Syncope Flashcards
Why isn’t hypoglycemia a good explanation for true syncope?
- True syncope is caused by complete ischemia to bilateral hemispheres or focal ischemia to RAS
- Hypoglycemia will have other symptoms. It is not a sudden loss of consciousness with a instant return to baseline
Lateral tongue biting is how specific for seizure?
Not sensitive but 97% specific
What is the most useful indicator to differentiate syncope from seizure?
Rapid return to consciousness
Syncope + CP could be what?
- ACS
- PE
- Dissection
Syncope + abdominal pain could be what?
- AAA
2. Ectopic
Syncope + pregnancy could be what?
- Normal physiology of pregnancy (CV changes)
- Dehydration
- Ectopic
Syncope + headache could be what?
- SAH
2. Basilar migraine
Syncope + focal neuro symptoms could what?
- Strokes (but syncope is RARE in strokes–remember, we really need hypoperfusion of both hemispheres)
- Vertebrobasilar TIA (vertigo, ataxia, diplopia–this can hit RAS)
Who needs a head CT for syncope + neuro symptoms?
These are VERY low yield if they don’t have focal findings on their exam
Syncope + orthostasis could be caused by what?
- Hypovolemia
- Medications
- Primary autonomic failure
Why do you have to be careful about checking orthostatics on all elderly patients with syncope?
The prevalence in the general elderly population is 55%, so you could miss something if you just focus on this
What are the two main causes of isolated syncope?
- Neurocardiogenic
2. Cardiac
What is the most common cause of syncope?
Neurocardiogenic (this is a benign process)
**vasovagal syncope
What are some provoking factors for neurocardiogenic syncope?
- Fear, stress, pain, standing
2. Micturition, defacation, standing
If history and physical aren’t enough, how can neurocardiogenic syncope be made?
Tilt-table test
What are some pharmacologic agents that can be used for neurocardiogenic syncope?
- Midodrine
- SSRIs
- Fludrocortisone
- B-blockers
What EKG findings will be seen in Bruggada syndrome?
RBBB and ST elevation in V1 and V2
What symptoms are commonly associated with syncope caused by orthostatic hypotension?
- Diaphoresis
- Light-headedness
- Graying of vision
What three rules can be used to help risk stratify syncope patients?
- San Francisco Syncope Rule
- OESIL
- ROSE
What are parts of San Francisco Syncope Rule?
- CHF
- Abnormal EKG
- Hematocrit
What are parts of ROSE rules?
- BNP > 300
- fecal occult blood
- Hgb
In what groups should near-syncope be evaluated as syncope?
High risk groups
What are generally accepted rules regarding prognosis in syncope patients?
- CHF
- Structural or coronary heart disease
- Abnormal EKG
All indicate poor prognosis
