Session 2: Managing Falls Flashcards
What is syncope?
A transient loss of consciousness characterised by fast onset and spontaneous recovery.
What is syncope caused by?
A reduced perfusion pressure in the brain
How is syncope usually managed?
By being horizontal which will fix low blood pressure.
Symptoms of pre-syncope.
Light-headedness
Sweating
Pallor
Blurred vision
What is a generalised tonic-clonic seizure?
A cause of loss of consciousness and will cause a fall.
It is not the same thing as syncope.
They are mostly associated with epilepsy.
Why do you need to be especially aware of new onset of epilepsy in elderly?
Because it is a sign of cerebrovascular disease like dementia, brain tumour or drug interactions.
Broad categories of syncope.
Reflex syncope
Orthostatic/postural hypotension
Cardiac/Cardiopulmonary disease
Explain reflex syncope.
A disorder of the autonomic regulation of postural tone.
There is an activation of part of medulla that leads to deacrease in sympathetic output and an increase in parasympathetic output.
This leads to a fall in CO due to reduced heart rate and leads to lower BP -> reduced cerebral perfusion.
Give examples of reflex syncope.
Vasovagal also known as the simple faint.
Situational syncope
Carotid sinus massage
Cause of vasovagal reflex syncope.
Prolonged standing
Stress
Sight of blood
Pain
Cause of situational syncope.
Coughing
Straining
Lifting heavy weight
Explain orthostatic hypotension.
Symptoms of pre-syncope occur after standing from a sitting or a lying position.
This can cause syncope if drop in blood pressure is severe enough.
What is orthostatic hypotension usually defined as?
A drop of 20 mmHg or more with pre-syncopal symptoms on standing.
Pathophysiology of orthostatic hypotension and ensuing syncope.
Standing up causes 500-800 ml of blood to pool in the legs. This leads to a reduction in EDV and also cardiac stretch.
Less stroke volume and cardiac output ensues which is normally managed by the baroreceptor reflex but if this doesn’t work then cerebral perfusion will drop and syncope occurs.
Why does the baroreceptor reflex fail?
Because the baroreceptors become less sensitive with age and also become less sensitive with hypertension.
Also medications like anti-hypertensives can impair the response or venous return.
Dehydration as well.
Causes of cardiac syncope.
Cardiac disease or abnormality which can be electrical, structural or coronary.
Electrical cardiac syncope causes.
Bradycardias
Tachycardias
Structural cardiac syncope causes.
Aortic stenosis
Hypertrophic obstructive cardiomyopathy
Coronary cardiac syncope causes.
MI
Coronary heart disease
Why might aortic stenosis cause cardiac syncope?
Narrowing of aortic valve leads to it being harder to push blood through the aortic valve and the heart has to work harder to adequately perfuse the brain.
Prognosis of AS with syncope.
Mean survival of 2-5 years untreated
Features of cardiac syncope.
Exertional syncope
FH of cardiac disease or sudden cardiac death
Preceding chest pain or palpitations
MH of heart disease
Abnormal ECG
What are non-syncopal falls?
Falls where the cause is not a syncope.
An example is a fall with loss of consciousness following head trauma is a non-syncopal fall.
Give examples of non-syncopal falls.
Head trauma
Trips
Slips
Infection
What is a multifactorial fall?
Osteoarthritis and diabetic neuropathy e.g.
Add an infection as well.
Any fall that a multitude of factors can account for in the patient.
Examinations of patients who have experienced falls.
Neurovascular
Cranial nerve
CVS
Resp examination
Investigations of a fall.
LSBP
ECG
FBC and U & Es
CK
What is a common complication of a fall with a long lie?
Rhabdomyolysis
Drugs that can cause falls.
Anti-hypertensives
Anti-arrythmials
Analgesia
Benzodiapezines
Antidepressants
Antipsychotics
