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Cardiology > Syncope > Flashcards

Syncope Flashcards

1
Q

What is the prevalence of syncope?

A

15%

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2
Q

Define syncope

A

Transient loss of consciousness and muscle tone resulting from inadequate cerebral perfusion

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3
Q

Define presyncope

A

Sensation of being about to faint with transient loss of postural tone but no LOC

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4
Q

What is the most common cause of syncope?

A

Vasovagal episode

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5
Q

List three causes of orthostatic intolerance

A
  1. Vasovagal syncope
  2. Orthostatic hypotension
  3. Postural orthostatic tachycardia syndrome (POTS)
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6
Q

What patient population is most commonly affected by vasovagal syncope?

A
  • Adolescent girls
  • Rare in kids under the age of 10-12
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7
Q

Describe vasovagal syncope

A
  • Prodrome lasting seconds to a minute: dizziness, nausea, pallor, diaphoresis, palpitations, blurred vision, HA, hyperventilation
  • Loss of consciousness and muscle tone
  • Fall without injury
  • Unconsciousness doesn’t last more than one minute
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8
Q

What are common triggers for vasovagal syncope?

A
  • After rising in the morning
  • After taking a morning shower
  • Prolonged anxiety
  • With fright, pain, anxiety, blood drawing, fasting
  • Hot and humid conditions, crowded places
  • After excersize is stopped abruptly
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9
Q

What is the pathophysiology of vasovagal syncope?

A
  • Not well understood
  • Prolonged standing = blood pooling in LE and decreased venous return, decreased stroke volume and BP
  • Reduced ventricular filling = less stretch on mechanoreceptors = decreased afferent neural output + decreased arterial pressure = tachycardia and peripheral vasoconstriction
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10
Q

Describe management of vasovagal syncope

A
  • Hydration
  • Supine position with feet elevated
  • Fludrocortisone (Florinef)
  • B blockers
  • Pseudoephedrine
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11
Q

What is the normal physiologic response to standing?

A
  • Reflex arterial and venous constriction
  • Slight increase in HR
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12
Q

What is the pathogenesis of orthostatis hypotension?

A
  • Normal adrenergic vasoconstriction of arterioles and veins in the upright position is absent or inadequate
  • Hypotension without reflex increase in HR
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13
Q

Contrast prodromes of orthostatis hypotension and vasovagal syncope

A
  • Orthostatic hypotension: lightheadedness alone
  • Vasovagal syncope: dizziness, nausea, pallor, diaphoresis, palpitations, blurred vision, HA, hyperventilation
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14
Q

What factors can exacerbate orthostatic hypotension?

A
  • Medications
  • Dehydration
  • Prolonged bed rest
  • Prolonged standing
  • Low circulating blood volume
  • Drugs inerfering with sympathetic response: CCBs, antihypertensives, vasodilators, phenothiazines, diuretics
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15
Q

What is the AHA definition of orthostatic hypotension?

A
  • Persistent fall in systolic/diastolic pressure of more than 20/10mm Hg within 3 mins of assuming the upright position without moving the arms or legs with no increase in HR but without fainting
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16
Q

Describe management for orthostatic hypotension

A
  • Compression stockings
  • High salt diet
  • Symathomimetic amines
  • Corticosteroids
  • Slow assumption of an upright position
17
Q

What is POTS?

A

Postural Orthostatis Tachycarda Syndrome

18
Q

Who gets POTS?

A

Adolscent females

19
Q

What is the pathophysiology of POTS?

A
  • Venous pooling associated with standing reduces venous return, increased sympathetic discharge and significant tachycardia
20
Q

How does POTS present?

A
  • Syncope
  • Dizziness
  • Chest discomfort/pain/palpitations
  • Nausea
  • Fatigue
  • Exercise intolerance
21
Q

What are the diagnostic criteria of POTS?

A
  • Development of orthostatic symptoms associated with a 30 beat/minute increase in HR or a HR > 120bpm in the first 10 minutes of standing from supine position
22
Q

Describe management of POTS

A
  • Avoid extreme heat and dehydration
  • Increase salt and fluid intake
  • Fludrocortisone
  • Midodrine
  • Venlafaxine
23
Q

List two rare causes of syncope

A
  • Cough syncope: after paroxysmal nocturnal coughing
  • Micturation syncope: rapid bladder decompression causes syncope
24
Q

What are the cardiac causes of syncope?

A
  • Obstructive lesions
    • Aortic stenosis
    • Pulmonary stenosis
    • HOCM
    • Pulmonary HTN
  • Arrythmias
    • Long QT syndrome
    • Short QT syndrome
    • WPW pre-excitation
    • RV dysplasia
    • Brugada syndrome
  • Myocardial dysfunction
    • Myocardial ischemia or infarction
  • Structural heart defects
    • Preop CHD: Ebstein’s, MS, MR
    • Post-op CHD: repaired TOF, TGA, fontan
    • DCM
    • HCM
    • Mitral valve prolapse
25
Q

List red flags for syncope

A
  • Syncope even in the recumbent position
  • Exertional syncope
  • Chest pain associated with syncope
  • Hx operated or preoperative CHD
  • FHx sudden death
26
Q

What is the differential diagnosis for syncope?

A
  • Epilepsy
  • Hypoglycemia
  • Hyperventilation
  • Hysteria

Cardiology (6 decks)

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