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MS4 - Geriatrics > Syncope > Flashcards

Syncope Flashcards

1
Q

acronym for causes of blackouts

A

Reflex
Orthostatic hypotension
Cardiac

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2
Q

Cardiac causes of blackouts

A
  1. Arrhythmias
    - Stokes-Adams Attacks
    - Brady , Tachy arrhythmia
  2. Structural - weak heart (LVF, tamponade), block (AS, HCM, PE)
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3
Q

Reflex causes of blackouts

A
  1. vasovagal
    - triggered by emotional or orthostatic stress
  2. situational
    - cough, sneeze, micturition
  3. carotid sinus hypersensitivity
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4
Q

Orthostatic hypotension causes

A
  • Volume depletion
  • Drug induced
  • Primary autonomic failure (eg LB Dementia or PD + ANS disturbance)
  • Secondary autonomic failure (eg DM, amyloidosis)
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5
Q

arterial causes of blackouts

A
  • Vertebrobasilar insufficiency: migraine, TIA, CVA,subclavian steal
  • Shock
  • Hypertension: phaeochromocytoma
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6
Q

general investigations for blackouts

A
  1. lying and standing BP (>20/10 difference after 3 min → postural hypotension)
  2. ECG ± 24hr ECG
  3. U+E, FBC, Glucose
  4. Tilt table
  5. EEG, sleep EEG
  6. Echo, CT, MRI brain
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7
Q

Triggers for cardiogenic syncope

A

exertion, drugs, unknown

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8
Q

symptoms before cardiogenic syncope

A

palpitations, chest pain, dyspnoea

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9
Q

symptoms during cardiogenic syncope

A

pale, slow/absent pulse, clonic jerks may occur

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10
Q

symptoms after cardiogenic syncope

A

rapid recovery

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11
Q

investigations for cardiogenic syncope

A
  • ECG
  • 24hr ECG
  • Echo
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12
Q

triggers for vasovagal syncope

A

prolonged standingheatfatiguestress

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13
Q

symptoms before vasovagal syncope or postural hypotension

A
  • Gradual onset: secs→mins
  • Nausea, pallor, sweating, tunnel vision, tinnitus
  • Cannot occur lying down
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14
Q

symptoms during vasovagal syncope or postural hypotension

A
  • Pale, grey, clammy, brady

- Clonic jerks and incontinence can occur, but no tongue biting

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15
Q

symptoms after vasovagal syncope or postural hypotension

A

rapid recovery

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16
Q

investigations for vasovagal syncope or postural hypotension

A

tilt-table testing

17
Q

triggers for postural hypotension

A

standing up

18
Q

triggers for arterial causes of blackout

A
  • arm elevation (subclavian steal)- migraine
19
Q

symptoms of arterial blackout

A

same as vasovagal+ diplopia, nausea, dysarthria

20
Q

investigations for arterial blackout

A
  • MRA

- duplex vertebrobasilar circulation

21
Q

symptoms of hypoglycaemic syncope

A

tremor, hunger, sweating, lightheadedness→ LOC

22
Q

triggers for epileptic causes of blackout

A

flashing lightsfatiguefasting

23
Q

symptoms before epileptic blackout

A

e.g. aura in complex partial seizures – feelingstrange, epigastric rising, deja/jamias vu, smells, lights,automatisms

24
Q

symptoms during epileptic blackout

A

Tongue biting, incontinence, stiffness→jerking,eyes open, cyanosis, ↓SpO2

25
Q

symptoms after epileptic blackout

A

headache, confusion, sleeps, Todd’s palsy

26
Q

investigations for epileptic blackout

A

EEG↑ se prolactin at 10-20min

27
Q

triggers for drop attacks

A

nil

28
Q

symptoms before drop attacks

A

no warning

29
Q

symptoms during drop attacks

A

sudden weakness of legs causes older womanto fall to the ground.

30
Q

symptoms after drop attacks

A

no post-ictal phase

31
Q

Examples of primary autonomic failure

A 
pure autonomic failure, 
multiple system atrophy, 
Parkinson's disease with
autonomic failure, 
Lewy body dementia
32
Q

Examples of secondary autonomic failure

A

diabetes,
amyloidosis,
spinal cord injuries

33
Q

Drugs causing orthostatic hypotension

A

alcohol,
vasodilators,
diuretics,
beta-adrenergic blockers

34
Q

Drug Rx of severe vasovagal

A 
Fludrocortisone (Na/H2o retension) 
Alpha agonist (Midodrine)
35
Q

Driving restriction after syncope

A

Advise pt to contact DVLA
and document in notes
It is them to decide how long for

MS4 - Geriatrics (10 decks)

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