Syncope Flashcards
What is the definition of syncope?
Sudden loss of consciousness due to drop in blood pressure?
What are some general questions you want to ask in a history for a patient with syncope?
What do you think happened?
What is the last thing you remember?
Any symptoms before?
Chest pain?
Dizziness?
SOB?
Remeber hitting the floor?
Do you remember waking up?
Did you feel confused?
Were you sick?
How did you wake up?
How did you wake up?
Has it ever happened before ?
Is epilepsy the same as syncope?
No
Epilepsy may cause LOC but its not syncope
How is syncope related to seizures/epilepsy?
Epilepsy is not the same as syncope
But syncope can lead to seizures (lack of blood to the brain can lead to seizures)
What are the different types/causes of syncope?
Cardiac causes
Neurological causes
Vasovagal causes
Unknown causes
Who do you class as a low risk patient with syncope?
Age<50
Vasovagal picture
Normal exam
Normal ECG
What are the stages of taking a syncope history?
Circumstances of the syncope
Predisposing factors
Before LOC
After LOC
Witnesses
Previous episodes
Risk factors
What is important to ask about the circumstances of the syncope?
Position pateint was in
Action pateitn did (posture change, exertion?)
Tiredness
Sleep deprived
Jet lag
Triggers: hot day, stress, anxiety
What are some common predisposing factors for syncope?
Medications:
-B-blockers
-ACEi
-Antihypertensives
-GTN
-TAMSULOSIN
-Parkinsonian meds
-neuroleptics
-antidepressants
What are some questions you’d like to know about a patient before they had their LOC?
Palpitations
Chest pain
Vertigo (room spinning, not syncope)
Light headed
Sweating
Hot and cold
Nausea
YAWNING
SOB
Cough
Aura/smells
What are some symptoms/signs very characteristic of a Vasovagal syncopal episode occurring?
Sweating
Hot and cold
What are some questions you want to ask a syncopal patient about after their LOC?
Do you remember waking up?
Do you remember hitting the ground?
Is there any evidence of patient trying to save themselves?
Is there an evidence to show a lack of trying to save themselves?
How quickly did you recover?
Where you incontinent? Bit your tongue?
What are some questions you’d like to ask to the witnesses of the syncopal episode?
Did the pateint look pale or flushed?
Did the patient look dead?
Did the patient have a pulse?
Was the patient tonic clonic?
If the patient was tonic clonic, where they tonic clonic straight away or after a few seconds?
Was the patient confused when they woke up?
Why is it important to establish when a patient was tonic clonic if they did when the lost consciousness?
If tonic clonic immediately = seizure/epilepsy
If tonic clonic few seconds after LOC = seizure due to Syncope
What are some risk factors for having syncope?
Febrile convulsions
FHx of epilepsy
Risk factor for CVS disease
Poor exercise tolerance
Heart disease
Any family members died younger than they should’ve?
Previous head injuries?
Previous meningitis?
What is an alternate name for Vasovagal syncope?
Neurocardiogenic syncope
What is thought to be the pathophysiology of Vasovagal/neurocardiogenic syncope?
Improper communication between the blood vessels and the vagus nerve to the heart leading to loss of consciousness
What can trigger Vasovagal syncope?
Pain
Stress
Medications
What worsens a Vasovagal episode?
Repeated elevation and sitting up
How quickly does a Vasovagal episode occur?
What are teh signs?
You know its coming on
Signs like sweating and clammy
How is Vasovagal syncope treated?
Typically resolves not requiring treatment
If Vasovagal episode coming on pateint should lie down so head is at same level as heart
When does vasovagal/neurocardiogenic syncope require treatment?
How is it treated?
When the vasovagal syncope is severely interfering with the patients life
Patient has a pacemaker which maintains the HR higher when it detects and episode is happening
If you are unsure on the cause of a patients syncope (not Vasovagal) but unsure from history, what can you give to a patient to aid diagnosis?
Implant an implantable loop recorder
What are some structural heart diseases that can lead to syncope?
Aortic stenosis
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
What are some signs of aortic stenosis?
Syncope
Slow rising low volume carotid pulse
Quiet or absent 2nd heart sound
Pressure loaded apex beat
Ejection systolic murmur
What cardio-respiratory issue often causes syncope?
PE
How can you investigate a PE?
Low sats
ABG
RV hypertrophy on ECG
What are some. Conditions that can be identified on an ECG which can lead to syncope?
Structural heart disease
Coronary artery disease (can cause VF)
Sinus node disease
Conductive tissue disease
Accessory pathways
Ion channelopathies
Electrolyte abnormalities
Apart from VF what other ECG change could be noticed in a pateitn with coronary artery disease?
QT prolongation
What can QT prolongation lead to?
Torsades de pointes
What is a difference between Torsades de Pointes and Ventricular fibrillation?
VF DOESNT self terminate (will eventually die)
Torsades de Pointes can self terminate (might not die)
What are some ion channelopathies that can cause syncope?
Brugada syndrome
ARVC (arrhytmogenic right ventricular cardiopathies)
Congential long QT
What is the recovery like for a pateitn with syncope caused by sinus node disease?
Very rapid recovery/wake up
What is another term to describe syncope caused by sinus node disease?
Drop attack
Stoke Adam attacks
What are some accessory pathways diseases that can cause syncope?
Wolffe Parkinson White syndrome
AVNRT
LGL
Mahain pathway
What are some accessory pathways diseases that can cause syncope?
Wolffe Parkinson White syndrome
AVNRT
LGL
Mahain pathway
