Syncope

Question 1

Syncope

Answer 1

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

Question 2

Presyncope/Near-Syncope

Answer 2

Feeling but w/o LOC

Question 3

Difference btw syncope and seizure

Answer 3

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

Question 4

Vasovagal syncope

Answer 4

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

Question 5

Orthostatic hypertension

Answer 5

. 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

Question 6

Orthostatic hypertension causes

Answer 6

. 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

Question 7

Cardiac causes for syncope

Answer 7

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

Question 8

Bradycardia

Answer 8

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

Question 9

Tachycardia

Answer 9

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

Question 10

Atrial fibrillation

Answer 10

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

Question 11

Atrial flutter

Answer 11

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

Question 12

AV nodal reentry tachycardia (AVNRT)

Answer 12

.

Question 13

Atrioventricular tachycardia (AVRT)

Answer 13

.

Question 14

Wolff-Parkinson-White Syndrome (WPW)

Answer 14

.

Question 15

Ventricular tachycardia

Answer 15

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

Question 16

Left side pump failure

Answer 16

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

Question 17

Pericardial effusion

Answer 17

. Fluid in pericardial sac

Question 18

Tamponade

Answer 18

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

Question 19

Beck’s Triad

Answer 19

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

Question 20

Aortic stenosis

Answer 20

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

Question 21

Aortic regurgitation

Answer 21

Valve is floppy, blood comes back

Mitral valve can also have this

Question 22

Classic situation for valvular disease

Answer 22

50-60 y/o male passed out while shoveling

Question 23

UTI in young patients

Answer 23

. Causes dysuria, inc. urinary frequency

Question 24

UTI in elderly patients

Answer 24

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

Question 25

Common tests for syncope

Answer 25

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

Question 26

WHat to check for in blood tests related to syncope

Answer 26

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

Question 27

how to conduct orthostatic bp measurement

Answer 27

``` . 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) ```

Question 28

What to check for in EKG

Answer 28

Arrhythmia and ischemia

Question 29

Telemetry

Answer 29

. Continous heart monitoring to evaluate arrhythmia | . Can correlate w/ symptoms in hospital

Question 30

Holter monitor

Answer 30

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

Question 31

Loop recorder

Answer 31

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

Question 32

Echocardiogram

Answer 32

. Ultrasound imaging of heart | . Evaluates pump failure, valvular disease, pericardial effusion

Question 33

Tilt table test

Answer 33

. 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)

Question 34

CT head in regards to syncope

Answer 34

. 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 .

Question 35

T/F Strokes cause collapse but DO NOT cause syncope

Answer 35

T