Syncope Flashcards
What is syncope?
- passing out but able to recover within a few min
- prob has an UNDERLYING dz for cxing the syncope
% of people exp syncope?
25%
Who get syncope?
females
What is happening in syncope?
brain is not getting perfused for 5-10 sec
What cxs syncope?
- reflex (65%):
- orthostatic (9%)
- cardiogenic (10%): 1/3 chance of dying w/in 1 yr
What is reflex?
- carotid sinus hypersensitivity
- vasovagal (most common): incr in parasymp and decr in symp
What is orthostatic?
-volume depletion
What is other cx?
- somatization (body is not sick but a psychiatric condition)
- hypoglycemia
- MHA (migraine headache)
- absence seizure (brain is having a seizure but not the body)
What is cardiogenic syncope?
- arrhythmias (most common cx of cardiogenic syncope)
- bradycardia
- tachycardia
- -conduction disorders
- – arrhthmogenic RV cardiomyopathy
- -stuctural: hypertrophic obstructive cardiomyopathy
- subclavian steal syndrome
How to eval?
1) ASSESSMENT
2) HX
3) ECG
Hx/Sx of syncope?
-palpitation
-chest pain
-SOB
= CARDIOGENIC
what are provocative factors of syncope?
- activity: cardiogenic
- at rest: arrhythmias
- w/ exertion: mechanical/ischemia
What would you find on ECG?
- 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
Risk stratification?
- common: reflex, orthostatic
- BAD/FATAL: cardiogenic (arrhythmia, cardiomyopathy)
Prognosis of syncope?
if you have higher RF, then worser outcome
-FAMILY Hx
Tx?
NO Tx!
Tx underlying cx of syncope!
Pathophysiology syncope?
autonomic is not working
Syncope pt eval?
Hx, PE, vitals, +/- labs (CBC, BMP, UA)
RF syncope?
abnormal ECG H xof cardiact dz low BP SOB Family hx of cardiac death
Neurally mediated syncope?
transient change in functioning autonomic when there is a stimuli
incr parasympathetic –> bradycardia
incr sympatehtic –> vasodilation
Subtypes of neurally mediated synope?
- vasovagal syncope (common faint d/t blood, etc)
- situational reflex syncope
****Prodromal sx of syncope?
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)
NMS - tx?
nothing (avoid triggers)
Orthostatic hypotension - classification?
volume depletion
neurogenic (autonomic)
Orthostatic hypotension - volume depletion?
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
Orthostatic hypotension - neurogenic?
occurs w/in 3 min d/t autonomic failure NO increase in HR supine HTN is common cx: neurodegenerative disorder, peripheral neuropathies
Subtypes of NOH?
Primary
Secondary
Other
NOH - primary?
central neurodegenerative cx: idiopathic LEWY BODY DEMENTIA PARKINSON d/t synucleinopathies
NOH - secondary?
peripheral and neuropathy
DIABETES
PRIMARY AMYLOIDOSIS (abnormal folded proteins and body cant break down and stays in neurons)
NOH - RF?
postprandial elderly iatrogenic motionless upright posture warm temp intravascular volume depletion ETOH
**NOH - presyncope?
dizzy
lightheadedness
weakness
cx: hypoperfusion/ischemia of various structures
NOH - tx?
pt education: rise head of bed to redue supine HTN, warn about after meals, stay hydrated
Neurally mediated syncope?
refelx
transient change in hemostatic reflexes
stimuli: blood, vasovagal
Neurogenic orthostatic hypotension?
something is wrong w/ autonomic system
