Syncope Flashcards
acronym for causes of blackouts
Reflex
Orthostatic hypotension
Cardiac
Cardiac causes of blackouts
- Arrhythmias
- Stokes-Adams Attacks
- Brady , Tachy arrhythmia - Structural - weak heart (LVF, tamponade), block (AS, HCM, PE)
Reflex causes of blackouts
- vasovagal
- triggered by emotional or orthostatic stress - situational
- cough, sneeze, micturition - carotid sinus hypersensitivity
Orthostatic hypotension causes
- Volume depletion
- Drug induced
- Primary autonomic failure (eg LB Dementia or PD + ANS disturbance)
- Secondary autonomic failure (eg DM, amyloidosis)
arterial causes of blackouts
- Vertebrobasilar insufficiency: migraine, TIA, CVA,subclavian steal
- Shock
- Hypertension: phaeochromocytoma
general investigations for blackouts
- lying and standing BP (>20/10 difference after 3 min → postural hypotension)
- ECG ± 24hr ECG
- U+E, FBC, Glucose
- Tilt table
- EEG, sleep EEG
- Echo, CT, MRI brain
Triggers for cardiogenic syncope
exertion, drugs, unknown
symptoms before cardiogenic syncope
palpitations, chest pain, dyspnoea
symptoms during cardiogenic syncope
pale, slow/absent pulse, clonic jerks may occur
symptoms after cardiogenic syncope
rapid recovery
investigations for cardiogenic syncope
- ECG
- 24hr ECG
- Echo
triggers for vasovagal syncope
prolonged standingheatfatiguestress
symptoms before vasovagal syncope or postural hypotension
- Gradual onset: secs→mins
- Nausea, pallor, sweating, tunnel vision, tinnitus
- Cannot occur lying down
symptoms during vasovagal syncope or postural hypotension
- Pale, grey, clammy, brady
- Clonic jerks and incontinence can occur, but no tongue biting
symptoms after vasovagal syncope or postural hypotension
rapid recovery
investigations for vasovagal syncope or postural hypotension
tilt-table testing
triggers for postural hypotension
standing up
triggers for arterial causes of blackout
- arm elevation (subclavian steal)- migraine
symptoms of arterial blackout
same as vasovagal+ diplopia, nausea, dysarthria
investigations for arterial blackout
- MRA
- duplex vertebrobasilar circulation
symptoms of hypoglycaemic syncope
tremor, hunger, sweating, lightheadedness→ LOC
triggers for epileptic causes of blackout
flashing lightsfatiguefasting
symptoms before epileptic blackout
e.g. aura in complex partial seizures – feelingstrange, epigastric rising, deja/jamias vu, smells, lights,automatisms
symptoms during epileptic blackout
Tongue biting, incontinence, stiffness→jerking,eyes open, cyanosis, ↓SpO2
symptoms after epileptic blackout
headache, confusion, sleeps, Todd’s palsy
investigations for epileptic blackout
EEG↑ se prolactin at 10-20min
triggers for drop attacks
nil
symptoms before drop attacks
no warning
symptoms during drop attacks
sudden weakness of legs causes older womanto fall to the ground.
symptoms after drop attacks
no post-ictal phase
Examples of primary autonomic failure
pure autonomic failure, multiple system atrophy, Parkinson's disease with autonomic failure, Lewy body dementia
Examples of secondary autonomic failure
diabetes,
amyloidosis,
spinal cord injuries
Drugs causing orthostatic hypotension
alcohol,
vasodilators,
diuretics,
beta-adrenergic blockers
Drug Rx of severe vasovagal
Fludrocortisone (Na/H2o retension) Alpha agonist (Midodrine)
Driving restriction after syncope
Advise pt to contact DVLA
and document in notes
It is them to decide how long for
