm
- Then goes into complete heart block
- P waves without QRS
- Escape beats
- ECG goes right up as the cat fell over
- This cat has COMPLETE HEART BLOCK
What is wrong with this ECG?
Supraventricular tachycardia
Describe findings on this ECG
Wide and bizarre complexes
Ventricular complexes
Describe what the arrow is pointing at here on this ECG
Inverted P waves
Sinoatrial node disease
