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DDx > Syncope > Flashcards

Syncope Flashcards

1
Q

Patient words for Syncope

A
  • Loss of Consciousness
  • Passing Out
  • Fainting
  • Falling Out
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2
Q

This is the term for abrupt, transient, complete loss of consciousness that occurs due to a period of insufficient cerebral perfusion. The loss of consciousness is typically brief and is followed by complete, rapid spontaneous recovery.

A

Syncope

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3
Q

This is the term for an alert cognitive state in which one is aware of oneself and situation.

A

Consciousness

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4
Q

What does consciousness refer to in reference to physiology?

A
  • Organized Cortical Activity

- Adequate supply of oxygen and glucose

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5
Q

This is the term for the feeling of lightheadedness as if one may faint.

A

Pre-Syncope

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6
Q

How should you approach pre-syncope (especially in the elders)?

A

Evaluate as if it was actually syncope.

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7
Q

T/F: Syncope is a common complaint in the ED, accounting for 10-30% of all hospital admissions.

A

False! This was pretty basic, you should know it’s 1-3%. Feel embarrassed.

But it is still a common complaint in the ED with 3-5% :)

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8
Q

T/F: Syncope can be a manifestation of a multitude of dz processes, some quite serious. However, it is often benign and self-limited.

A

True

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9
Q

What are the three classifications of Syncope?

A
  1. Neurally-Mediated Syncope (~58%)
  2. Cerebrovasclar Disease
  3. Cardiopulmonary Diseases
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10
Q

This is the most common cause of syncope, accounting for 25-65% of cases. Most importantly discovered in retrieving a history.

A

Neurocardiogenic Syncope (Vasovagal)

Classification: Neurally Mediated Syncope

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11
Q

This is a variant of vasovagal syncope. Usually caused by post-tussive, post-micturition, GI-stimulated, Psych, etc. Most importantly discovered in retrieving a history.

A

Situational Syncope

Classification: Neurally Mediated Syncope

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12
Q

This is a type of syncope that occurs when orthostatic hypotension is the underlying problem. Commonly assc with DM, EtOH, Advanced Age, Medications, etc. Most importantly discovered in retrieving a history, PE, med review, EKG, or appropriate labs.

A

Autonomic Failure

Classification: Neurally Mediated Syncope

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13
Q

This is a type of syncope that is most common in elderly patients with atherosclerosis. Most importantly discovered in performing a carotid sinus massage or compression of the sinus.

A

Carotid Sinus Sensitivity

Classification: Neurally Mediated Syncope

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14
Q

This type of syncope is usually from rupture of a berry aneurysm or AV malformation. It presents with a severe acute headache. Possibly a THUNDERCLAP. Followed by a syncopal episode.

A

Subarachnoid Hemorrhage

Classification: Cerebrovascular Dz

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15
Q

If suspecting a subarachnoid hemorrhage, what do you do next?

A

Non-contrast Brain CT and/or Lumbar Puncture

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16
Q

This type of syncope is caused by retrograde vertebral artery flow assc with transient neurologic symptoms related to cerebral ischemia. Commonly presents with pain and fatigue in the affected upper extremity, coolness, paresthesia, dizziness, vertigo, syncope, and/or nystagmus.

A

Subclavian Steal Syndrome

Classification: Cerebrovascular Dz

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17
Q

What can cause the retrograde vertebral artery flow in Subclavian Steal Syndrome?

A
  • Proximal Subclavian Artery Stenosis

- Proximal Subclavian Artery Occlusion

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18
Q

How would you move forward if you suspect Subclavian Steal Syndrome in a patient?

A
  • Check BP and Distal Pulses in BOTH arms
  • Duplex US
  • MRA
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19
Q

This type of syncope is caused by ischemia or infarct.

A

Ischemia/Infarct :D

Classification: Cardiopulmonary Dz

20
Q

This type of syncope is caused by arrhythmia.

A

Arrhythmia :D

Classification: Cardiopulmonary Dz

21
Q

This type of syncope is caused by pulmonary emboli.

A

Pulmonary Emboli :D

Classification: Cardiopulmonary Dz

22
Q

Management of suspected Pulmonary Emboli due to syncopal episode?

A
  • Spiral CT
  • Pulm Angiography
  • D-dimer?
23
Q

Management of suspected Ischemia/Infarct due to syncopal episode?

A
  • EKG
  • Cardiac Enzymes
  • Stress Test
  • Cardiac Cath
24
Q

Management of suspected Arrhythmia due to syncopal episode?

A
  • Identify if Tachy, Brady, AV Block, Long QT, etc.
  • EKG
  • Holter Monitor
25
Q

This type of syncope is caused by structural abnormalities.

