syncope

Question 1

defintion

Answer 1

Syncope may be defined as a transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery

Question 2

3 types

Answer 2

Reflex syncope (neurally mediated)
vasovagal: triggered by emotion, pain or stress. Often referred to as 'fainting'
situational: cough, micturition, gastrointestinal
carotid sinus syncope

Orthostatic syncope
primary autonomic failure: Parkinson’s disease, Lewy body dementia
secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia
drug-induced: diuretics, alcohol, vasodilators
volume depletion: haemorrhage, diarrhoea

Cardiac syncope

arrhythmias: bradycardias (sinus node dysfunction, AV conduction disorders) or tachycardias (supraventricular, ventricular)
structural: valvular, myocardial infarction, hypertrophic obstructive cardiomyopathy
others: pulmonary embolism

Question 3

most common cause of syncope in all age groups

Answer 3

reflex

Question 4

what investigations and evaluations would you carry out

Answer 4

cardiovascular examination
postural blood pressure readings: a symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic
ECG
carotid sinus massage
tilt table test
24 hour ECG