Syncope Flashcards
Syncope
The abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery.
Syncope is a ______ and NOT a ______
Symptom
Diagnosis
Pre-Syncope
lightheadedness without LOC
Drop Attack
loss of posture without LOC
Seizure
Tonic-Clonic Movements that start WITH LOC (vs hypoxic myoclonus which can occur with syncope), post-ictal recovery period
Vasodepressor Syncope
AKA Vasovagal/Neurocardiogenic
- Most common
- Pain/Noxious Stimuli
- Situational (micturation, cough, defecation)
- Carotid Sinus
- Hypersensitivity (CSH)
- Fear
- Prolonged heat exposure
Cardiovascular Syncope
- Most dangerous
- Arrhythmia – Tachycardia/Bradycardia
- Mechanical – Aortic Stenosis, HOCM
Orthostatic Hypotension Syncope
- Drugs: BP meds - Vasodilators, Diuretics, Alpha blockers
- Autonomic Insufficiency (Parkinsons, DM, Adrenal Insufficiency)
- Hypovolemia: Dehydration, Blood loss, infection
MOA- going from sitting to standing, blood pools in legs, low profusion to brain
Neuro / Functional / Psychiatric -
Psuedosyncope
TIA or Vertibro-basilar Insufficiency
Vasovagal-
Vagal tone increases, peripheral vasodilation, preload decreases and brief period of time, blood to head is low, supply of heart catches up and profuse brain adequately
Vasodepressor Syncope is due to
excessive vagal tone
-Vasovagal Hypotension: Initiated by stressful, painful situation
Situational Vasovagal Syncope: Associated with activity that may cause ________
increase in vagal tone
Micturation Syncope
After Defecation
Post Prandial (after eating)
Carotid Sinus Hypersensitivity:
- Common in Elderly
- Sensitive Baroreceptors in Carotid body – when activated can decrease HR and drop BP = possible Syncope
- May occur with pressure on neck – tight collar, turning neck
During syncope EKG may show
Large pauses (usually old patients)
Orthostatic Syncope
Common in Elderly
Essentially Pooling of blood in LE – while standing or sitting up – leading to decreased Preload = Syncope
Causes of orthostatic Syncope
- Autonomic Insufficiency, ex: DM Neuropathy
- Hypovolemia: Dehydration (from decreased thirst or infections) or Blood loss, Alpha Blockers, Diuretics
Orthostatic BP Measurement:
- Measure same arm
- Measure while patient laying, sitting and standing
- Wait 5min between change of position
Orthostatic BP Measurement is positive if
- a drop in BP of 20 mmhm or more, OR
- a drop in diastolic BP of 10 or more, OR
- pt is experiencing lightheadedness or dizziness (abnormal)
KNOW: Diabetic neuropathy often presents as
orthostatic hypotension
Mechanical causes of cariogenic syncope
Valvular problems (aortic or pulmonic stenosis) Structural problems (HOCM, severe cardiomyopathy, myxoma)
Arrhythmias that can cause cariogenic syncope
Tachycardia (SVT, VT, VF)
Bradycardia (Sinus, AV blocks, AV dissociation)
During aortic stenosis, t
- LV outflow tract gradient secondary to stenosis of Aortic Valve (lower pressure in aorta than normal, higher pressure in LV than normal)
- Aortic Stenosis likely secondary to senile degeneration/ bicuspid aortic valve
- Syncope from Aortic stenosis= poor prognosis
CO=
SV x HR
Murmur heard with AS
- crescendo-decrescendo systolic ejection murmur
- LV pressure > aortic P
- Loudest at heart base
- Radiates to carotids
- Pulses are weak w/ delayed peak
- can lead to SAD: syncope, angina, dyspnea
- often age related calcification
Hypertrophic Obstructive Cardiomyopathy
walls of atria, ventricles and septum are all enlarged (can lead to syncope), not pumping enough blood out bc ventricles and atria are small due to hypertrophic muscle
SA/AV node dysfunction will show _____ on EKG
long pauses
SVT (supraventricular tachycardia) will show ____ on EKG
narrow QRS complex
Vasodepressor Syncope is usually associated with
premonitory symptoms – Nausea, Diaphoresis
-Ask for activity pt was doing at the time
-can use tilt table testing
If suspecting cariogenic cause, ask
ask for palpitations, SOB any prior episodes
Treatment for orthostatic syncope
Avoid dehydration
Encourage oral hydration
Volume expanders – Fludricortisone
Vasoconstrictor – Midodrine
Bradycardia Tx
Adjust medications
Evaluate for Pacemaker placement
Tachycardia Tx
- Beta Blocker or Calcium channel blocker
- EP study or ablation if needed
