Syncope

Question 1

syncope

Answer 1

Abrupt, transient complete loss of consciousness and postural tone

Question 2

To remain conscious we need:

Answer 2

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

Question 3

Differential for syncope

Answer 3

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

Question 4

What meds might cause syncope due to vasodilatation?

Answer 4

Nitro+Hydralazine

Question 5

Neurocardiogenic syncope Sx

Answer 5

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

Question 6

Cardiogenic syncope

Answer 6

syncope secondary from disorder arising form the heart

Question 7

Cardiogenic causes of syncope

Answer 7

arrhythmias, valvular heart disease, HF or CAD

Question 8

Exertional syncope or supine syncope is most likely

Answer 8

cardiogenic

Question 9

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

Answer 9

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

Question 10

Seizure Sx

Answer 10

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

Question 11

Syncope Sx

Answer 11

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

Question 12

Time course of syncope is typically

Answer 12

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

Question 13

Etiologic groups causing of syncope

Answer 13

Vasodepressor (Neurally mediated), Orthostatic hypotension, cardiogenic

Question 14

Vasodepressor syncope

Answer 14

vasovagal syncope - PNS function, coughing, micturation, stress

Question 15

Orthostatic Hypotension syncope

Answer 15

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

Question 16

Cardiac Syncope

Answer 16

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

Question 17

Most common subtype of Vasodepressor syncope

Answer 17

vasovagal (common in young women)

Question 18

Vasodepressor syncope is precipitated by

Answer 18

stress, pain, claustrophobia

Question 19

Vasovagal syncope physiology

Answer 19

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

Question 20

Vasodepressor syncope may leads to

Answer 20

sinus bradycardia, sinus pause/arrest or AV block

Question 21

Increased vagal tone may be exacerbated by

Answer 21

micturation, defecation, swallowing, coughing

Question 22

Cough syncope is esp common in

Answer 22

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

Question 23

Orthostatic hypotension aka

Answer 23

postural hypotension

Question 24

Orthostatic hypotension is a common problem in what patient population

Answer 24

elderly and diabetics (autonomic neuropathy)

Question 25

Orthostatic hypotension may be common in elderly taking what meds

Answer 25

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

Question 26

Common idiopathic variant of orthostatic hypotension in

Answer 26

elderly males

Question 27

Cardiogenic Causes of syncope

Answer 27

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

Question 28

Aortic Stenosis causes mechanical failure but also

Answer 28

autonomic reflex abnormalities

Question 29

Young athlete w/ syncope or sudden death

Answer 29

HOCM

Question 30

What Arrhythmias can cause syncope?

Answer 30

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

Question 31

Sx of syncope may be aborted by

Answer 31

lying supine or removal of inciting stimulus

Question 32

Orthostatic Hypotension is defined as

Answer 32

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

Question 33

Sx upon standing w/ Orthostatic Hypotension

Answer 33

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

Question 34

Orthostatic hypotension physiology

Answer 34

diminished venous return

Question 35

Orthostatic hypotension may be accentuated by

Answer 35

TCAs, alpha-blockers, marijuana

Question 36

PE finding in young patients

Answer 36

look for skin tenting, dry mucous membranes

Question 37

EKG for syncope

Answer 37

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

Question 38

Holter monitor

Answer 38

worn for 48h, outpatient monitoring of heart function

Question 39

Autonomic Diagnostics

Answer 39

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

Question 40

Use caution when using carotid sinus massage in pts w/

Answer 40

bruits, CVA, atherosclerotic disease

Question 41

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

Answer 41

b-Blocker (paradoxical)

Question 42

Treatment for syncope pts w/ tacky or brady arrhythmias

Answer 42

treat cause, pacemakers

Question 43

Treatment for syncope pts

Answer 43

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