Prunuske: SIM Lab

Question 1

What is syncope?

Answer 1

The transient loss of consciousness secondary to cerebral hypoperfusion.

Question 2

What are the characteristics of syncope?

Answer 2

RSR

Rapid onset
Short duration
complete spontaneous Recovery

Question 3

What are three types of neurally mediated (reflex) syncopes?

Answer 3

1. vasovagal (pain, fear, emotional distress, prolonged standing)
2. situational (urination, defecation, coughing, sneezing, swallowing)
3. carotid sinus syncope (shaving, massage)

Question 4

What is neurally mediated syncope?

Answer 4

Loss of tone leads to bradycardia, hypotension and LOC

Question 5

What are cardiogenic syncopes?

Answer 5

Arrythmias:

1. SA/AV node dysfunction
2. PSVT
3. Paroxysmal Vtach
4. Medication effects
5. Ischemia/CAD
6. Pacer/ ICD dysfunction
7. Inherited syndromes (long QT)

Structural Diseases:
obstructive cardiac valve disease
acute coronary syndrome
obstructive cardiomyopathy
atrial myxoma
acute dissection of aorta
pericardial disease
pericardial tamponade
pulmonary hypertension
pulmonary embolism

Question 6

How does autonomic dysfunction cause syncope?

Answer 6

1. Primary autonomic failure (lewy body disease, Parkinson disease)
2. Secondary autonomic failure (diabetic neuropathy, amyloid neuropathy, spinal cord injury)

Question 7

What medications can cause autonomic dysfunction?

Answer 7

Antihypertensives and diuretics (in our case it was hydrochlorothiazide), TCA, phenothiazines

Question 8

What type of syncope:

defecation, urination, prolonged coughing, pain, fear, heat exposure

Answer 8

Neurally mediated

Question 9

What type of syncope?
syncope during prone posture, during exercise, palpitations, startling (alarm clock, siren)–more likely prolonged QT syndrome

Answer 9

Cardiogenic

Question 10

What type of syncope?

Standing quickly or for prolonged periods, postprandial, heat exposure, following cessation of exercise

Answer 10

Autonomic

Question 11

What is the prevalence of syncope?

Answer 11

3-37%

Question 12

What is the incidence of syncope in institutionalized elderly?

Answer 12

6%

Question 13

What is the distribution for peak incidence of syncope?

Answer 13

10-30 OR greater than 65

Question 14

What is the primary cause of syncope?

Answer 14

Unknown followed by vasovagal, followed by cardiac arrhythmia

Question 15

What is vtach?

Answer 15

3 or more consecutive beats of ventricular origin (wide QRS) at rate 100-200 pbm

Question 16

What are the causes of vtach?

Answer 16

CAD
cardiomyopathy
electrolyte abnormalities
myocardial ischemia
hypoxemia
acidosis
idiopathic

Question 17

How do you treat unstable vtach?

Answer 17

Immediate syncrhonized cardioversion.

Use 50 joules initially, and repeat at increased energy levels as necessary.

Question 18

How do you treat STABLE vtach?

Answer 18

Amiodarone–and plan for elective synchronized cardioversion

Question 19

What is the safest and most effective treatment for vtach?

Answer 19

DC cardioversion

Question 20

What is used for long term therapy of vtach?

Answer 20

1. implantable cardioverter defibrillator (ICD)
2. amiodarone
3. beta blockers

Question 21

What is the recommended period that you shouldn’t drive if you’ve had vtach?

Answer 21

6 month arrythmia free interval