Syncope

Question 1

What is syncope?

Answer 1

• passing out but able to recover within a few min

- prob has an UNDERLYING dz for cxing the syncope

Question 2

% of people exp syncope?

Answer 2

25%

Question 3

Who get syncope?

Answer 3

females

Question 4

What is happening in syncope?

Answer 4

brain is not getting perfused for 5-10 sec

Question 5

What cxs syncope?

Answer 5

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

Question 6

What is reflex?

Answer 6

• carotid sinus hypersensitivity

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

Question 7

What is orthostatic?

Answer 7

-volume depletion

Question 8

What is other cx?

Answer 8

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

Question 9

What is cardiogenic syncope?

Answer 9

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

Question 10

How to eval?

Answer 10

1) ASSESSMENT
2) HX
3) ECG

Question 11

Hx/Sx of syncope?

Answer 11

-palpitation
-chest pain
-SOB
= CARDIOGENIC

Question 12

what are provocative factors of syncope?

Answer 12

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

Question 13

What would you find on ECG?

Answer 13

• 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

Question 14

Risk stratification?

Answer 14

• common: reflex, orthostatic

- BAD/FATAL: cardiogenic (arrhythmia, cardiomyopathy)

Question 15

Prognosis of syncope?

Answer 15

if you have higher RF, then worser outcome

-FAMILY Hx

Question 16

Tx?

Answer 16

NO Tx!

Tx underlying cx of syncope!

Question 17

Pathophysiology syncope?

Answer 17

autonomic is not working

Question 18

Syncope pt eval?

Answer 18

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

Question 19

RF syncope?

Answer 19

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

Question 20

Neurally mediated syncope?

Answer 20

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

Question 21

Subtypes of neurally mediated synope?

Answer 21

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

- situational reflex syncope

Question 22

****Prodromal sx of syncope?

Answer 22

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)

Question 23

NMS - tx?

Answer 23

nothing (avoid triggers)

Question 24

Orthostatic hypotension - classification?

Answer 24

volume depletion

neurogenic (autonomic)

Question 25

Orthostatic hypotension - volume depletion?

Answer 25

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

Question 26

Orthostatic hypotension - neurogenic?

Answer 26

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

Question 27

Subtypes of NOH?

Answer 27

Primary Secondary Other

Question 28

NOH - primary?

Answer 28

``` central neurodegenerative cx: idiopathic LEWY BODY DEMENTIA PARKINSON d/t synucleinopathies ```

Question 29

NOH - secondary?

Answer 29

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

Question 30

NOH - RF?

Answer 30

``` postprandial elderly iatrogenic motionless upright posture warm temp intravascular volume depletion ETOH ```

Question 31

****NOH - presyncope?

Answer 31

dizzy lightheadedness weakness cx: hypoperfusion/ischemia of various structures

Question 32

NOH - tx?

Answer 32

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

Question 33

Neurally mediated syncope?

Answer 33

refelx transient change in hemostatic reflexes stimuli: blood, vasovagal

Question 34

Neurogenic orthostatic hypotension?

Answer 34

something is wrong w/ autonomic system