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FA17 Cardio 2 > Syncope > Flashcards

Syncope Flashcards

1
Q

syncope

A

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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2
Q

distinguishing syncope from coma

A

coma has prolonged LOC

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3
Q

pre-syncope symptoms

A

high headedness

imbalance

hot flashes, diaphoresis

loss of vision

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4
Q

syncope pathophysiology

A

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

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5
Q

mc causes of syncope

A

vasovagal
orthostatic hypotension
cardiac dysrhythmia

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6
Q

vasovagal classifications of syncope

A

emotional distress

situational (coughing, urination)

carotid sinus syndrome

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7
Q

orthostatic causes of syncope

A

volume deletion

drug induced

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8
Q

cardiac causes of syncope

A

brady cardia
tachycardia
PEA
structural disease

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9
Q

most dangerous form of syncope

A

cardiac related syncope

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10
Q

categories of cardiac related syncope

A

structural abnormality/anomaly

  1. rhythm disturbance
  2. pulmonary obstruction
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11
Q

structural sources of disease

A

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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12
Q

aortic stenosis

A

increased resistance to ejection of blood from left ventricle into aorta

mc in elderly men

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13
Q

clinical features of aortic stenosis

A

loud systolic murmur

decreased exercise tolerance

angina

heart failure

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14
Q

aortic stenosis diagnostic test and treatment

A

echocardiogram

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

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15
Q

dysrhythmia causes of syncope

A

bradycardia and tachycardia

symptoms depend on ANS ability to accommodate

results in sudden onset of syncope without prodromal symptoms

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16
Q

symptoms of bradycardia

A

syncope
mental status changes
chest pain
hypotension

17
Q

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

A 
electrolyte issues
brugada's 
prolonged QT 
catecholamines 
commotion cordis
18
Q

which elements in electrolyte derangement?

A

K+, Na+, Ca++

19
Q

Brugada syndrome

A

syncope, sustained v tach or sudden death

more common in men

characterized by ECG - pseudo-RBBB and ST segment elevation

20
Q

Brugada syndrome treatment

A

focused on termination ventricular arrhythmia

ICDs + pharm treatment

21
Q

prolonged QT causes

A

congenital prolonged QT

acquired prolonged QT (meds)

22
Q

catecholamine associated ventricular tachycardia

A

usually familial

presents in childhood

presents as syncope during stressful situation

23
Q

commotion cordis

A

agitation of heart

fib and sudden cardiac death following innocent chest wall impact

often associated with sports

mostly males <15

24
Q

pulmonary embolism

A

pulmonary outflow obstruction may also lead to syncope

PE can cause syncope secondary to acute obstruction

25
Q

orthostatic hypotension

A

decreased cerebral perfusion when switching from seating to standing

typically secondary to medications or fluid loss

elderly more suscpetial

26
Q

vasovagal syncope

A

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

27
Q

carotid sinus hypersensitivity

A

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

28
Q

hydrologic syncope

A

RARE

definition syncope is transient LOC w/o persistent neurological deficits

subclavian steal, TIA, vertebrobasillar atherosclerotic dz, basilar artery spasm, SAH

29
Q

subclavian steal

A

abnormal narrowing of subclavian artery during exercise of ipsilateral arm

blood is shunted from vertebrobasilar system to subclavian artery

dizziness, vertigo, ataxia, visual changes

30
Q

subarachnoid hemorrhage

A

rare that it causes syncope

instead sudden onset of headache

31
Q

how is a seizure different from a syncope

A

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

32
Q

psychiatric syncope

A

anxiety and depression

hyperventilation causing decreased cerebral perfusion

most common in younger patient, diagnosis of exclusion

33
Q

medication induced syncope

A

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

34
Q

pregnancy syncope

A

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

35
Q

key features of syncope history should include

A

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

36
Q

symptoms of concern in syncope history

A

chest pain, SOB, abdominal or back pain, GI bleed

events that occur without warning and those with activity are concerning

37
Q

Diagnosis of syncope

A

typically a clinical diagnosis

EKG

continues cardiac monitoring

pregnancy tests

orthktatic vital signs

38
Q

who is admitted to hospital?

A

cardiac or neurologic source of diseases

syncope of unknown origin with San Fransisco positive findings

39
Q

CHESS

A

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

FA17 Cardio 2 (10 decks)

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