syncope Flashcards
syncope
complete and transient LOC and postural tone.
character of syncope
rapid onset, complete LOC and postural tone. brief for 30sec-<5 min with spontaneous recovery
is syncope common?
yes. 1-5% of ER visits. >1 million patients
what is the lifetime incidence
30-35%
what are the ages common for syncope?
bimodal 20-70
why does it cost so much money/
due to unnecessary or low-yield tests
what is the etiology?
global cerebral hypoperfusion
what determines cerebral perfusion?
blood pressure
what is BP dependent on?
cardiac output and vascular tone.
reflex/neurally mediated syncope
abrupt withdrawal of sympathetic tone leads to vasodilation/hypotension and bradycardia.
examples of neurally mediated syncope
vaso-vagal, situational, carotid sinus hypersensitivity
what causes vaso-vagal
stress, pain, phobia.
what causes situational
eat, sneeze, cough, poop, pee.
what is orthostatic hypotension
inadequate peripheral vasoconstriction in response to orthostatic stress. by definition it is a drop in BP by 20/10 within 3 minutes of standing.
what can commonly cause othrostatic hypo.
DAAD. drugs, alcohol, autonomic dys, dehydration
examples of drug-induced
diuretics, etoh, sedative, antipsychotics, alpha-blockers BPH.
causes of primary autonomic failure
parkinsons, multiple-system atrophy, LBD.
secondary autonomic failure
diabetes, amyloidosis, spinal cord injury
common causes of volume depletion
dehydration, hemorrhage, diarrhea
cardiac syncope
bradycardia due to drugs, electrolyte abnormal, or conduction system disease. this can due to tachyarrhythmia (VT or SVT) aortic stenosis, severe CHF, systolic murmurs.
how useful is history in diagnosis?
50% diagnostic
common questions that should be asked…
what were doing? coughing, sneezing, pooping, etc. sudden noises? extreme emotion
prodrome for vasovagal syncope?
nausea, abdominal pain, dizziness, tinnitus, neck and shoulder pain. elderly may not have them
prodrome for arrhythmia
none or very brief prodrome. palpitations.
seizure prodrome
deja vu, hallucinations, sensory aura.
how does arrhythmia recover?
rapidly
how does vasovagal recover
may take longer to recover.
what is the postdrome for seizure
poskt-ictal confusion or neurodeficits
high risk features of syncope
exercise-induced, family history of SCD, drop-attack, abnormal EKG. pallor/anemia/electrolyte disturbance.
what tests does everyone get?
H and P, CBC, BMP, EKG.
what tests for cardiac?
echo, rhythm monitoring, EP study
tests for neurogenic
tilt-table
neurology testing
EEG and mRi
lifestyle modifications for treatment
adequate salt and hydration, avoiding triggers, moderate exercise.
what other treatments are available for orthostatic?
counterpressure: stockings and tilt training
pharma for syncope
B-blockers, fludrocortisone, alpha-agonists, SSRI
what is high risk syncope?
cardiac.
what is the most easily treated syncope?
cardiac.
how do we treat bradyarrhythmias
pacemakers
how do we treat tachyarrhythmias
ablation therapy
how do we treat aortic stenosis or systolic murmurs?
with surgery
what is the most high risk and what is their prognosis
structural cardiac disease and arrhythmia. unless treated have a poor prognosis.
