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Year 3 Neuro > Syncope > Flashcards

Syncope Flashcards

1
Q

Define syncope

A

Global cerebral hypoperfusion

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2
Q

What are the types of syncope?

A

Reflex e.g. Vasovagal
Cardiovascular e.g. Aortic stenosis
Orthostatic e.g. Alphablockers
Cerebrovascular e.g. Subclavian steal

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3
Q

What can cause vasovagal syncope?

A 
Emotional distress (e.g. fear, pain, instrumentation, blood phobia, enclosed space)
Orthostatic stress (e.g. prolonged standing)
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4
Q

What can cause cardiovascular syncope?

A

Arrhythmias

Structural cardiovascular disease e.g. valve disease (aortic stenosis)

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5
Q

What can cause orthostatic syncope?

A

Hypovolaemia (e.g. haemorrhage, diarrhoea, vomiting)

Iatrogenic (e.g. beta-blockers, diuretics, alcohol, vasodilators, antidepressants, phenothiazines)

Autonomic failure (e.g. diabetic neuropathy, Parkinson’s disease, spinal cord injury)

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6
Q

What are some other causes of reflex syncope?

A

Situational syncope is a form of reflex syncope which can be triggered by coughing, sneezing, defecating, urinating, exercising and eating (post-prandial).

Carotid sinus hypersensitivity is another form of reflex syncope which can be triggered by sudden head-turning, wearing a tight collar and shaving.

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7
Q

50 y/o?

A

Vasovagal
Cardio
Palpitations
History of heart disease

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8
Q

Elderly?

A

Orthostatic
Poly-pharmacy
Look out for alphablockers e.g. prostate cancer drugs
Doxazozin

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9
Q

Define orthostatic hypotension

A

drop of SBP >20mmHg in 3 minutes
OR
drop of DBP >10mmHg in 3 minutes

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10
Q

What can be triggers for a syncopal episode?

A

Hypoglycaemia
Exercise
Fears/Phobias
Trauma

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11
Q

Before

A

Was there a warning?
Any triggers?
Trauma?

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12
Q

During

A

Duration

  • short: vasovagal
  • long: seizure

Movements

  • jerking
  • tongue biting
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13
Q

Before

A

Was there a warning?
Any triggers?
Trauma? Did you bang your head?

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14
Q

What should you ask about after HPC?

A

Has it happened before?
PMH - cardiac, diabetes, anxiety, epilepsy, anaemia
DH - medications e.g. alphablockers, insulin, nitrates, anti-arrhythmics, anti-coagulants

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15
Q

What symptom is typical of hyperventilation?

A

Tingling

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16
Q

What is relevant in the family history?

A

Any sudden deaths in the family, particular young < 60 years?
E.g. HOCM

17
Q

What is relevant in the social history?

A

Alcohol

Recreational drugs e.g. cocaine, amphetamines

18
Q

What investigations for Syncope?

A 
Bloods
Cardio exam
ECG
BP/Sats
Glucose

Echo
Head CT

19
Q

What are some non-syncopal causes of blackout?

A

Intoxication
Head trauma
Metabolic
Epileptic seizure

20
Q

If there were no warnings what is the most likely cause of syncope?

A

Cardiac

Others have preceding symptoms e.g. dizziness before vasovagal or aura before epileptic seizure

Year 3 Neuro (17 decks)

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