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Cardiology YR3 > Syncope > Flashcards

Syncope Flashcards

1
Q

What is syncope?

A

Loss of conciousness due to lack of blood pressure

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2
Q

Causes of syncope

A
  • Postural hypotension
  • Bradycardia/tachycardia - if VF or torsade
  • Structural heart disease eg aortic stenosis
  • Hypertrophic cardiomyopathy
  • Ion channelopathies - long QT, Brugada, ARVC
  • Massive PE

Arrhythmogenic right ventricular cardiomyopathy

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3
Q

What to determine if LOC?

A

Seizure or syncope?

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4
Q

Syncope vs seizure

A

Syncope can lead to seizure - anoxic seizure
Need to keep head at same level as heart if vasovagal

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5
Q

Who is low risk if have syncope fall?

A
  • Less than 50
  • Vasovagal
  • No CVD disease
  • Normal ECG
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6
Q

Steps when someone presents with LOC

A
  • History
  • Witness history
  • Examination
  • ECG
  • Investigations
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7
Q

What is asked in history about syncope?

A
  • Position - found on floor, landing etc
  • Action - did they break fall with arms etc?
  • Tired/sleepy/jetlagged or other triggers
  • Before and after events of fall
  • Previous episodes
  • Extended FH - did anyone die younger than they should?
  • Predisposing factors eg CV disease etc?
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8
Q

Triggers for syncope

A
  • Hot
  • Stressed
  • Anxious
  • Dehydrated
  • Alcohol
  • Squemish eg blood
  • Large meal
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9
Q

Predisposing factors for syncopal fall

A

Drugs:
* Beta blocker
* GTN
* Antihypertensives
* Tamsulosin/finasteride - profound pos hypo
* Parkinsons medication
* TCA’s
* Neuroleptics eg haloperidol

  • Alcohol
  • Recreational drugs
  • Parkinsons
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10
Q

Questions to ask about what happened before syncope?

A
  • Palpitations?
  • Chest pain?
  • Vertigo - inner ear/cerebellum problem
  • Light headed
  • Aura/smells
  • Tunnel vision
  • Sweating
  • Hot/cold
  • Nausea
  • Yawning - air hunger - as HR slows
  • SOB
  • Cough/micturition/other valsalva
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11
Q

Questions to ask about after

A
  • Do you remember falling?
  • Hitting the ground?
  • Remember waking up?
  • Recovery time?
  • Evidence of any evasive action - Guardsmans (shoulder # vs colles)
  • Any incontinence, tongue biting
  • Time to tonic
  • Time to clonic
  • Post event mental state
  • Diuresis after event - sign of rapid HR
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12
Q

Questions to ask witness to fall

A
  • Pale/flushed
  • Eyes roll - lost cardiac output
  • Pulse?
  • Did they look dead?
  • Confused post event? - cardiac event
  • Focal seizure signs
  • Sat/propped up/flat
  • Position on floor when fell
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13
Q

Questions to ask patient about PMH

A
  • Febrile convulsions as child
  • FH epilepsy
  • Faint as a child
  • Does it happen in particualr environments?
  • Screen cardiac RF and neuro RF
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14
Q

What happens in vasovagal?

A
  • BP drops
  • HR drops
  • Get warning - go hot, sweaty, nauseous
  • Triggered by something
  • Lose conc when sat up again sometimes
  • NEED TO LIE FLAT
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15
Q

What is vasovagal also known as?

A

Neurocardiogenic syncope

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16
Q

Signs to look for on examination if syncope

A
  • Aortic stenosis - slow rising, low volume carotid pulse, quiet/absent S2, EJSM
  • Hypertrophic cardiomyopathy
17
Q

ECG findings for syncope

A
  • Massive PE - S1, Q3, T3, RV heart strain T wave inversion V1-V3
  • Sinus node disease?
  • Coronary disease
  • Conducting issue - LBBB etc
  • Accessory pathway
  • Ion channelopathies - Brugada ST elevation, long QT
  • Electrolyte problems - calcium, K+, Mg low = long QT
  • Assymetric T wave inversion = strain
18
Q

What is TAchy Brady?

A
  • AF to sinus rhythm
  • But when go to sinus their heart stops for a few seconda
  • Need pacemaker
19
Q

Test if unsure if LOC was vasovagal

A

Tilt table test

20
Q

What can we do is vasovagal is more due to HR dropping than BP when on tilt table?

A

Can have rate drop response permanent pace maker

21
Q

What is AVRC?

A

Fatty fibrous tissue replaces normal cardiac tissue
Causes arrhytmias

22
Q

Longer term wayss to monitor heart

A

24hr tape
Implantable loop recorder

23
Q

Troponin leak in ruptured plaque?

A

Not always

24
Q

What is retrograde amnesia?

A

Loss of memory before collapse
Signals cardiac event

25
Q

Responsibility regarding DVLA and LOC

A
  • If you are first healthcare professional it is your responsibility to tell pt they cannot drive for at least 6 months or until cause is found and treated
  • Exception is vasovagal as they have warning and can pull over and postural hypotension
  • You must inform DVLA if pt says they won’t and document that you have informed them always
26
Q
A

Cardiology YR3 (21 decks)

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