Syncope Flashcards
Patient words for Syncope
- Loss of Consciousness
- Passing Out
- Fainting
- Falling Out
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.
Syncope
This is the term for an alert cognitive state in which one is aware of oneself and situation.
Consciousness
What does consciousness refer to in reference to physiology?
- Organized Cortical Activity
- Adequate supply of oxygen and glucose
This is the term for the feeling of lightheadedness as if one may faint.
Pre-Syncope
How should you approach pre-syncope (especially in the elders)?
Evaluate as if it was actually syncope.
T/F: Syncope is a common complaint in the ED, accounting for 10-30% of all hospital admissions.
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% :)
T/F: Syncope can be a manifestation of a multitude of dz processes, some quite serious. However, it is often benign and self-limited.
True
What are the three classifications of Syncope?
- Neurally-Mediated Syncope (~58%)
- Cerebrovasclar Disease
- Cardiopulmonary Diseases
This is the most common cause of syncope, accounting for 25-65% of cases. Most importantly discovered in retrieving a history.
Neurocardiogenic Syncope (Vasovagal)
Classification: Neurally Mediated Syncope
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.
Situational Syncope
Classification: Neurally Mediated Syncope
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.
Autonomic Failure
Classification: Neurally Mediated Syncope
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.
Carotid Sinus Sensitivity
Classification: Neurally Mediated Syncope
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.
Subarachnoid Hemorrhage
Classification: Cerebrovascular Dz
If suspecting a subarachnoid hemorrhage, what do you do next?
Non-contrast Brain CT and/or Lumbar Puncture
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.
Subclavian Steal Syndrome
Classification: Cerebrovascular Dz
What can cause the retrograde vertebral artery flow in Subclavian Steal Syndrome?
- Proximal Subclavian Artery Stenosis
- Proximal Subclavian Artery Occlusion
How would you move forward if you suspect Subclavian Steal Syndrome in a patient?
- Check BP and Distal Pulses in BOTH arms
- Duplex US
- MRA
This type of syncope is caused by ischemia or infarct.
Ischemia/Infarct :D
Classification: Cardiopulmonary Dz
This type of syncope is caused by arrhythmia.
Arrhythmia :D
Classification: Cardiopulmonary Dz
This type of syncope is caused by pulmonary emboli.
Pulmonary Emboli :D
Classification: Cardiopulmonary Dz
Management of suspected Pulmonary Emboli due to syncopal episode?
- Spiral CT
- Pulm Angiography
- D-dimer?
Management of suspected Ischemia/Infarct due to syncopal episode?
- EKG
- Cardiac Enzymes
- Stress Test
- Cardiac Cath
Management of suspected Arrhythmia due to syncopal episode?
- Identify if Tachy, Brady, AV Block, Long QT, etc.
- EKG
- Holter Monitor
