Syncope Flashcards
Benign causes of syncope
Orthostatic hypotension
Vasovagal syncope
Reflex-anoxic seizures (reflex-asystolic syncope)
‘Functional’ collapse
Pathological causes of syncope
o Neurogenic – epilepsy and periodic paralysis
o Cardiogenic – congenital heart disease or arrhythmias
Key features to ask in syncope hx
Ask patient/parent to describe a typical event
o Triggers - exercise, pain, emotion
o Prodrome - autonomic symptoms, palpitations, chest pain, nothing
o Period of unresponsiveness - duration
o Change in tone - ‘stiff or floppy’; seizure-like movements
o Incontinence
o Breathing/pulse
o Post-ictal period - ‘how long until back to normal’
o Frequency of events
o PMHx-presyncope/’near misses’, seizures/febrile convulsions
o FHx - syncope, ‘epilepsy’, sudden/unexplained death, cardiac devices
Investigations for syncope in child
o ECG - rhythm, rate, PR interval, presence of VPE, calculate QTc
o Echocardiography - LVOTO/aortic stenosis, systolic function, coronary arteries
o Ambulatory monitor - intenti coincide clinical event with rhythm recording
o Other - bloods (CBG), EEG, head-up tilt-table testing
Three types of LQTS
LQTS1 - KCNQ1 - Long broad T - exercise trigger
LQTS2 - KCNH2 - Bifid T - shock/surprise trigger
LQTS3 - SCN5a - Delayed small T - sleep trigger
Key features of LQTS
Risk proportional to QTc length
Clinical diagnosis, risk criteria based on QT + sx + genetics
Mx: Nadolol (non-cardioselective BB), to avoid QT-prolonging drugs (www.crediblemeds.org)
Genetic screening for family
ILR +/- ICD if events
Key features of CPVT
Characterised by increased VEs polymorphic with increasing HR and exercise
Usually syncope after or during exercise or stress
Nadolol and flecanide + ICD
RYR2 mutations
Key features of anomalous coronary arteries
Commonly abnormal origin of LCA from NC sinus with intramural course
Intermittent ischaemia and therefore can cause arrest
Surgical approach for management
