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POM unit 4 > syncope > Flashcards

syncope Flashcards

1
Q

syncope

A

complete and transient LOC and postural tone.

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2
Q

character of syncope

A

rapid onset, complete LOC and postural tone. brief for 30sec-<5 min with spontaneous recovery

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3
Q

is syncope common?

A

yes. 1-5% of ER visits. >1 million patients

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4
Q

what is the lifetime incidence

A

30-35%

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5
Q

what are the ages common for syncope?

A

bimodal 20-70

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6
Q

why does it cost so much money/

A

due to unnecessary or low-yield tests

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7
Q

what is the etiology?

A

global cerebral hypoperfusion

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8
Q

what determines cerebral perfusion?

A

blood pressure

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9
Q

what is BP dependent on?

A

cardiac output and vascular tone.

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10
Q

reflex/neurally mediated syncope

A

abrupt withdrawal of sympathetic tone leads to vasodilation/hypotension and bradycardia.

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11
Q

examples of neurally mediated syncope

A

vaso-vagal, situational, carotid sinus hypersensitivity

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12
Q

what causes vaso-vagal

A

stress, pain, phobia.

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13
Q

what causes situational

A

eat, sneeze, cough, poop, pee.

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14
Q

what is orthostatic hypotension

A

inadequate peripheral vasoconstriction in response to orthostatic stress. by definition it is a drop in BP by 20/10 within 3 minutes of standing.

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15
Q

what can commonly cause othrostatic hypo.

A

DAAD. drugs, alcohol, autonomic dys, dehydration

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16
Q

examples of drug-induced

A

diuretics, etoh, sedative, antipsychotics, alpha-blockers BPH.

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17
Q

causes of primary autonomic failure

A

parkinsons, multiple-system atrophy, LBD.

18
Q

secondary autonomic failure

A

diabetes, amyloidosis, spinal cord injury

19
Q

common causes of volume depletion

A

dehydration, hemorrhage, diarrhea

20
Q

cardiac syncope

A

bradycardia due to drugs, electrolyte abnormal, or conduction system disease. this can due to tachyarrhythmia (VT or SVT) aortic stenosis, severe CHF, systolic murmurs.

21
Q

how useful is history in diagnosis?

A

50% diagnostic

22
Q

common questions that should be asked…

A

what were doing? coughing, sneezing, pooping, etc. sudden noises? extreme emotion

23
Q

prodrome for vasovagal syncope?

A

nausea, abdominal pain, dizziness, tinnitus, neck and shoulder pain. elderly may not have them

24
Q

prodrome for arrhythmia

A

none or very brief prodrome. palpitations.

25
Q

seizure prodrome

A

deja vu, hallucinations, sensory aura.

26
Q

how does arrhythmia recover?

A

rapidly

27
Q

how does vasovagal recover

A

may take longer to recover.

28
Q

what is the postdrome for seizure

A

poskt-ictal confusion or neurodeficits

29
Q

high risk features of syncope

A

exercise-induced, family history of SCD, drop-attack, abnormal EKG. pallor/anemia/electrolyte disturbance.

30
Q

what tests does everyone get?

A

H and P, CBC, BMP, EKG.

31
Q

what tests for cardiac?

A

echo, rhythm monitoring, EP study

32
Q

tests for neurogenic

A

tilt-table

33
Q

neurology testing

A

EEG and mRi

34
Q

lifestyle modifications for treatment

A

adequate salt and hydration, avoiding triggers, moderate exercise.

35
Q

what other treatments are available for orthostatic?

A

counterpressure: stockings and tilt training

36
Q

pharma for syncope

A

B-blockers, fludrocortisone, alpha-agonists, SSRI

37
Q

what is high risk syncope?

A

cardiac.

38
Q

what is the most easily treated syncope?

A

cardiac.

39
Q

how do we treat bradyarrhythmias

A

pacemakers

40
Q

how do we treat tachyarrhythmias

A

ablation therapy

41
Q

how do we treat aortic stenosis or systolic murmurs?

A

with surgery

42
Q

what is the most high risk and what is their prognosis

A

structural cardiac disease and arrhythmia. unless treated have a poor prognosis.

POM unit 4 (5 decks)

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