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A- Resp and cardio > Syncope > Flashcards

Syncope Flashcards

1
Q

What is syncope?

A

Decreased blood supply to brain causing loss of consciousness - transient, self-terminating,inadequate nutrient flow to brain. May have pro formal syndrome (hypoperfusion to brain)

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2
Q

Common types of syncope

A

Neurocardiogenic syncope
Carotid sinus hypersensitivity
Orthostatic syncope
Medication related syncope

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3
Q

Examples of neurocardiogenic syncope

A

Micturition
Defecation
Cough mediated
Degluttition
Glossopharyngeal nerve
Situational

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4
Q

What can cause carotid sinus hypersensitivity?

A

Head turning
Circumferential neck compression - neck tie
Shaving

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5
Q

What causes orthostatic syncope?

A

Volume loss
Autonomic dysfinction
Deconditioning, prolonged bed rest

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6
Q

What groups of meds can cause syncope>

A

Vaso active
Meds affecting conduction - antiarrhythmics, CCBs, Beta blockers, digoxin
Meds affecting QT interval
Diuretics

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7
Q

What meds affect the QT interval?

A

Antiarrhythmics
Antiemetics
Antipsychotics/depressants

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8
Q

What medications are vasoactive?

A

Alpha and beta blockers, CCBs, nitrates, anithypertensive medications, diuretucs, erectile dysfunction meds

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9
Q

Other common causes of syncope

A
  • Lack of blood/oxygen
  • Accidental fall
  • Narcolepsy
  • Psychogenic pseudosyncope
  • Psychogenic non epileptic seizure
  • Cardiac arrest
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10
Q

What to check in a syncope history?

A
  • Context
  • Prodrome
  • Duration
  • Recovery
  • Frequency
    Did LOC happen before or after fall?
    Amnesia around fall?
    Long lie?
    Transient LOC or unresponsive?
    Collateral history?
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11
Q

What could cause a responsive syncope?

A
  • Syncope
  • Generalised seizure
  • Stroke
  • psychogenic pseudosyncope
  • Psychogenic no epileptic seizure
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12
Q

Causes of unresponsive syncope?

A
  • Toxic metabolic causes
  • Status epilepticus
  • Psychogenic of above
  • Stroke
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13
Q

What conditions are not technically syncope but should be considered in initial history?

A
  • Seizure
  • Stroke
  • Head injury
  • Cardaic syncope
  • Blood loss
  • PE
  • Subarrachnoid haemorrhage
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14
Q

High risk factors of onset of syncope

A

During exertion
In supine position
New onset chest discomfort
Palpitations before syncope
Ass with dyspnoea

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15
Q

High risk factors in medical history with syncope?

A

FH sudden death
Decompensated/congestive HF
Aortic stenosis
LV outflow tract disease
Dilated cardiomyopahty
Hypertrophic cardiomyopathy
Arrhythmogenic RV cardiomyopathy
LV ejection fraction <35%
Documented Ventricular arrythmia
Coronary artery disease
Congenital HD
Pulmonary HPTN
ICD implantation

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16
Q

High risk symptoms, signs or variables ass with syncopal episode

A

Anaemia - Hb < 9g/dL
Lowest systolic BP in emergency department <90mmHg
Sinus bradycardia < 40bpm

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17
Q

High risk ECG ffeatures with syncope

A

New or prev undiagnosed LBBB N
Bifascicular block + first degree AV block
Brugada ECG pattern
ECG changes consitent with acute ischaemia
Non sinus rhythm thats new
Bifascicular block
Prolonged QTc >450ms

18
Q

Causes of VT

A

Channelopathies (Na+ and K+)
WPW
QT prolongation
Electrolyte disturbances
Hypothermia
Structural HD

19
Q

How is VT defined on ECG?

A

3 or more ventricular atopic beats at a rate of < 130bpm
if > 30s = sustained

20
Q

What is seen on ECG in RBBB?

