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CSI Exam 4 > Syncope > Flashcards

Syncope Flashcards

1
Q

syncope

A

Abrupt, transient complete loss of consciousness and postural tone

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2
Q

To remain conscious we need:

A

organized cortical electrical activity, glucose, O2, functional delivery of O2 and glucose

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3
Q

Differential for syncope

A

hypotension (common), low EDV, high ESV, HR disorders, vasodilation, seizures, hypoxemia, obstructed vascular conduits, HCM

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4
Q

What meds might cause syncope due to vasodilatation?

A

Nitro+Hydralazine

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5
Q

Neurocardiogenic syncope Sx

A

lightheaded, anxiety, nausea, dehydration, diaphoresis, fear, prolonged standing, absence of heart ds and rapid normalization of consciousness

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6
Q

Cardiogenic syncope

A

syncope secondary from disorder arising form the heart

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7
Q

Cardiogenic causes of syncope

A

arrhythmias, valvular heart disease, HF or CAD

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8
Q

Exertional syncope or supine syncope is most likely

A

cardiogenic

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9
Q

Testing for a pt who presents w/ a CC of syncope

A

Orthostatic BP, EKG, ECHO, Tilt table, stress test, Holter monitor, external loop recorders, invasive EP study

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10
Q

Seizure Sx

A

tongue cut, head turning, posturing, loss of bladder/bowels, postictal confusion

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11
Q

Syncope Sx

A

diaphoresis, chest pain, palpitations, dyspnea, pallor, CAD, syncope w/ prolonged standing, convulsive syncope < 1 min

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12
Q

Time course of syncope is typically

A

rapid onset, self-limited/rapid recovery, no post-syncope confusion, +/- prodrome

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13
Q

Etiologic groups causing of syncope

A

Vasodepressor (Neurally mediated), Orthostatic hypotension, cardiogenic

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14
Q

Vasodepressor syncope

A

vasovagal syncope - PNS function, coughing, micturation, stress

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15
Q

Orthostatic Hypotension syncope

A

Autonomic failure (MSA: Parkinson’s + syncope), Secondary autonomic failure (DM, neuropathy), drug-induced, volume depletion (vasodilatation, diuretics)

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16
Q

Cardiac Syncope

A

Bradycardia, Tachycardia, Drug-induced, Valvular disease, MI, ischemia, CAS, PE

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17
Q

Most common subtype of Vasodepressor syncope

A

vasovagal (common in young women)

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18
Q

Vasodepressor syncope is precipitated by

A

stress, pain, claustrophobia

19
Q

Vasovagal syncope physiology

A

PNS output increases and SNS output decreases -> decreased HR and CO, vasodilation - > hypotension

20
Q

Vasodepressor syncope may leads to

A

sinus bradycardia, sinus pause/arrest or AV block

21
Q

Increased vagal tone may be exacerbated by

A

micturation, defecation, swallowing, coughing

22
Q

Cough syncope is esp common in

A

middle-aged obese males w/ underlying lung ds and EtOH abuse

23
Q

Orthostatic hypotension aka

A

postural hypotension

24
Q

Orthostatic hypotension is a common problem in what patient population

A

elderly and diabetics (autonomic neuropathy)

25
Q

Orthostatic hypotension may be common in elderly taking what meds

A

vasodilators (Nitro, diuretics, b-Blockers, Viagra)

26
Q

Common idiopathic variant of orthostatic hypotension in

A

elderly males

27
Q

Cardiogenic Causes of syncope

A

Aortic stenosis, Pulmonary stenosis, HOCM, LA myxoma causing mitral obstruction, R->L shunt (congenital)

28
Q

Aortic Stenosis causes mechanical failure but also

A

autonomic reflex abnormalities

29
Q

Young athlete w/ syncope or sudden death

A

HOCM

30
Q

What Arrhythmias can cause syncope?

A

Sick Sinuse Syndrome, AV Block, Tachyarrhthymia (VT, SVT w/ RVR), Long QT Syndrome

31
Q

Sx of syncope may be aborted by

A

lying supine or removal of inciting stimulus

32
Q

Orthostatic Hypotension is defined as

A

falling in BP of 20mmHg systolic or 10mmHg diastolic upon standing

33
Q

Sx upon standing w/ Orthostatic Hypotension

A

lightheadedness, n/v, blurred vision, euphoria, dizziness

34
Q

Orthostatic hypotension physiology

A

diminished venous return

35
Q

Orthostatic hypotension may be accentuated by

A

TCAs, alpha-blockers, marijuana

36
Q

PE finding in young patients

A

look for skin tenting, dry mucous membranes

37
Q

EKG for syncope

A

accessory pathways, prolonged QT, LVH, previour MI, Q waves

38
Q

Holter monitor

A

worn for 48h, outpatient monitoring of heart function

39
Q

Autonomic Diagnostics

A

Carotid Sinus Massage (Hypotension results, sinus node arrest or AV Block), Orthostats, Tilt Table, EP, Exercise testing

40
Q

Use caution when using carotid sinus massage in pts w/

A

bruits, CVA, atherosclerotic disease

41
Q

Treatment for syncope pts w/ + tilt table (orthostatic hypotension)

A

b-Blocker (paradoxical)

42
Q

Treatment for syncope pts w/ tacky or brady arrhythmias

A

treat cause, pacemakers

43
Q

Treatment for syncope pts

A

Volume expansion (normal saline!, fludrocortisone), vasoconstrictors (midodrine), SSRIs

CSI Exam 4 (11 decks)

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