A

Structural Abnormality :D

Classification: Cardiopulmonary Dz

26
Q

This type of syncope is cause by cardiac tamponade.

A

Cardiac Tamponade :D

Classification: Cardiopulmonary Dz

27
Q

Management of suspected Cardiac Tamponade due to syncopal episode?

A
  • Physical Exam
  • EKG
  • CXR
  • Echo
28
Q

Management of suspected Structural Abnormality due to syncopal episode?

A
  • Physical Exam
  • Echo

Looking for:
A. Aortic Stenosis
B. HCM/HOCM

29
Q

T/F: Non-Syncopal Loss of Consciousness should not be included in your differential diagnoses for a patient with syncopal or pre-syncopal incident.

A

False, they should be! #BASIC #pH10

30
Q

Common causes of Non-Syncopal Loss of Consciousness

A
  • Sz
  • Head Trauma
  • Metabolic Factors

***Although they have lost consciousness, it may not be due to insufficient cerebral perfusion.

31
Q

Approximately ___ of individuals are likely to experience a syncopal episode in their lifetime.

A

1/3

32
Q

As we age, the risk for syncopal episodes increase. According to a study, at what age is there a sharp rise in the incidence of syncopal episodes? What sex is more affected?

A

Age 70; Women

33
Q

Is cardiac related syncope more common in men or women?
Non-cardiac related syncope?
Unknown cause of syncope?

A

Men; Women; Women

34
Q

Pathophysiology of Syncope

A

Transient inadequate cerebral perfusion

35
Q

Risk Factors for Syncope

A
  1. Age
  2. CV Dz
  3. Hx of CVA or TIA
  4. HTN
  5. Low BMI
  6. Inc. EtOH intake
  7. DM
36
Q

T/F: An etiology can be identified in approximately 50% of syncope cases using history, PE, and EKG.

A

True

37
Q

Important things to investigate in History of a Syncopal Patient

A
  • PMH of Cardiac Dz
  • Number of Syncopal Episodes
  • Circumstances surrounding episode of syncope
  • Assc Symptoms
  • Pre-syncopal Symptoms
  • Duration of Symptoms
  • Other PMH
  • Medications
  • Drug/EtOH Use
  • ROS
  • Social and Family Hx

Don’t use leading questions; Get witness reports if possible

38
Q

Important things to investigate in Physical Exam of a Syncopal Patient

A
  • VITAL SIGNS (include orthostatics)
  • Cardiac Exam (including Valsalva)
  • Pulmonary Exam
  • Neck Exam
  • Neurologic Exam
  • Rectal for Occult Blood
  • Others per pt presentation
39
Q

Important things to investigate in Labs/Testing of a Syncopal Patient

A
  • CBC
  • BMP/CMP
  • Tox Screen
  • Cardiac Enzymes
  • EKg
  • Carotid Sinus Massage
  • Tilt Table Testing
  • CT Brain
  • EEG
  • Carotid US
  • Others per pt presentation
40
Q

Tx of Syncope

A

Dependent on the underlying cause!!

  1. Cardiac causes
    - - Arrhythmias may require cardioversion, medications for long term control, pacemaker implantation
    - - Structural deficits may require surgery
  2. Orthostatic hypotension
    - - IV rehydration, discontinue medications that are exacerbating the condition
  3. Neurally mediated
    - - Require reassurance, educating the patient regarding the circumstances causing the syncope, avoidance of triggers
  4. Psychiatric
    - - Antidepressants, anxiolytics, avoidance of triggering events, therapy
  5. Neurologic
    - -SAH may require surgery
41
Q

T/F: Patients with Cardiac Syncope are at a low risk for sudden death.

A

False, they are at a significant risk (Greater if they have CHF too)

42
Q

This type of syncope is common in young patients with no cardiac diseases. Typically they present with multiple episodes.

A

Psychiatric Syncope

43
Q

T/F: Hypoglycemia and hypoxia more often result true syncope.

A

False: They more often result in stupor or coma rather than true syncope.

44
Q

Approximately 5-15% of patients thought to have syncope actually have a seizure disorder.

A

Good to know! It is difficult to determine the difference sometimes. Some Szs don’t have convulsions, some syncope have convulsive episodes. #Sigh

45
Q

Factors that suggest a sz:

A
  • Prodrome (aura)
  • Episode of abrupt onset with assc. injury
  • Presence of tonic phase before the rhythmic clonic activity.
  • Head deviation or unusual posturing during the episode
  • Tongue biting (lateral aspect)
  • Loss of bowel or bladder control
  • Postictal phase

DDx (9 decks)

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