Syncope Flashcards by Sara Fieger

syncope

symptom that is complex, composed of brief LOC with inability to keep postural tone

Spontaneously and completely resolves w/.o medicine

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distinguishing syncope from coma

coma has prolonged LOC

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pre-syncope symptoms

high headedness

imbalance

hot flashes, diaphoresis

loss of vision

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syncope pathophysiology

lack of blood flow to both cerebral cortex as well as brainstem reticular activating system for > 10-15 seconds

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mc causes of syncope

vasovagal
orthostatic hypotension
cardiac dysrhythmia

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vasovagal classifications of syncope

emotional distress

situational (coughing, urination)

carotid sinus syndrome

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orthostatic causes of syncope

volume deletion

drug induced

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cardiac causes of syncope

brady cardia
tachycardia
PEA
structural disease

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most dangerous form of syncope

cardiac related syncope

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categories of cardiac related syncope

structural abnormality/anomaly

rhythm disturbance
pulmonary obstruction

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structural sources of disease

syncope with exertion

limits ability of heart to compensate
decreases SVR, obstruction to flow CO is relatively fixed
aortic stenosis
hypertrophic cardiomyopathies

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aortic stenosis

increased resistance to ejection of blood from left ventricle into aorta

mc in elderly men

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clinical features of aortic stenosis

loud systolic murmur

decreased exercise tolerance

angina

heart failure

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aortic stenosis diagnostic test and treatment

echocardiogram

tx: valve replacement, antihypertensives, lipid lowering agents, management of heart failure

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dysrhythmia causes of syncope

bradycardia and tachycardia

symptoms depend on ANS ability to accommodate

results in sudden onset of syncope without prodromal symptoms

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symptoms of bradycardia

syncope
mental status changes
chest pain
hypotension

additional causes of dysrhythmia syncope (other than brady and tachy)

electrolyte issues
brugada's 
prolonged QT 
catecholamines 
commotion cordis

which elements in electrolyte derangement?

K+, Na+, Ca++

Brugada syndrome

syncope, sustained v tach or sudden death

more common in men

characterized by ECG - pseudo-RBBB and ST segment elevation

Brugada syndrome treatment

focused on termination ventricular arrhythmia

ICDs + pharm treatment

prolonged QT causes

congenital prolonged QT

acquired prolonged QT (meds)

catecholamine associated ventricular tachycardia

usually familial

presents in childhood

presents as syncope during stressful situation

commotion cordis

agitation of heart

fib and sudden cardiac death following innocent chest wall impact

often associated with sports

mostly males <15

pulmonary embolism

pulmonary outflow obstruction may also lead to syncope

PE can cause syncope secondary to acute obstruction

orthostatic hypotension

decreased cerebral perfusion when switching from seating to standing typically secondary to medications or fluid loss elderly more suscpetial

vasovagal syncope

slow progressive onset associated with prodorome feeling warm, dizzy.light headed, sweating , nausea common to occur following exposure to unexpected or unpleasant sight, sound, smell, fear OR prolonged standing/kneeling in crowded, warm place

carotid sinus hypersensitivity

hypersensitivity of carotid sinus causes vagal parasympathetic stimulation and inhibition of sympathetic vasovagal syncope most commonly effects its with ischemic heart dz, head and neck cancers, ELDERLy

hydrologic syncope

RARE definition syncope is transient LOC w/o persistent neurological deficits subclavian steal, TIA, vertebrobasillar atherosclerotic dz, basilar artery spasm, SAH

subclavian steal

abnormal narrowing of subclavian artery during exercise of ipsilateral arm blood is shunted from vertebrobasilar system to subclavian artery dizziness, vertigo, ataxia, visual changes

subarachnoid hemorrhage

rare that it causes syncope instead sudden onset of headache

how is a seizure different from a syncope

seizures have concussions, post octal state, tongue biting, urinary incontinence

psychiatric syncope

anxiety and depression hyperventilation causing decreased cerebral perfusion most common in younger patient, diagnosis of exclusion

medication induced syncope

Beta blockers and CCB blunt HR changes Diuretics can cause volume depletion medications can be pro-arhythmic laxatives and weight loss meds can cause electrolyte changes

pregnancy syncope

can be due to many things (increased HR, decreased PVR, increased stroke volume) late pregnancy= enlarged uterus compresses the IVC early pregnancy= dehydration from hyperemesis, ectopic, PE, appendicitis

key features of syncope history should include

symptoms and events leading up to it characteristics of the event characteristic/symptoms after the event any history of cardiopulmonary disease more than 5 syncopal episodes in 1 yr indicative of psycho or vasovagal source

symptoms of concern in syncope history

chest pain, SOB, abdominal or back pain, GI bleed events that occur without warning and those with activity are concerning

Diagnosis of syncope

typically a clinical diagnosis EKG continues cardiac monitoring pregnancy tests orthktatic vital signs

who is admitted to hospital?

cardiac or neurologic source of diseases syncope of unknown origin with San Fransisco positive findings

CHESS

San Fransisco Rules ID risk of cardiac and mortality w/in 1 yr of event ``` C - congestive HF H - HEMATOCRIT <30% E - EKG abnormalities S - SOB S - systolic BP <90 ```