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OMS - 2 Neuro Final > Syncope > Flashcards

Syncope Flashcards

1
Q

Syncope

A
  • Transient, sefl-limited loss of consciousness due to acute global impairment of cerebral blood flow for 6-8 seconds
  • Rapid, brief, spontaneous recovery

(aka: “passing out”, “falling out”, “fainting”, “blackout”)

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2
Q

Syncope: high risk features

A
  1. History of chest pain or EKG shows ischemia
  2. Heart: failure, structural defect
  3. Long QT
  4. interventricular conduction delay
  5. family Hx: sudden death
  6. palpitations in time of syncopal event
  7. syncope during exercise or at rest
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3
Q

Syncope prevalence and cost

A

3% ER visits (1% of all hospital admissions)

35% lifetime

MC between 10-30 yrs & after 70

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4
Q

Vascular causes of syncope

A
  1. Cardiogenic
  2. CVA
  3. Volume depletion
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5
Q

Infectious causes of syncope

A
  • Shock
  • Sepsis
  • Meningitis
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6
Q

Psychogenic cause of syncope

A
  1. Fair
  2. Disgust
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7
Q

Three most common causes of syncope

A
  1. Neurologic
  2. Orthostatic
  3. Cardiac
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8
Q

Define neurologic syncope

A

Related to pathological changes to happen within the autonomic nervous system → signal medulla to decreases blood pressure and heart rate → decrease in cerebral blood flow to brain

(relies on intact ANS)

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9
Q

MC causes of neurally mediated syncope

A
  1. Vasovagal (MC)
  2. Pulmonary (cough, wind-instrument player, the “fainting game”)
  3. Urogenital (micturition syncope)
  4. GI (swallow syncope, defication)
  5. Cardiac (outflow obstruction)
  6. Carotid sinus sensitivity
  7. Ocular (sudden IOP increase)
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10
Q

Orthostatic-mediated syncope is due to the body’s inability to ______

A

maintain blood pressure after standing or sitting up (HR doesn’t increase despite hypotension)

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11
Q

Orthostatic hypotension is a reduction and systolic blood pressure of at least ____ mm Hg or diastolic blood pressure of at least ____ mm Hg w/in 30 minutes of standing or head tilt on a tilt table.

A

20

10

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12
Q

Types of orthostatic-mediated syncope (4)

A
  1. Autonomic failure (primary or secondary)
  2. Postprandial hypotension
  3. Drug (Iatrogenic)
  4. Volume Depletion
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13
Q

Peripheral neuropathies that can cause Secondary autonomic failure → orthostatic mediated syncope (5)

A
  1. Amyloidosis
  2. Diabetes
  3. HIV neuropathy
  4. Sjogren’s
  5. Paraneoplastic autonomic neuropathy

(There are also hereditary sensory and autonomic neuropathies)

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14
Q

Primary autonomic failure (orthostatic mediated syncope) is due to _______ (2 conditions).

A
  • Lewy Body Disease
  • Multiple system atrophy
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15
Q

Medications for orthostatic-mediated syncope (4)

A
  1. Fludrocortisone
  2. midodrine
  3. dihydroxyphyenlserine
  4. pseudoephedrine

(2nd line: Pyridostigmine, vohmbine, desmopressin, erythropoietin)

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16
Q

Cardiac-mediated syncope is due to ______ or ______ issue that prevents blood from perfusing the brain.

A
  • structural
  • electrical

(all are high risk!!)

17
Q

Cardiac syncope: arrhythmias causes (4)

A
  1. Sinus node dysfunction
  2. AV node dysfunction
  3. Supraventricular tachycardia
  4. Inherited channelopathy
18
Q

Cardiac-mediated syncope: structural causes (4)

A
  1. Valve disease
  2. Obstructive cardiomyopathies
  3. Atrial Myxoma (tumor)
  4. Pericardial effusions or tamponade

(obstruction or its being squeezed)

19
Q

How do you evaluate a patient for cardiac syncope (6)?

A
  1. Hx of arrhythmia
  2. Hx of palpitations or chest pain w/syncope
  3. Known structural heart disease
  4. Rx review
  5. EKG
  6. Echo
20
Q

It takes a ventricular heart rate above ____ or below ____ to cause syncope

A
  • 200
  • 40
21
Q

You must differentiate syncope from _____.

A

seizure

(patients will confuse these, key difference = time to recovery)

22
Q

Neurally-mediated syncope is due to ________ autonomic activation/autonomic failure. Orthostatic syncope is due to ________ (autonomic activation/autonomic failure).

A
  • Neurally: autonomic activation
  • Orthostatic: autonomic failure
23
Q

If a patient has a family history of syncope, they are at risk of developing ______-mediated syncope.

A

neurally

24
Q

What is the biggest difference between seizure and neurally-mediated syncope?

A

confusion quickly resolves after neurally-mediated syncope episode

25
Q

Symptoms during a neurally-mediated syncope event (5).

A
  1. myoclonic movement/jerks
  2. eyes open & deviate upward
  3. dilated pupils
  4. roving eyes
  5. urinary incontinence
26
Q

Myoclonic movements/jerks are seen in both neurally-mediated syncope and seizures. What is the distinction?

A
  • neurally-mediated: arrhythmic & multifocal
  • seizures: rhythmic & focal
27
Q

Autonomic symptoms seen in neurally-mediated syncope (6).

A
  1. diaphoresis
  2. hyperventilation
  3. nausea
  4. pallor
  5. palpitations
  6. yawning
28
Q

Coat-hanger headache is seen in ______-mediated syncope.

A

orthostatic

29
Q

Supine hypertension is commonly seen in ______-mediated syncope.

A

orthostatic (50% of patients w/autonomic failure)

30
Q

Visual blurring or blacking out is commonly seen in ______-mediated syncope.

A

orthostatic

31
Q

define pre-syncope

A

light-headedness/dizziness

(usually response to position change that precedes orthostatic-mediated syncope)

32
Q

Medications for cardiac-mediated syncope (2)

A
  1. beta blocker
  2. anti-arhythmics
33
Q

What are the general differences in syncope management (between orthostatic, cardiac and neural)?

A
  • Orthostatic: behavior & underlying disease
  • Cardiac: surgery & meds
  • Neural: hydration & maneuvers
34
Q

Behavioral modifications to treat ortho-static mediated syncope (4)

A
  1. salt diet
  2. teach them to get up slowly
  3. elevate head of bed
  4. control underlying disease

(also medication)

35
Q

Isometric counter-pressure is used to treat ______-mediated syncope and vagal maneuvers are used to treat ______-mediated syncope.

A
  • neurally
  • cardiac
36
Q

Other than medication, what is the treatment for neurally-mediated syncope (3)?

A
  1. isometric counter-pressure (knees to chest)
  2. crossed legs, flexed arms
  3. IV hydration
37
Q

What are the procedures used to treat cardiac-mediated syncope (4)?

A
  1. cardioversion
  2. valve replacement
  3. ablation
  4. pacemaker implantation

OMS - 2 Neuro Final (36 decks)

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