A

MaRroW
‘W’ pattern in V1
Widened S spaces
QRS > 120ms
Dominant S wave in V1
Broad R wave, absence of Q waves in lateral leads
Prolonged R wave peak time > 60ms in V5-6

21
Q

What is torsades de pointes?

A

V fast ventricular - polymorphic tachycardia
Treat with magnesium, implantable device

22
Q

What causes Torsades de pointes?

A

Prolonged QT syndrome
Medications: Antifungals.
Antibiotics.
Antipsychotics.
Antiemetics (for nausea and vomiting).
Antiarrhythmics.
Cancer medicines.

23
Q

Life threatening causes of syncope

A

MI
Cardiac arrhytmia
PE - massive
Occult haemorrhage
Arotic dissection
Cardiac tamponade
Severe hypoglycaemia
Major intracranial event

24
Q

What does a massive PE on ECG?

A

RBBB
Extreme R axis deviation
S1Q3T3
T-wave inversions in V1-4 + lead III
Clockwise rotation with persistent S wave in V6

25
Q

What is bifascicular block adn first egree AV block on ECG?

A

RBBB
LAD
1st degree AV block

26
Q

Causes RBBB

A

Right ventricular hypertrophy/cor pulmonale
PE
IHD
Rheumatic heart disease
Congenital HD
Myocarditis
Lenegre Lev disease - primary degenerative disease/fibrosis of conducting system

27
Q

What is brugada syndrome and what does it look like on ECG?

A

Hereditary channelopathy causing syncope, VT, VF, cardiac arrest, sudden death
ST elevation in V1-3

28
Q

VF on ECG

A

Dx of VF
Chaotic irregular deflections of varying amplitude
No identifiable P waves, QRS complexes or T waves
Rate 150 to 500 BPM
Amplitude decreases with duration

29
Q

Structural heart abnormalities causing syncope

A
  • Valvular heart disease: aortic stenosis, mitral stenosis
  • Cardiomyopathy - ischaemic, dilated, hypertrophic
  • Atrial myxoma
  • Cardiac tampon are
  • Aortic dissection
30
Q

3 Ps of vasovagal

A

Posture - blackout occured after prolonged standing
Provoking factors - pain or medical procedure
Prodromal symptoms - sweating or feeling warm/hot before the blackout occured

31
Q

How to diagnose vasovagal syncope

A

Postural BO falls by 20 systolic or 10 diastolic
ECG for QT changes

32
Q

Diagnosis of orthostatic syncope

A

Lying standing BP -> Fall in systolic BP of at least 20 mmHG at least 30 if have HPTN and or fall of diastolic - 10 mmhg within 3 mins of standing

33
Q

Management of orthostatic syncope

A

Reduce polypharmacy
Graded pressure stockings
Fluorocortisone can help but cause increase BP

34
Q

Causes of orthostatic syncope

A
  • Old age
  • Parkinsons
  • Diabetic autonomic neuropahty
  • Lewy Body dementia
  • Volume loss
  • Autonomic dysfunction
  • deconditioning, prolonged bed rest
  • Drugs that ower HR, BP
34
Q

How can parkinsons cause syncope

A

Autonomic dysfunction prone ot

35
Q

Examples of pseudosyncope

A

Epilepsy - seizure
Hypoglycaemia
Drug overdose

36
Q

Investigations syncope

A

Check relevance
Bloods
ECG
CXR
CT head if injured or indicated

37
Q

What is seen on ECG in LBBB?

A

Prolonged QRS complexes
W in Lead I - positive waves
M in lead 6 - negative waves
WiLliam

38
Q

R bundle branch block on ECG? What is it seen in?

A

M in Lead I - positive
W in lead 6 - negative
PE, S1Q3T3 pattern
MaRroW

39
Q

What counts as a widened QRS?

A

> 120ms - 3 small swuares

40
Q

What to ask about before and after syncope?

A

Prodrmie - aura, dizzy, sweat, blurred vision
After - memory, recovery time, post-ictal phase, injury

A- Resp and cardio (58 decks)

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