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Emergency Medicine > Lecture 6: Syncope > Flashcards

Lecture 6: Syncope Flashcards

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1
Q

How long does syncope typically last?

A

< 1 minute, with full recovery after.

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2
Q

What are the 4 MCC of syncope?

A
  1. Reflex syncope
  2. Orthostatic syncope
  3. Cardiac arrhythmias
  4. Structural cardiopulmonary disease
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3
Q

What is reflex syncope?

A

Upright position resulting in vasodilation.

MC after exercise, defecation/urination, coughing, etc

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4
Q

What can help differentiate a seizure from syncope physically?

A

Seizures tend to have their eyes open

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5
Q

What is a long QTc?

A

> = 440ms in men, 460 in women

> 500 is risk of torsades

General rule of thumb: Less than half of preceding RR interval

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6
Q

What drug classes are common for QT prolongation?

A
  • Zofran
  • Macrolides
  • FQs
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7
Q

What is the exclusion criteria for Canadian Head CT?

A
  1. Age < 16
  2. Pt on blood thinners
  3. Seizure after injury
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8
Q

When can you NOT use the canadian syncope risk score?

A
  • LOC > 5 min
  • AMS
  • Seizure
  • Head trauma with LOC
  • Intoxication
  • Language barrier
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9
Q

San Francisco Syncope Mnemonic

A
  • CHF history
  • Hct < 30%
  • EKG abnormal
  • SOB hx
  • SBP < 90 at triage

CHESS

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10
Q

What makes cardiac syncope more likely?

A
  • Lack of prodrome
  • Happens without precipitating event
  • Underlying heart disease
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11
Q

What falls under reflex syncope?

A
  • Vasovagal
  • Situational
  • Carotid Sinus Syncope
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12
Q

Features of vasovagal syncope

A
  • MC type of syncope overall
  • Prodrome usually present
  • Occurs either sitting or standing
  • Classic: donating blood or emotionally upset
  • After vigorous exercise
  • Usually a dx of exclusion
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13
Q

What is the underlying pathology of trigger reflex syncope?

A

Increased parasympathetic activity, slowing the heart.

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14
Q

What is the underlying pathology of orthostatic syncope?

A
  • Change in position causes BP change
  • Sympathetic is impaired, so there is a reflexive tachycardic response
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15
Q

Define orthostatic hypotension

A

Greater than 20 SBP or 10 DBP drop from supine to standing.

Often accompanied by 20 BPM increase as well.

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16
Q

MCC of orthostatic hypotension

A
  • Neurodegenerative
  • Neuropathies
  • Autoimmune disorder
  • Volume depletion
  • Medications
  • DM
17
Q

What meds can contribute to orthostatic hypotension?

A
  • Loop diuretics
  • alpha-1 adrenergics
  • beta-adrenergics
  • alpha-2 adrenergics
  • Nitric oxide vasodilators
  • RAS inhibitors
  • CCBs (Non-DHP)
  • Dopamine antagonists
  • Antidepressants
  • SSRIs
  • SGLT2i

Things that vasodilate or lower volume

18
Q

Who is carotid sinus hypersensitivity MC in?

A

Older males with atherosclerosis

Secondary: neck abnormalities or tumors in the carotid sinuses

19
Q

What is positive carotid syncope?

A

> 50 SBP drop or symptomatic upon carotid massage

20
Q

What are the indications for aortic stenosis valve replacement?

A
  • Severe AS with symptomatic
  • Severe AS undergoing CABG, aortic, or valve sx
  • Severe AS with LVEF < 50%
21
Q

What must you avoid in the ED for aortic stenosis?

A
  • Non-DHP CCBs
  • Preload reducers (Nitro)
  • BBs
22
Q

What is subclavian steal syndrome?

A
  • Stenosis of subclavian artery
  • Decreased perfusion pressure to distal subclavian, so retrograde flow goes into ipsilateral vertebral artery
  • Summary: Arm steals blood flow from vertebrobasilar system, causing neurologic and UE symptoms due to arterial insufficiency
23
Q

What presentation suggests subclavian steal syndrome?

A
  • BP is much lower in the ipsilateral arm
  • UE pain, fatigue, coolness, paresthesia
  • Right is much more common
24
Q

Dx of subclavian steal syndrome

A
  • Arterial US or CTA with contrast

Maybe arm, chest, and head

25
Q

Tx of subclavian steal syndrome

A
  • Statins
  • AP/AC therapy
  • Smoking cessation
  • BP management

Tx of stenosis

26
Q

Presentation of basilar artery insufficiency

A
  • Head position change can cause symptoms
  • Syncope if contralateral side is stenotic
  • N/V
  • Weakness
  • Numbness
  • Dysphagia
  • Dysarthria
  • Syncope
  • Vision changes

V similar to stroke

27
Q

Dx of basilar artery insufficiency

A
  • Glucose
  • CT brain w/o con
  • CTA Head & neck w/ con
  • Full neuro
  • HINTS exam (distinguish between central vs peripheral vertigo)

HI abnormal = peripheral
N unidirectional horizontally = peripheral
TS no skew = peripheral

28
Q

What is the HINTS exam?

A
  • Horizontal Head Impulse Test
  • Nystagmus in eccentric gaze
  • Test of Skew (Vertical Skew)

when you suspect a posterior stroke

This differentiates between central and peripheral vertigo, since central vertigo etiologies are much worse.

Emergency Medicine (29 decks)

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