Syncope Flashcards
Transient loss of postural tone and consciousness caused by period of inadequate cerebral perfusion. Episodes rarely last >1 minute. Full recovery to baseline mental status without resuscitation, no postictal state
Syncope
Prodromal symptom of fainting “I almost fainted”
Presyncope
What causes should be at the forefront of syncope/presyncope differential?
Cardiac and Neurologic
A patient tells you they have had multiple syncopal events with a new onset. What condition should be considered?
AV block
A patient tells you they have had multiple syncopal events over many years. What condition should you be considering?
Vasovagal syncope
A patient tells you that they have multiple syncopal episodes daily lasting multiple minutes. What condition should be considered?
Psychogenic
A patient has an extended prodrome prior to their syncopal event. What should be considered?
Vasovagal syncope
A patient has no prodrome prior to their syncopal event. What cause should be considered?
Cardiac causes
A patient tells you their syncopal episodes always occur supine. What are you thinking?
Cardiac etiology
A patient tells you that syncopal episodes always occur with change in position. What are you thinking?
Orthostatic hypotension (even multiple minutes after change)
A patient tells you that they have syncopal episodes when they are standing upright. What should be considered?
Reflex syncope (vasodilation +/- bradycardia
What are provocative factors for reflex syncope?
- Immediately after exercise
- Defecation or urination
- Coughing or swallowing
- Post-prandial
- Warm and crowded place
- Prolonged standing
- Fear, sight of blood, stress
- Abrupt neck movements
What are possible prodrome symptoms for syncope?
- Lightheadedness
- Warmth or cold
- Sweating
- Palpitations
- Nausea- abdominal discomfort
- Blurred vision (blindness possible)
- Diminished hearing or tinnitus
- Pallor reported by observers
What are historical factors post syncopal event?
- Continued nausea, pallor, diaphoresis with Reflex syncope
- True syncope usually 1-2 minutes at most as supine position restores cerebral perfusion
- Extended syncope- think seizure vs psychogenic
If the “syncopal episode” is actually a seizure, what would witnesses likely see?
Eyes open
If a patient has syncope in the presence of a new/severe HA, what should be ruled out?
SAH
If a patient has syncope with chest pain or shortness of breath, what should be ruled out?
PE, MI, HF
If a patient has syncope with fever, what should be done?
- Sepsis workup
- Consider COVID19 infection (this can be only symptom)
What conditions are at high risk for syncope due to arrhythmias?
- CAD
- Valvular disease
- Cardiomyopathy
- Congenital heart disease
- Previous cardiac surgery
What condition places patient at high risk for orthostatic hypotension due to autonomic neuropathy and hypoglycemia?
DM
What antibiotics medications can cause QT prolongation that can lead to syncope?
Antibiotics
* Fluoroquinolones
* Macrolides
* Trimethoprim
* Pentamidine
* Azole antifungals
What antipsychotic medications can cause long QT leading to syncope?
- Haloperidol
- Droperidol
- Thioridazine
- Pimozide
What antiemetics cause LQTS causing syncope?
- Ondansetron
- Granisetron
- Metoclopramide
What antiarrhythmics cause LQTS leading to syncope?
Class IA: Na+ channel blockers
* Quinidine
* Procainamide
* Disopyramide
Class III: K+ channel blockers
* Amiodarone
* Sotalol
* Dofetilidev
* Ibutilide
* Dronedarone
