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Cardio > Overview of physiology and pathophysiology of syncope > Flashcards

Overview of physiology and pathophysiology of syncope Flashcards

1
Q

General explanation of syncope?

A

Specific form of a transient loss of consciousness

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2
Q

3 types of syncope?

A

Reflex
Orthostatic hypotension
Cardiac

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3
Q

Sub types of reflex syncope?

A

Vasovagal (VVS)
Carotid sinus (CCS)
Situational

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4
Q

Transient Loss of Consciousness (TLOC) definition?

A

A state of real or apparent loss of consciousness with loss of awareness, characterized by amnesia for the period of unconsciousness, loss of motor control, loss of responsiveness and a short duration.

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5
Q

What conditions can cause TLOC?

A 
Head trauma 
Syncope 
Epileptic seizures 
TLOC mimics  (psychogenic, pseudo syncope)  
Other causes
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6
Q

Definition of syncope?

A

Transient loss of consciousness due to cerebral hypoperfusion, characterized by rapid onset, short duration and spontaneous complete recovery

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7
Q

Reflex syncope?

A

All types of syncope in which neural reflexes modify HR and/or vascular tone (vasodepression) hence predisposing to a fall in MAP (sysetmic hypotension) of sufficient severity to affect cerebral perfusion causing a transient period of cerebral hypoperfusion resulting syncope or near syncope

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8
Q

Reflex syncope is uncommon. True or false?

A

False. It is common

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9
Q

Events that occur in reflex syncope?

A

When reflex is activated
this causes cardioinhibition through vagal stimulation
causing decreased HR and CO
AND/OR
Vasodepression through depression of sympathetic activity to blood vessels
Decreasing systemic vascular resistance (vasodilation), venous return, stroke volume and CO
This decreases in everything causes decrease in MAP
=
Cerebral hypoperfusion and syncope/ near syncope

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10
Q

Most common type of syncope?

A

Vasovagal

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11
Q

What causes vasovagal syncope?

A

Faint is caused by emotional stress or orthostatic stress

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12
Q

What symptoms occur in vasovagal syncope?

A

Palor
Sweating
Nausea

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13
Q

How can vasovagal syncope be averted?

A

Lying down )adopting horizontal gravity neutralisation)
Leg crossing

Both of these increase venous return

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14
Q

Main risk of Vasovagal syncope?

A

Injury when falling

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15
Q

VVS is not associated with increased mortality. True or false?

A

True

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16
Q

Treatment of VVS?

A

Education
Reassurance
Avoidance of triggers
Adequate hydration

17
Q

What happens in situational syncope?

A

Faint during or immediately after a specific trigger. Eg coughing, urination, swallowing

18
Q

Vasovagal syncope is less common than situational syncope. True or false?

A

False. Vasovagal is most common

19
Q

Treatment for situational syncope?

A

Treat the cause eg if it is a cough
Advise patient to lie down if possible
Avoid dehydration and XS alcohol

However some cases of cardiac pacing may be required in some cases

20
Q

What is the carotid sinus reflex triggered by?

A

Mechanical manipulation of the neck eg shaving, tight collar

21
Q

Who is CSS more common in?

A

Elderly males

22
Q

When might CSS occur?

A

After head and neck surgery or radiation

23
Q

Treatment of carotid sinus syncope?

A

Permanent pacing is generally recommended

24
Q

Associated conditions with CSS?

A

Carotid artery atherosclerosis- not clear if this is causative or not

25
Q

Another reason why people have syncope?

A

Postural hypotension

26
Q

What is postural hypotension?

A

Results from failure of baroreceptor responses to gravitational shifts in blood, when moving from horizontal to vertical position

27
Q

Other term for postural hypotension?

A

Orthostatic hypotension

28
Q

Risk factors for orthostatic hypotension?

A 
Age related 
Medications 
Certain diseases 
Reduced intravascular disease 
Prolonged bed rest
29
Q

Positive result showing postural hypotension?

A

Drop in blood pressure within 3 minutes of standing up from lying position
Systolic= Atleast 20mmHg
Diastolic= 10mmHg

30
Q

Symptoms of postural hypotension?

A

Those of cerebral hypoperfusion- Dizzy, light headed blurred vision, faintness and falls

31
Q

What is cardiac syncope caused by?

A

Cardiac event caused resulting in a sudden drop in cardiac output

32
Q

What can cardiac syncope be caused by?

A

Arrhythmias- Resulting in tachy or bradychardia
Acute myocardial infarction
Structural cardiac dieases - aortic stenosis, hypertrophic cardiomyopathy
Other cardiovascular diseases- pulmonary embolism, aortic dissection

33
Q

Initial evaluation of a patient presenting with TLOC?

A

Careful history
Full physical examination
Orthostatic BP measurement
12 lead ECG

34
Q

Features that suggest cardiac syncope?

A

Syncope during excretion or when supine
Presence of structural cardiac abnormality or coronary heart disease
Family history of sudden death at a young age
Sudden onset palpitations immediately followed by syncope
Finding on ECG suggestive of arrhythmic syncope

Cardio (36 decks)

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