syncope

Question 1

Define syncope (this was short answer on quiz)

Answer 1

Abrupt, transient, complete loss of consciousness that occurs due to a period of insufficient cerebral perfusion. LOC followed by complete, rapid, spontaneous recovery

Question 2

What factors are required for a person to be “conscious”?

Answer 2

1) Organized cortical activity
2) Glucose
3) Oxygen

Question 3

What are the 3 broad categories of syncope?

Answer 3

1) Neurally Mediated
2) Cerebrovascular
3) Cardiopulmonary

Question 4

What are the 5 subcategories of Neurally mediated syncope?

Answer 4

1) vasovagal
2) situational
3) autonomic insufficiency
4) carotid sinus hypersensitivity
5) psych

Question 5

What is the most common type of syncope? Give an example.

Answer 5

Vasovagal: faint at the sight of blood

Question 6

Syncope following a coughing spell or bowel movement

Answer 6

situational

Question 7

Orthostatic hypotension is responsible for what type of syncope?

Answer 7

Autonomic failure

Question 8

Give some examples of who might have autonomic failure:

Answer 8

1) DM
2) EtOH
3) Elderly
4) Meds

Question 9

What is carotid sinus sensitivity?

Answer 9

Atherosclerotic patients commonly have carotid artery occlusion and are likely to have syncope if carotids are compressed/massaged

Question 10

Your patient has a “thunderclap headache”. What do you suspect? And what classification of syncope is this?

Answer 10

SAH, cerebrovascular disease

Question 11

This cerebrovascular dz is caused by ischemia that reduces the perfusion in the back of the neck. Ischemic vessels cause retrograde blood flow which results in vertigo, syncope, nystagmus, and arm symptoms which include coolness, paresthesias, and pulse discrepancies

Answer 11

Subclavian steal syndrome

Question 12

How can you dx SSS?

Answer 12

Check distal pulses, US, MRA

Question 13

What are the cerebrovascular syncopes?

Answer 13

SAH and SSS

Question 14

What are the 5 major cardiopulmonary diseases?

Answer 14

1) ischemia/infarct
2) arrhythmia
3) PE
4) Structural
5) Cardiac tamponade

Question 15

What structural abnormality can be detected by performing the Valsalva?

Answer 15

HOCM

Question 16

what does HOCM stand for?

Answer 16

hypertrophic cardiomyopathy

Question 17

Would seizures, head trauma, or metabolic factors be termed syncope? If so, what category do they fall under? If not, why not?

Answer 17

Nonsyncopal, b/c the cause of LOC is not insufficient cerebral perfusion, also recovery is often slow rather than spontaneous

Question 18

How do you treat neurally mediated syncope?

Answer 18

Reassurance, avoid triggers

Question 19

Who is the biggest risk group of syncope patients? (for sudden death)

Answer 19

CHF’ers

Question 20

SAH is in the cerebrovascular syncope category. You could also say it is a neurologic syncopy. What else falls into this category?

Answer 20

TIA

Question 21

If you have a young, healthy patient with normal PE and basic dx tests who’s been having multiple syncopal episodes, what is high on your DDx?

Answer 21

Psychiatric syncope

Question 22

What factors can help you determine if you patient had a syncopal episode or a seizure?

Answer 22

1) was there a prodrome?
2) was there tonic/clonic activity or posturing?
3) has the lateral tongue been bitten?
4) b/b incontinence?
5) postictal phase?
(some require witness, obviously)