Syncope Flashcards
1
Q
Extreme lightheadedness, visual sensations, variable degrees of altered consciousness without complete LOC
A
Near Syncope
2
Q
transient, complete LOC, inability to maintain postural tone with rapid and complete recovery
A
syncope
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)
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
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
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
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
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
9
Q
what are preventable treatment options of brugada
A
implantable cardioverter defibrillator (ICD)
pacemaker, or specific medicines are available
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
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)
12
Q
- continuous monitoring
- trans-telephonic transmission
- automatic detection of significant arrhythmias
- patient activation
- 2-3 years of longevity
A
implantable loop recorder
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
14
Q
Extrinsic mechanisms of sick sinus syndrome?
A
drugs (e.g, digoxin, B-blockers, Ca channel blockers)
autonomic dysfuntion, hypothyroidism, hyperkalemia
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)
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
* **defined as a decrease in SBP > 20mmHg within 2 hours after a meal**
* warm foods, carbohydrates cuase splanchnic vasodilation
* common in the elderly
postprandial hypotension
26
treament of postprandial hypotension?
* drinking cold water up to 500ml prior to meals
* decrease carbohydrate consumption
* caffeine with meal
* smaller, frequent meals throughout the day
27
medications to treat orthostatic hypotension?
* fludrocortisone (0.05-0.3mg daily)
* midrodrine (2.5-10mg 2-3x daily)
28
* 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?
Psychogenic syncope
29
treatment of psychogenic syncope?
* empathy, acknowledge symptoms
* identify the stressor
* cognitive behavioral therapy
* treat illness
* healthy lifestyle
* antidepressants, anxiolytics, etc
