FN: Blackouts Flashcards
Causes Pneumonia
CRASH Cardiac Reflexes Arterial Systemic Head
Cardiac causes of blackouts
Stokes-Adams Attacks
- Brady: heart block, sick sinus, long QT
- Tachy: SVT, VT
- Structural
1. Weak heart: LVF, tamponade
2. Block: AS, HOCM, PE
Refexes
- Vagal overactivity
2. sympathetic underactivity
Vagal overactivity
- vasovagal syncope
- Situational: cough, effort, micturition
- Carotid sinus syncope
Sympathetic underactivity
STANDUP
- Salt deficiency: addisons, hypovolaemia
- Toxin
- Autonomic Neuropathy: DM, Parkinsons. GBS
- Dialysis
- Unwell: chronic bed rest
- Pooling venous: varicose veins, prolonged standing
Toxins cause sympathetic underactivity
Cardiac: ACEi, diuretics, nitrates, alpha blockers
Neuro: TCAs, benzos, antipsychotics, L-DOPA
Arterial causes of blackouts
- Vertebrobasilar insufficiency: migraine, TIA, CVA, subclavian steal
- Shock
- Hypertension: Phaeochromocytoma
Systemic causes fo blackouts
- Metabolic: reduced glucose
- Resp: hypoxia, Hypercapnoea (e.g. anxiety)
- Blood: anaemia, hyperviscosity
Head causes of blackouts
Epileps
Drop attacks + cataplexy emotional collapse
Examiantion findings
Postural hypotension: difference of >20/10 after standing for 3 min vs. ;ing down
Cardiovascular examination
Neurological examination
investigations
ECG ± 24hr ECG U+E, FBC, Glucose Tilt table EEG, sleep EEG Echo, CT, MRI brain
Cardiogenic syncope presentation trigger
Exertion, drug, unknow
Cardiogenic syncope presentation before
palpitations, chest pain, dyspnoea
Cardiogenic syncope presentation during
pale, slow/absent pulse, conic jerks may occur
Cardiogenic syncope presentation after
rapid recovery
Cardiogenic syncope presentation investigations
ECG, 24hr ECG, Echo
Reflex: vasovagal presentation trigger
prolonged standing, heat, fatigue, stress
Reflex: vasovagal presentation before
Gradual onset: secs- mins
Nausea, pallor, sweating, tunnel vision, tinnitus
Cannot occur lying down
Reflex: vasovagal presentation during
Pale, grey, clammy, brady
Clonic jerks and incontinence can occur, ut no tongue bitting
Reflex: vasovagal presentation after
Rapid recovery
Reflex: vasovagal presentation Investigations
Tlt-table testing
Reflex: Postural Hypotension trigger
STanding up
Reflex: Postural Hypotension before, during and after
same as vasovagal
Reflex: Postural Hypotension Ix
Tilt-table testing
Arterial trigger
Arm elevation (subclavin steel) migraine
Arterial before, during and after
As for vasovagal ± brainstem Sx (diplopia, nausea, dysarthria)
Arterial Ix
MRA, duplex vertebrobasilar circulation
Systemic symtpoms
Hypoglycaemia: tremor, hunger, sweating, light-headness - LOC
Head: epileptic trigger
Flashing lights, fatigue, fasting
Head: epileptic before
e.g. aura in complex partial seizures - feeling strange, epigastric rising, deja.jamais vu, smells, lights, automatisms
Head: epileptic during
Tongue biting, incontinence, stiffness - jeking, eyes open, cyanosis, reduced sats
Head: epileptic after
headache, confusion, sleeps, todds palsy
Head: epileptic Ix
EEG, raised Serum prlactin at 10-20 mins
Head: drop attacks trigger
nil
Head: drop attacks before
no warning
Head: drop attacks during
sudden weakness of legs cause older women to fall to the ground
Head: drop attacks after
no post-ictal phase
