Syncope (1)

Question 1

What is it?
→ What’s it also known as?

What is the pathophysiology?

Answer 1

➊ Temporary loss of consciousness due to disruption of blood flow to the brain, leading to a fall
→Vasovagal episodes or Fainting

➋ Due to a problem with the autonomic nervous system regulating blood flow to the brain
• When vagus nerve receives strong stimulus, such as an emotion/pain/change in temp, it can stimulate the parasympathetic nervous system → Dilation of vessels leading to the brain → Syncope

Question 2

What are the pre-syncopal symptoms called?
→ Which symptoms could they have?

Which else could they have? What can this be confused with?

Answer 2

➊ Prodrome
→ • Hot/clammy
• Sweaty
• Dizzy/Lightheaded
• Visual disturbance
• Headache

➋ • Twitching/convulsion activity, which shouldn’t be confused with a seizure
• Feeling of grogginess/tiredness after, which shouldn’t be confused with a post-ictal period (prolonged confusion, drowsiness, irritability or disorientation)

Question 3

Primary Syncope:
What is it also known as?

What can cause it?

Secondary Syncope:
What does it suggest?

What can cause it?

Answer 3

➊ Simple faint

➋ • Dehydration
• Missed meals
• Prolonged standing in a warm environment
• Vasovagal response to stimuli e.g. sudden surprise, pain, sight of blood

➌ Underlying health problem

➍ • Hypoglycaemia
• Anaemia
• Infection
• Anaphylaxis
• Arrhythmias
• Valvular HD
• Hypertrophic obstructive cardiomyopathy

Question 4

Investigations:
What is important to carry out properly? Why?
→ What should also be asked during this?

Which symptoms point towards a Syncopal episode?

Which symptoms point towards a Seizure?

Answer 4

➊ History – Mainly to differentiate between a syncopal episode and seizure
→ Triggers, infection symptoms, cardiac symptoms, neurological symptoms, family hx

➋ • Prolonged upright position before event
• Prodromal symptoms
• Reduced tone during episode
• Return of consciousness soon after falling
• No prolonged post-ictal period

➌ • Epilepsy Aura
• Head-turning or abnormal limb positions
• Tonic-Clonic activity
• Cyanosis
• Tongue-biting
• Incontinence
• Lasts 5+ mins
• Prolonged post-ictal period