Syncope Flashcards
syncope
symptom that is complex, composed of brief LOC with inability to keep postural tone
Spontaneously and completely resolves w/.o medicine
distinguishing syncope from coma
coma has prolonged LOC
pre-syncope symptoms
high headedness
imbalance
hot flashes, diaphoresis
loss of vision
syncope pathophysiology
lack of blood flow to both cerebral cortex as well as brainstem reticular activating system for > 10-15 seconds
mc causes of syncope
vasovagal
orthostatic hypotension
cardiac dysrhythmia
vasovagal classifications of syncope
emotional distress
situational (coughing, urination)
carotid sinus syndrome
orthostatic causes of syncope
volume deletion
drug induced
cardiac causes of syncope
brady cardia
tachycardia
PEA
structural disease
most dangerous form of syncope
cardiac related syncope
categories of cardiac related syncope
structural abnormality/anomaly
- rhythm disturbance
- pulmonary obstruction
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
aortic stenosis
increased resistance to ejection of blood from left ventricle into aorta
mc in elderly men
clinical features of aortic stenosis
loud systolic murmur
decreased exercise tolerance
angina
heart failure
aortic stenosis diagnostic test and treatment
echocardiogram
tx: valve replacement, antihypertensives, lipid lowering agents, management of heart failure
dysrhythmia causes of syncope
bradycardia and tachycardia
symptoms depend on ANS ability to accommodate
results in sudden onset of syncope without prodromal symptoms
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
