Syncope

Question 1

what is syncope?

Answer 1

a transient, self-limited LOC
rapid onset
spontaneous, usually prompt and complete recovery
caused by global cerebral hypoperfusion

Question 2

Syncopal disorders include:

Answer 2

neurally mediated reflexes
orthostatic
cardiac arrhythmias
structural cardiac/pulmonary disease
cerebrovascular

Question 3

Non-syncopal include:

Answer 3

disorders resembling syncope with impairment or LOC e.g. seizures
or without LOC, e.g. psychogenic syncope

Question 4

What conditions are linked to increased mortality in syncope?

Answer 4

LVF
hyoertrophic cardiomyopathy
aortic stenosis
previous ventricular arrhythmia

Question 5

what have no increased mortality?

Answer 5

young patients with no HD and normal ECG

neurally mediated syndromes

Question 6

reflex mediated syncope

Answer 6

mostly vasovagal
situational - e.g. cough, micturition, defacation, adolescent stretch, wind instrument
any age (mostly younger)

Question 7

orthostatic hypotension is:

Answer 7

fall of SBP>20mmHg or DBP>10mmHg within 3 mins of standing
Drugs
Autonomic failure

Question 8

what are the important factors to get from the initial evaluation?

Answer 8

LOC attributable to syncope?
HD present or absent?
Clinical features in the Hx?

Question 9

When to hospitalize a patient

Answer 9

Significant HD
ECG abnormalities
Syncope during exercise
Severe injury
FH of sudden death
Syncope in supine position
Freq recurrent episodes
high suspicion of cardiac arrythmia
stroke/focal neurology