Falls

Question 1

What is syncope

Answer 1

Syncope - transient loss of consciousness characterised by fast onset and spontaneous recovery

Caused by reduced perfusion pressure in the brain

Usually self-limiting

Being horizontal will fix the low BP

Question 2

Name some pre-syncope symptoms

Answer 2

Light-headedness

Sweating

Pallor

Blurred vision

Question 3

What are the catagories of syncope

Answer 3

Reflex syncope

Orthostatic hypotension

Cardiac syncope

Question 4

What is reflex syncope

Answer 4

Reflex syncope - disorder of autonomic regulation of postural tone where the body does not regulate BP

Activation of part of the medulla leads to decreased sympathetic and increased parasympthatic output

This causes a fall in CO (decreased HR) and a decreased BP leading to reduced cerebral perfusion and syncope

Question 5

Name some types of reflex syncope

Answer 5

Vasovagal - from prolonged staning, stress, pain, sight of blood

Situational syncope - coughing, urinating, straining, heavy lilfting

Carotid sinus massage - lower HR and BP

Question 6

Describe orthostatic hypotension

Answer 6

Orthostatic hypotension occurs after standing from a sitting or lying position

Standing causes a drop in BP and if severe enough it causes syncope

Drop in BP is caused by 500-800ml of blood pooling in legs -> have decreased EDV and preload -> decreased CO and decreased BP

Normally the decreased BP is managed by baroreceptor reflex but if this fails then cerebral perfusion drops and syncope occurs

Question 7

Name some reasons why the baroreceptor reflex may fail

Answer 7

Baroreceptors become less sensitive with age

Baroreceptors become less sensitive with hypertension

Mediation - e.g. anti-hypertensives

Dehydration

Question 8

Describe cardiac syncope and the featues of a patient with cardiac syncope

Answer 8

Cardiac syncope is caused by a cardiac disease or abnormality

Features of cardiac syncope include - exertional syncope, family history of cardiac disease or sudden death, preceding chest pain, palpitations, past medical history of heart disease, abnormal ECG

Question 9

Name some causes of cardiac syncope

Answer 9

Electrical - arrhythmias

Structural - aortic stenosis, hypertrophic obstructive cardiomyopathy

Coronary - MI, IHD, PE