Syncope

Question 1

Syncope pathophysiology

Answer 1

-reduction in systemic BP, causing decrease in global cerebral flow and reduced LOC
-as we age we become more susceptible to small falls in BP, increased incidence of syncope
-many causes with unique pathophysiological cause

Question 2

2 umbrella terms of syncope

Answer 2

Cardiac:
caused by- arrythmias, structural cardiac diseases
Non cardiac:
Further classifications
-reflex- vasovagal, situational
-orthostatic hypotension

Question 3

Reflex syncope

Answer 3

-2 types- vasovagal and situational
-group of conditions where cardiovascular reflexes, normally control circulation don’t function properly
-causes reduced blood flow to brain
-usually response to trigger eg. vasodilation, bradycardia causing reduction in BP

Question 4

Vasovagal/ Neurocardiogenic

Answer 4

-also known as simple/ common faint
-triggered by pain, emotional upset, phobias
-usually preceded by symptoms of autonomic activation (sweaty, nausea, pale)

Question 5

Situational syncope

Answer 5

-triggered by specific situation
eg. urination, post exercise, post eating, GI stimulation, cough, phobia of needles/ blood

Question 6

Orthostatic syncope
-what is it, causes

Answer 6

-fall in BP of at least 20mmHg systolic or 10mmHg diastolic when standing
-caused dysfunction ANS, causing reduced peripheral venous resistance causing decreases cardiac output
Causes: medication, dehydration, blood loss, anaemia

Question 7

Cardiac syncope

Answer 7

-either mechanical cause (valvular disease, MI cardiac tamponade or cardiomyopathy) or electrical cause (arrythmia)
-highest mortality rate and more complex
-need to be conveyed urgently to hospital

Question 8

Syncope prodromal symptoms

Answer 8

-light headed
-sweating
-nausea
-visual disturbance
Signs of a simple faint and in absence of red flags and with full recovery, discharge on scene

Question 9

Syncope assessment

Answer 9

-assess manage CABCD
-ascertain from patient/ witness what happened before, during and after
-ECG
-full examination, all obs and seated and standing BP and CBG
-assess for uncomplicated faint eg. vasovagal/ situational
-identify red flags

Question 10

Features suggestive of uncomplicated faint

Answer 10

-Posture- prolonged standing or similar episodes that have prevented lying down
-Provoking factors eg. pain/ medical procedure
-Prodromal symptoms eg. sweating, hot

Question 11

Red flags of syncope

Answer 11

-new ECG abnormalities
-physical signs of HF
-occurred during exertion
-FHx of sudden cardiac death or inherited cardiac condition
-breathlessness
-heart murmur

Question 12

Syncope treatment and management

Answer 12

-manage CABCD
-O2 if necessary, rare
-give IV NaCl (fluid) if necessary, rare
-raise legs?
-allow patient to recover, will take time

Question 13

When can diagnose uncomplicated faint

Answer 13

-no red flags
-features of uncomplicated faint (3Ps)

Question 14

When can diagnose situational syncope

Answer 14

-no features of alternative diagnosis
-syncope clearly and consistently provoked by straining during urination, coughing etc.