syncope

Question 1

cardiovascular of syncope

Answer 1

1-aortic stenosis ( IF SEVER resulting in exertional syncope )
2-Hypertrophic obstructive cardiomyopathy HOCM ( suggestive of dynamic obstruction )
3-mitral regurgitation ( likely sever in the context of syncope )
4-aortic sclerosis ( unlikely to be significant to cause syncope )
5-Brugada syndrome( congenital Na channelopathy )
prolonged QT

Question 2

typical features of aortic stenosis

Answer 2

ejection systolic murmur , loudest in aortic area , radiate to carotids

Question 3

typical features of aortic sclerosis

Answer 3

early-mid systolic murmur ,split the second heart sound

Question 4

typical features of HOCM

Answer 4

mid systolic murmur ,affected by dynamic manouvres

Question 5

typical features of mitral regurgitation

Answer 5

pansystolic murmur , radiating into axilla

Question 6

what is the disposition of sever aortic stenosis patient ( presenting with exertional syncope , murmur and signs of heart failure , mid zones crepitations )

Answer 6

cardiology admit for monitoring , echo to determine severity and planning for surgical intervention

Question 7

Examination findings that would suggest a cardiovascular cause of syncope , include the significance of each findings ?

Answer 7

irregular HR ( predisposing to tachy/bradycardia )
bibasal crepitations ( suggestive of heart failure )
Becks triad( suggestive of pericardial tamponade )
Ejection systolic murmur ( suggestive of AS )
chest pain ( suggestive of AMI )
Sternotomy ( suggestive of ischemic heart disease )
Pacemaker ( suggestive of pacemaker failure )

Question 8

ECG done to a patient 80 yr M P/W syncope which shows LBBB and first degree HB , list 3 reversible causes of this condition

Answer 8

electrolytes abnormalities : hyperkalemia
ischemia :
drugs ( digoxin )

Question 9

why elderly more often get syncope ?

Answer 9

more co morbidities 
renal failure 
medications 
BM disease ( anaemia ) 
cardiac : ischemia , valvular degeneration

Question 10

In paediatric population , what are the risk factors for predicting adverse events in syncope ?

Answer 10

family hx of sudden cardiac death 
syncope during exercise 
syncope when lying down 
congenital heart disease / hx of murmur 
<6 yr old 
prolonged LOC
chest pain /palpitation preceding event 
medications that may alter cardiac function

Question 11

alternative DX ( DD ) that may be mistaken for cardiac syncope in children ?

Answer 11

seizure 
hypoglycemia
BRUE 
SEPSIS 
vasovagal syncope 
breath holding episode 
functional disorder

Question 12

Prolonged QT , what are the pharmacological causes

Answer 12

antidepressants TCA 
antibiotics : erythromycin 
antiemetics ; ondansetrone 
opiates : methadone 
antiarrhythmics : sotalol

Question 13

prolonged QT , non pharmacological causes ?

Answer 13

electrolyte disturbance
myocardial ischemia
congenital QT syndrome
idiopathic