Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine Exam 1 > Syncope > Flashcards

Syncope Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Extreme lightheadedness, visual sensations, variable degrees of altered consciousness without complete LOC

A

Near Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

transient, complete LOC, inability to maintain postural tone with rapid and complete recovery

A

syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is considered good syncope?

A
  • several episodes of syncope since their 20-30s
  • prodromal sx present before event (lightheaded, hearing loss, room closing in, etc)
  • autonomic sx after event (fatigue, pale, sweaty, loss of urine or stool)
  • no major injuries
  • recent illness (Dehydration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is considered the bad syncope?

A
  • Single episode of syncope
  • “i just went out”
  • “i found myself on the floor”
  • syncope with exercise
  • syncope lying down
  • sustained injury (fractures, contusion, etc.)
  • known heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cardiac-Arrhythmic conditions that are reasons for admissions?

A
  • inheritable CV conditions predisposing to arrythmias (long-QT pattern, brugada pattern)
  • sinus bradycardia < 40 beats/min (symptomatic) or pauses > 3 sec
  • mobitz II or 2:1 second-degree or third degree atrioventricular block
  • sustained supraventricular tachycardia
  • sustained ventricular tachycardia
  • pacemaker (ICD) malfunction with cardiac pauses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are predictors of cardiac syncope?

A
  • Palpitations preceding syncope
  • quick event, minimal or no symptoms, amestic
  • known heart disease; abnormal ECG
  • syncope while lying down
  • syncope during effort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • due to a mutation in the cardiac sodium channel gene (sodium channelopathy)
  • abnormal ECG along with… one or more of the following
  • documented ventricular fibrillation (VFO or polymorphic ventricular tachycardia (VT)
  • family history of sudden cardiac death < 45 years old
  • coveted-type ECGs in family members
  • syncope
A

Brugada

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what ECG abnormality is diagnostic or seen brugada syndrome?

A
  • Type 1: Coved type ST- segment elevation
  • Type 2 &3 : saddle-back type ST-segment elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are preventable treatment options of brugada

A

implantable cardioverter defibrillator (ICD)
pacemaker, or specific medicines are available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some etiologies of long QT syndrome?

A
  • medications (amiodarone, TCAs, SSRIs, antibiotics, metoclopramide, haloperidol, ondansetron)
  • genetic: cardiac ion channel mutation (Na+, K+)
  • Myocardial disease: myocardial infarction, 3rd degree HB, cardiomyopathy
  • electrolyte abnormalities: low calcium, potassium and/or magnesium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of cardiac monitors are available?

A
  • Holter monitor: 24-48hrs
    -continuous recording; patient with frequent symptoms
    -symptom rhythm correlation with patient event diary
  • Event Monitor: up to 30 days
    -Patient activated or automatically activated
    -symptoms “a few times/ month”
  • Zio Patch: 1 to 2 weeks
    -continuous recording
    -patient-trigger capability (2 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • continuous monitoring
  • trans-telephonic transmission
  • automatic detection of significant arrhythmias
  • patient activation
  • 2-3 years of longevity
A

implantable loop recorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are intrinsic mechanisms of sick sinus syndrome?

A

Intrinsic

  • Idiopathic degenerative fibrosis (most common)
  • ischemia
  • cardiomyopathies
  • infiltrative diseases (e.g, sarcoidosis, hemochromatosis)
  • congenital abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Extrinsic mechanisms of sick sinus syndrome?

A

drugs (e.g, digoxin, B-blockers, Ca channel blockers)
autonomic dysfuntion, hypothyroidism, hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when should you suspect aortic stenosis in your patient?

A
  • fatigue, dyspnea, exertional angina, lower extremity edema, near syncope and syncope
  • murmur= crescendo-decrescendo SEM (heard best at the right sternal border)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the treatment options available for aortic stenosis?

A
  • valvuloplasty or replace
17
Q

What is considered reflex neurally mediated syncope?

A
  • vasovagal
  • carotid sinus hypersensitivity
  • situational: “ post cough, swallow, laugh, exercise, micturition and/or defaction”
18
Q
  • Look for triggers
  • heat exposre
  • seeing blood, having blood drawn
  • fear of bodily injury, actue pain
  • straining, such as to have a bowel movement or urination
  • coughing, laughing
A

reflex mediated syncope

19
Q
  • what are symptoms of reflex syncope? what might a bystander notice during an episode
A

symptoms

  • pale skin
  • lightheadedness
  • tunnel vision
  • nausea
  • feeling warm
  • cold, clammy sweat
  • yawning
  • hearing loss

During episode

  • jerky abnormal movements
  • slow, weak pulse
  • dilated pupils
20
Q
  • exaggerated response to pressure applied to the carotid sinus located in the carotid bifurcation.
  • Positive= asystolic period of >3 seconds and/or decrease in SBP of >50mmHg
A

Carotid Sinus Syndrome

21
Q

how to treat reflex mediated syncope ?

A
  • avoid triggers (warm environments, dehydration, prolonged standing, fear, quick head turns)
  • hydration!
  • salt to diet 6 to 8 grams/day (1/2 tsp)
  • if symptomatic: counterpressure maneuvers (hand clasp and pull, crossing legs and squeeze or squat)
22
Q

what falls under the category of orthostatic dysautonommia?

A
  • hypovolemia
  • medication induced
  • post prandial
  • parkinson’s disease, lewy body
  • multiple system atrophy
  • diabetic/ other neuropathies
  • amyloid
23
Q
  • a sustained decline of > 20mmHg in sysstolic or >10mmHg diastolic with standing
  • gradual in onset beginning with weakness, dizziness and lightheadedness ultimately leading to near syncope or syncope
  • can be delayed 3 to 45 minutes later
A

orthostatic hypotension

24
Q

ways to offset orthostatic hypotension?

A
  • Eliminate or change offending medications
  • slowly rise from chair/bed to standing
  • “March” legs up and down X 1 minute before standing
  • hydration, salt in diet
  • elevated head of bed 15 to 30 degrees
  • small frequent meals
  • compression sleeves, stockings, shorts
25
Q
  • defined as a decrease in SBP > 20mmHg within 2 hours after a meal
  • warm foods, carbohydrates cuase splanchnic vasodilation
  • common in the elderly
A

postprandial hypotension

26
Q

treament of postprandial hypotension?

A
  • drinking cold water up to 500ml prior to meals
  • decrease carbohydrate consumption
  • caffeine with meal
  • smaller, frequent meals throughout the day
27
Q

medications to treat orthostatic hypotension?

A
  • fludrocortisone (0.05-0.3mg daily)
  • midrodrine (2.5-10mg 2-3x daily)
28
Q
  • syncope events tend to be numerous, often occuring several times a day or at the same time each day
  • the eyes might be tightly closed with a lid flutter, compared to reflex syncope or epilepsy the eyes are often open
  • symptoms: looking pale or becoming sweaty, maybe absent
  • often lasts much longer than reflex syncope
  • ptx with a hx of reflex syncope often experience this?
A

Psychogenic syncope

29
Q

treatment of psychogenic syncope?

A
  • empathy, acknowledge symptoms
  • identify the stressor
  • cognitive behavioral therapy
  • treat illness
  • healthy lifestyle
  • antidepressants, anxiolytics, etc

Emergency Medicine Exam 1 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions