Syncope Flashcards
What is syncope?
Transient loss of consciousness due to global cerebral hypoperfusion with rapid onset and short duration
Spontaneous and complete recovery occurs.
What are the key characteristics of pre-syncope?
Clinical characteristics of cerebral hypoperfusion without loss of consciousness
Includes symptoms that may precede syncope.
What are the prodromal symptoms of reflex syncope?
- Lightheadedness
- Dizziness
- Nausea
- Diaphoresis
- Visual disturbances (tunnel or blurred vision)
- Tinnitus or muffled hearing
- Pallor
These symptoms may act as warning signs for impending episodes.
What happens to postural tone during loss of consciousness?
Patient may lose postural tone
Duration of unconsciousness can range from seconds to minutes.
What are the symptoms during the recovery phase after syncope?
- Confusion or disorientation
- Fatigue and weakness
- Recollection of prodromal symptoms but amnesia of actual loss of consciousness
These symptoms indicate the transition back to awareness.
What investigations are done for syncope?
- CV Exam
- ECG
- Postural Blood Pressure
These tests help assess cardiovascular health and identify potential causes.
What are the diagnostic criteria for postural blood pressure?
Symptomatic fall in BP > 20 mmHg
Diastolic BP > 10 mmHg after waiting 3 minutes between measurements
20 10 3
A decrease in systolic BP < 90 mmHg is diagnostic.
What risk factor is associated with postural hypotension?
Type 2 Diabetes Mellitus (T2DM)
May cause postural hypotension secondary to autonomic dysfunction.
What are non-pharmacological management strategies for syncope?
- Patient Education
- Counter-pressure manoeuvres (e.g., leg crossing)
- Avoiding triggers (dehydration, prolonged standing, hot environments)
These strategies help prevent syncope episodes.
What is the first pharmacological treatment for syncope?
Fludrocortisone
A mineralocorticoid that increases blood volume and improves orthostatic tolerance.
What is the second pharmacological treatment for syncope?
Midodrine
An alpha-1 adrenergic agonist that causes vasoconstriction and increases blood pressure.
What are the 3 types of syncope
- Reflex
- Cardiac
- Orthostatic
Causes of reflex syncope
- **most common type! **
- Vasovagal
- situational
- carotid sinus syncope
Causes of cardiac syncope
- Arrythmia - AF, POTs
- Structual issue e.g. valve
- PE
Causes of orthostatic syncope
- Primary autonomic failure = Parkinson’s, Lewy body dementia
- Secondary autonomic failure - ureamia, diabetic neuropathy
- Drugs - diuretics
- Volume depletion - diarrhoea
