Syncope

Question 1

Syncope is defined as

Answer 1

a sudden transiet loss of consciousness with inability to maintain postural tone

Syncope by whatever mechanism is caused by lack of adequate cerebral blood flow with loss of consciousness and inability to remain upright

Question 2

Most common cause of syncope in the normal pediatric population

Answer 2

Neurocardiogenic syncope
aka vasovagal syncope
aka fainting

Question 3

Vasovagal syncope is classical associated with

Answer 3

a prodrome that includes diaphoresis, warmth, pallor, or feeling lightheadedness
and is often triggered by a specific event or situation such as pain, medical procedures, or emotional distress
this type of syncope is characterized by hypotension and bradycardia

Question 4

The most important goal in the evaluation of the new patient with syncope is

Answer 4

to diagnose life-threatening and cardiac causes of syncope so that these causes can be managed

Question 5

The most important tool in evaluation is

Answer 5

Careful history

Question 6

Features of Syncope in contrast to Seizures

Answer 6

Relation to posture
Pallor
Diaphoresis
With cardiovascular signs

Question 7

Features of Seizures in contrast to Syncope

Answer 7

Injuries
Urinary incontinence
Tongue biting
Postictal confusion/headache

Question 8

Features suggestive of cardiac syncope

Answer 8

No prodrome
Occurrence during exercise
Injury (indicates sudden occurence)
Syncope while recumbent
Family history of sudden death

Question 9

A loud and single second heart sound is suggestive of

Answer 9

primary pulmonary hypertension
may also have an ejection click and the murmur of pulmonary insufficency

Question 10

remarks on patients with first episode of syncope

Answer 10

must have an ECG obtained
looking primarily for
- QT interval prolongation
- preexcitation
- ventricular hypertrophy
- T-wave abnormalities
- conduction abnormalities

Question 11

In patients for whom there is a strong suspicion of a paroxysmal arrhythmia, this may be the most effective means of diagnosis

Answer 11

implantable loop recorder

Question 12

If a reentrant tachyardia (AVNRT, AVRT) is found, this may be indicated

Answer 12

catheter ablation

Question 13

If bradycardia from AV block was the cause of the syncope, this may be warranted

Answer 13

pacemaker

Question 14

These patients may require implantable cardioverter-defibrillator (ICD)

Answer 14

Medically refractory malignant arrhythmias
- HCM
- long QT syndrome (LQTS)
- arrhytmogenic cardiomyopathy
- catecholaminergic polymorpohic V tach (CVPT)

Question 15

These patients should be referred for surgery

Answer 15

With structural heart disease (valvular disease or coronary artery anomalies)

Question 16

3 types of orthostatic disorders

Answer 16

1. Postural tachycardia syndrome (POTS)
2. Orthostatic hypotension (OH)
3. Reflex syncope

Question 17

Remarks on POTS

Answer 17

With the phenomenon of initial orthostatic hypotension (IOH) where syncope is very short (30-60 secs), and BP returns to baseline in 30-60 seconds
Patient complains of lightheadedness and “blacking out” or tunnel vision 5-10 sec after standing
(POTS requires symptoms while upright)

Question 18

Remarks on OH

Answer 18

OH is defined as sustained decrease in SBP of >20 mm Hg of DBP >10 mm Hg in the 1st 3 min of upright tilt
rarely occurs in children
patient frequently has no symptoms despite very low pressures

Question 19

Remarks on reflex syncope

Answer 19

i.e., vasovagal or neurally mediated
defined as relatively sudden change in autonomic nervous system activity that leads to a sudden decrease in BP, HR, and cerebral perfusion