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Cardiology > Syncope > Flashcards

Syncope Flashcards

1
Q

What is syncope?

A
  • passing out but able to recover within a few min

- prob has an UNDERLYING dz for cxing the syncope

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2
Q

% of people exp syncope?

A

25%

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3
Q

Who get syncope?

A

females

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4
Q

What is happening in syncope?

A

brain is not getting perfused for 5-10 sec

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5
Q

What cxs syncope?

A
  • reflex (65%):
  • orthostatic (9%)
  • cardiogenic (10%): 1/3 chance of dying w/in 1 yr
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6
Q

What is reflex?

A
  • carotid sinus hypersensitivity

- vasovagal (most common): incr in parasymp and decr in symp

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7
Q

What is orthostatic?

A

-volume depletion

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8
Q

What is other cx?

A
  • somatization (body is not sick but a psychiatric condition)
  • hypoglycemia
  • MHA (migraine headache)
  • absence seizure (brain is having a seizure but not the body)
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9
Q

What is cardiogenic syncope?

A
  • arrhythmias (most common cx of cardiogenic syncope)
    • bradycardia
    • tachycardia
  • -conduction disorders
  • – arrhthmogenic RV cardiomyopathy
  • -stuctural: hypertrophic obstructive cardiomyopathy
    • subclavian steal syndrome
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10
Q

How to eval?

A

1) ASSESSMENT
2) HX
3) ECG

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11
Q

Hx/Sx of syncope?

A

-palpitation
-chest pain
-SOB
= CARDIOGENIC

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12
Q

what are provocative factors of syncope?

A
  • activity: cardiogenic
  • at rest: arrhythmias
  • w/ exertion: mechanical/ischemia
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13
Q

What would you find on ECG?

A
  • prolonged QRS, QTc
  • VERY BAD bradycardia
  • SA dysfunction
  • 2nd and 3rd degree blocks
  • PVC
  • MI hx
  • WPW, Long QT
  • hypertrophic obstructive cardiomyopathy
  • SVT
  • Afib/flutter
  • pacemaker broken
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14
Q

Risk stratification?

A
  • common: reflex, orthostatic

- BAD/FATAL: cardiogenic (arrhythmia, cardiomyopathy)

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15
Q

Prognosis of syncope?

A

if you have higher RF, then worser outcome

-FAMILY Hx

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16
Q

Tx?

A

NO Tx!

Tx underlying cx of syncope!

17
Q

Pathophysiology syncope?

A

autonomic is not working

18
Q

Syncope pt eval?

A

Hx, PE, vitals, +/- labs (CBC, BMP, UA)

19
Q

RF syncope?

A 
abnormal ECG
H xof cardiact dz
low BP
SOB 
Family hx of cardiac death
20
Q

Neurally mediated syncope?

A

transient change in functioning autonomic when there is a stimuli
incr parasympathetic –> bradycardia
incr sympatehtic –> vasodilation

21
Q

Subtypes of neurally mediated synope?

A
  • vasovagal syncope (common faint d/t blood, etc)

- situational reflex syncope

22
Q

****Prodromal sx of syncope?

A

common in neurally mediated syncope
cx of autonomic activation –> diaphoresis, pallor, palpitation, nausea, hyperventilation (does not happen in orthostatic b/c autonomic is NOT intact)

23
Q

NMS - tx?

A

nothing (avoid triggers)

24
Q

Orthostatic hypotension - classification?

A

volume depletion

neurogenic (autonomic)

25
Q

Orthostatic hypotension - volume depletion?

A

occurs w/in 15 min
mismatch between CO and PVR
compensatory increase in HR (b/c autonomic is intact)
supine HTN is uncommon
cx: volume depletion, vasodilation, decreased CO

26
Q

Orthostatic hypotension - neurogenic?

A 
occurs w/in 3 min
d/t autonomic failure
NO increase in HR
supine HTN is common
cx: neurodegenerative disorder, peripheral neuropathies
27
Q

Subtypes of NOH?

A

Primary
Secondary
Other

28
Q

NOH - primary?

A 
central
neurodegenerative
cx: idiopathic
LEWY BODY
DEMENTIA
PARKINSON 
d/t synucleinopathies
29
Q

NOH - secondary?

A

peripheral and neuropathy
DIABETES
PRIMARY AMYLOIDOSIS (abnormal folded proteins and body cant break down and stays in neurons)

30
Q

NOH - RF?

A 
postprandial
elderly
iatrogenic
motionless upright posture
warm temp
intravascular volume depletion
ETOH
31
Q

**NOH - presyncope?

A

dizzy
lightheadedness
weakness
cx: hypoperfusion/ischemia of various structures

32
Q

NOH - tx?

A

pt education: rise head of bed to redue supine HTN, warn about after meals, stay hydrated

33
Q

Neurally mediated syncope?

A

refelx
transient change in hemostatic reflexes
stimuli: blood, vasovagal

34
Q

Neurogenic orthostatic hypotension?

A

something is wrong w/ autonomic system

Cardiology (10 decks)

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