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PSP > Syncope > Flashcards

Syncope Flashcards

1
Q

Syncope

A

. Clinical syndrome in which transient loss of consciousness (LOC) is usually caused by period of dec. global cerebral blood flow
. Pulse still present

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2
Q

Presyncope/Near-Syncope

A

Feeling but w/o LOC

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3
Q

Difference btw syncope and seizure

A

. Seizure have postictal state upon awakening (confusion, disorientation, numbness/weakness) that can last for hours
. Syncope should regain orientation w/in seconds to minutes

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4
Q

Vasovagal syncope

A

. Fainting bc body overreacts to certain triggers
. Most common cause
. Stimulus causes neural reflex
. Can be emotional or situational

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5
Q

Orthostatic hypertension

A

. 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

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6
Q

Orthostatic hypertension causes

A

. 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

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7
Q

Cardiac causes for syncope

A

. Heart can’t pump enough blood to brain
. Arrhythmia (Brady/tachycardia)
. Pump failure
. Valvular

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8
Q

Bradycardia

A

. HR<60
. Lightheadedness and syncope
. Can be from AV blocks
. Pacemaker treatment

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9
Q

Tachycardia

A

. Physiologic response to exercise, fever, hypotension
. Can;t exceed 150 bpm through normal pathways
. Causes palpitations, shortness of breath, lightheadedness, syncope

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10
Q

Atrial fibrillation

A

. Many signal from LA register through AV node (irregularly irregular)

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11
Q

Atrial flutter

A

Similar to A-fib but has saw tooth pattern on EKG

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12
Q

AV nodal reentry tachycardia (AVNRT)

A

.

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13
Q

Atrioventricular tachycardia (AVRT)

A

.

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14
Q

Wolff-Parkinson-White Syndrome (WPW)

A

.

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15
Q

Ventricular tachycardia

A

. Many signals come from ventricles
. Can be stale or unstable
. Ventricular fibrillation: ventricle quivers w/o effective pumping (leads to death )

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16
Q

Left side pump failure

A

. brain
. Left ventricle dependent
. Caused by systolic/diastolic heart failure, cardiomyopathy

17
Q

Pericardial effusion

A

. Fluid in pericardial sac

18
Q

Tamponade

A 
. Emergency
. So much fluid compressing all chambers
. Can’t fill during diastole
. Less blood pumped overall 
. Can cause syncope
19
Q

Beck’s Triad

A

. Jugular venous distension
. Muffled heart sounds
. Hypotension
. Signs of cardiac tamponade

20
Q

Aortic stenosis

A

Valve is stiff, blood can’t leave (mitral valve can also have this)

21
Q

Aortic regurgitation

A

Valve is floppy, blood comes back

Mitral valve can also have this

22
Q

Classic situation for valvular disease

A

50-60 y/o male passed out while shoveling

23
Q

UTI in young patients

A

. Causes dysuria, inc. urinary frequency

24
Q

UTI in elderly patients

A

. Altered mental status (AMS)
. Metabolic encephalopathy
. Generalized weakness/collapse

25
Q

Common tests for syncope

A 
. Bloodwork (CBC, BMP)
. Orthostatic bp 
. EKG,  monitor or telemetry
. Echo 
. Holter monitor 
. Loop recorder
. Tilt table test
.  CT head
26
Q

WHat to check for in blood tests related to syncope

A

. Anemia from blood loss
. Electrolyte abnormalities
. Dehydration
. Acute kidney injury

27
Q

how to conduct orthostatic bp measurement

A 
. 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)
28
Q

What to check for in EKG

A

Arrhythmia and ischemia

29
Q

Telemetry

A

. Continous heart monitoring to evaluate arrhythmia

. Can correlate w/ symptoms in hospital

30
Q

Holter monitor

A

. Given to patients w/ frequent symptoms (2-3x/month)
. Telemetry for home, continuous recording
. Looking for arrhythmia
. Records for couple of days

31
Q

Loop recorder

A

. Implantable device
. For patients w/ infrequent symptoms (less than once/month)
. Can stay under skin or over a year

32
Q

Echocardiogram

A

. Ultrasound imaging of heart

. Evaluates pump failure, valvular disease, pericardial effusion

33
Q

Tilt table test

A

. 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)

34
Q

CT head in regards to syncope

A

. 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
.

35
Q

T/F Strokes cause collapse but DO NOT cause syncope

A

T

PSP (35 decks)

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