Syncope

Question 1

What is the definition of syncope?

Answer 1

A transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery.

Question 2

What are the 3 different types of syncope as described by the European Society of Cardiology?

Answer 2

1. Reflex syncope
2. Orthostatic syncope
3. Cardiac syncope

Question 3

Which type of syncope is more common in all age groups?

Answer 3

Reflex syncope

Question 4

Which type of syncope is most common in older patients?

Answer 4

Orthostatic syncope

Question 5

What can cause reflex syncope?

Answer 5

• Vasovagal: triggered by emotion, pain or stress.
  
  • Often referred to as ‘fainting’
• Situational: cough, micturition, gastrointestinal
• Carotid sinus syncope

Question 6

What are the causes of orthostatic syncope?

Answer 6

• Primary autonomic failure: Parkinson’s disease, Lewy body dementia
• Secondary autonomic failure (examples):
  
  • Diabetic neuropathy
  • Amyloidosis
  • Uraemia
• Drug-induced: diuretics, alcohol, vasodilators
• Volume depletion: haemorrhage, diarrhoea

Question 7

What are some causes of cardiac syncope?

Answer 7

• Arrhythmias: bradycardias (sinus node dysfunction, AV conduction disorders) or tachycardias (supraventricular, ventricular)
• Structural: valvular, myocardial infarction, hypertrophic obstructive cardiomyopathy
• Others: pulmonary embolism

Question 8

What is your “syncope screen”?

Answer 8

• Cardiovascular examination: Listen for murmurs (Cardiac syncope)
• Exlude orthostatic: Postural blood pressure readings: a symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic
• ECG: Cardiac syncope.
• Carotid sinus massage (Reflex syncope)
• Tilt table test
• 24 hour ECG

Question 9

What can be used to treat orthostatic hypotension/syncope?

Answer 9

Midodrine

Question 10

What are some side effects of Midodrine?

Answer 10

• Headache
• Feeling of pressure/fullness in the head
• Vasodilation/Facial flushing
• Confusion
• Dry Mouth

Question 11

In what conditions is Midodrine contraindicated in?

Answer 11

• Organic heart disease
• Acute renal disease
• Urinary retention
• Phaeochromocytoma
• Thyrotoxicosis