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Foundations II (Cholley) > Syncope > Flashcards

Syncope Flashcards

1
Q

Define: Syncope

A

Sudden, transient, complete loss of consciousness & postural tone w/ spontaneous recovery

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2
Q

What are some characteristics of syncope?

A
  • Self-limited, rapid onset
  • Variable warning symptoms
  • Spontaneous, complete, & prompt recovery w/out meds/surgical intervention
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3
Q

What is syncope attributed to?

A

Cerebral hypoperfusion

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4
Q

What are “pre-syncopal” sx?

A
  • Lightheadedness/dizziness
  • Tunnel vision
  • “Graying-out”
  • Altered consciousness
  • Palpitations
  • Weakness
  • Tremulousness
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5
Q

What are the causes of true syncope?

A
  • Neurally-mediated
  • Orthostatic
  • Arrhythmia (brady, tachy)
  • Cardiopulmonary
  • *Unexplained in 1/3
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6
Q

What is #1 on your DDx?

A

Somatization disorder (psychogenic pseudo-syncope)

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7
Q

What sx are consistent w/ vasovagal syncope?

A
  • Lightheaded
  • Facial pallor
  • Diaphoresis
  • Nausea
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8
Q

What is the tilt table?

A

A provocative test for vasovagal syncope

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9
Q

What does the tilt table measure?

A
  • Vasodepressor response

- Pauses

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10
Q

Describe how the tilt table is performed. What is it helpful for?

A

Pt tilted upright by 60-90 degrees

*Teaches pts how to recognize prodromal sx

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11
Q

Tilt table: What are normal vs abnormal findings?

A
  • Normal: minimal drop in BP & increase in HR

- Abnormal: exaggerated drop in BP w/ or w/out drop in HR (associated w/ dizziness & lightheadedness)

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12
Q

When is a tilt table test indicated?

A

After recurrent episodes of unexplained syncope

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13
Q

What is the most common type of syncope?

A

Vasovagal syncope

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14
Q

What triggers vasovagal syncope?

A
  • Heat
  • Standing
  • Exertion
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15
Q

Define: Orthostatic BP

A

≥ 20 drop in SBP or ≥ 10 drop in DBP (measured 3 minutes after supine to standing)

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16
Q

Which type of syncope has a higher risk of recurrent syncope?

A

Cardiac!

17
Q

Which type of syncope has lower survival rates?

A

Cardiac!

18
Q

Define: Sinus node dysfunction (type of bradyarrhythmia)

A

Intermittent pauses w/ alternating bradycardia & tachycardia (tachy-brady syndrome)

19
Q

Define: AV block (type of bradyarrhythmia)

A
  • 2nd degree, type II (Mobitz II)

- Complete heart block

20
Q

What are types of tachyarrhythmias?

A
  • SVT
  • WPW
  • AF/flutter w/ RVR
  • Ventricular tachycardias
21
Q

Psychogenic causes of syncope

A
  • Not true syncope!
  • Conversion disorder
  • Pseudo syncope
  • Pseudo-seizures
22
Q

The San Francisco Syncope Rule identifies…

A

Low-risk pts for short-term serious outcomes who are unlikely to benefit from hospital admission
- Uses “CHESS” Criteria

23
Q

What is the “CHESS” Criteria?

A
  • CHF hx
  • Hematocrit > 30%
  • ECG abnormal
  • SOB
  • Systolic BP < 90
  • If any of the above –> higher risk (consider hospital admission)
24
Q

What is the goal of the Canadian Syncope Arrhythmia Risk Score?

A

Identify small subset of pts who suffer arrhythmia or death within 30 days of ED visit for syncope

25
Q

Canadian Syncope Arrhythmia Risk Score: What are the 8 criteria scored?

A
  • Vasovagal predisposition
  • Hx of HD
  • Any ED systolic BP <90 or > 180
  • Troponin elevated
  • QRS duration > 130
  • Corrected QT interval >480
  • ED dx of vasovagal syncope or cardiac syncope
26
Q

What is the risk of arrhythmia in pts w/ a score of ≤ 0?

A

< 1%

27
Q

What is the risk of arrhythmia in pts w/ a score of 1-3?

A

1.9-7.5%

28
Q

What is the risk of arrhythmia in pts w/ a score of 4-8?

A

14.3-22.2%

29
Q

In a young pt, what red flags might indicate he/she has VVS?

A
  • Family hx of sudden death or early cardiac disease
  • EKG abnormalities
  • Exertional syncope
30
Q

If the syncope has a long duration, what etiology might you think of?

A

Seizure!

31
Q

Does a normal ECG rule out an arrhythmia cause?

A

No no no no no!

*May need to monitor on telemetry or wear an event monitor

32
Q

Who should be admitted as inpatient?

A

Serious underlying conditions

33
Q

Who should be admitted for observation?

A

“Intermediate-risk” pts

34
Q

Who should be admitted for outpatient management?

A

Reflex-mediated syncope

*Prompt f/u necessary

35
Q

What are life-threatening causes of syncope?

A
  • Cardiac
  • Acute severe hemorrhage
  • Pulmonary embolism
  • Subarachnoid hemorrhage
  • Stroke, seizure, head injury
36
Q

What is considered a “dx of exclusion”?

A

Orthostatic hypotension

37
Q

What meds can cause syncope?

A
  • Vasodilatory
  • Cardiotoxic
  • QT prolonging
38
Q

What diagnostic tests should you perform for syncope?

A
  • CBC, CMP, troponin
  • ECG (holter/event monitor)
  • Echo
39
Q

If there is a cardiovascular abnormality, what additional dx tests should you perform?

A
  • External loop recorder (2-6 wks)
  • External patch (2-14 days)
  • Outpatient telemetry (30 days)
  • ICG
  • EP study
  • Carotid u/s
  • Stress testing
  • Chest imaging
  • Neuro tests (MRI, EEG to r/o seizure)
  • Tilt table

Foundations II (Cholley) (25 decks)

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