Syncope Flashcards
Syncope
. Clinical syndrome in which transient loss of consciousness (LOC) is usually caused by period of dec. global cerebral blood flow
. Pulse still present
Presyncope/Near-Syncope
Feeling but w/o LOC
Difference btw syncope and seizure
. Seizure have postictal state upon awakening (confusion, disorientation, numbness/weakness) that can last for hours
. Syncope should regain orientation w/in seconds to minutes
Vasovagal syncope
. Fainting bc body overreacts to certain triggers
. Most common cause
. Stimulus causes neural reflex
. Can be emotional or situational
Orthostatic hypertension
. Drop of bp upon standing
. Blood pools to legs from gravity, normally body inc. sympathetic and dec. parasympahetics to inc. HR constricting blood vessels but that doesn’t happen here
Orthostatic hypertension causes
. Drug induced: most common, BP meds, antidepressants, nitrates, alcohol, narcotics
. Volume depletion: hemorrhage, vomiting, diarrhea
. Autonomic failure: neurogenic, diabetic neuropathy, Parkinson’s, Lewy body dementia, aging
Cardiac causes for syncope
. Heart can’t pump enough blood to brain
. Arrhythmia (Brady/tachycardia)
. Pump failure
. Valvular
Bradycardia
. HR<60
. Lightheadedness and syncope
. Can be from AV blocks
. Pacemaker treatment
Tachycardia
. Physiologic response to exercise, fever, hypotension
. Can;t exceed 150 bpm through normal pathways
. Causes palpitations, shortness of breath, lightheadedness, syncope
Atrial fibrillation
. Many signal from LA register through AV node (irregularly irregular)
Atrial flutter
Similar to A-fib but has saw tooth pattern on EKG
AV nodal reentry tachycardia (AVNRT)
.
Atrioventricular tachycardia (AVRT)
.
Wolff-Parkinson-White Syndrome (WPW)
.
Ventricular tachycardia
. Many signals come from ventricles
. Can be stale or unstable
. Ventricular fibrillation: ventricle quivers w/o effective pumping (leads to death )
Left side pump failure
. brain
. Left ventricle dependent
. Caused by systolic/diastolic heart failure, cardiomyopathy
Pericardial effusion
. Fluid in pericardial sac
Tamponade
. Emergency . So much fluid compressing all chambers . Can’t fill during diastole . Less blood pumped overall . Can cause syncope
Beck’s Triad
. Jugular venous distension
. Muffled heart sounds
. Hypotension
. Signs of cardiac tamponade
Aortic stenosis
Valve is stiff, blood can’t leave (mitral valve can also have this)
Aortic regurgitation
Valve is floppy, blood comes back
Mitral valve can also have this
Classic situation for valvular disease
50-60 y/o male passed out while shoveling
UTI in young patients
. Causes dysuria, inc. urinary frequency
UTI in elderly patients
. Altered mental status (AMS)
. Metabolic encephalopathy
. Generalized weakness/collapse
Common tests for syncope
. Bloodwork (CBC, BMP) . Orthostatic bp . EKG, monitor or telemetry . Echo . Holter monitor . Loop recorder . Tilt table test . CT head
WHat to check for in blood tests related to syncope
. Anemia from blood loss
. Electrolyte abnormalities
. Dehydration
. Acute kidney injury
how to conduct orthostatic bp measurement
. Lie down 5 minutes . Check BP/HR . Sit 1-2 min . Check BP/HR . Stand 1-2 min . Check BP/HR . Drop of 20 systolic it inc. 10 diastolic .If HR is the same or lowers upon standing shows autonomic dysfunction (sympathetic)
What to check for in EKG
Arrhythmia and ischemia
Telemetry
. Continous heart monitoring to evaluate arrhythmia
. Can correlate w/ symptoms in hospital
Holter monitor
. Given to patients w/ frequent symptoms (2-3x/month)
. Telemetry for home, continuous recording
. Looking for arrhythmia
. Records for couple of days
Loop recorder
. Implantable device
. For patients w/ infrequent symptoms (less than once/month)
. Can stay under skin or over a year
Echocardiogram
. Ultrasound imaging of heart
. Evaluates pump failure, valvular disease, pericardial effusion
Tilt table test
. Telemetry/continuous BP
. Lay patient flat
. Tilt patient upward 70-80 degrees for 30 minutes and monitor symptoms
. Give nitroglycerin and check symptoms
. If symptoms and drop in BP: reflex syncope
. Symptoms w/o drop in BP: psychogenic pseudosyncope
. Not reliable, not used as much unless in small circumstances ( recurring symptoms, thorough work up negative)
CT head in regards to syncope
. Not typically needed
. Done in ER workups dur to unwitnessed falls, unreliable history, concerns or stroke
. Rules out trauma from fall, bleeding, stroke, or other brain pathology
.
T/F Strokes cause collapse but DO NOT cause syncope
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