Syncope

Question 1

What is the laymans term for syncope?

Answer 1

fainting

Question 2

Definition of Transient loss of consciousness

Answer 2

A state of real or apparent loss of consciousness with a loss of awareness, characterised by amnesia for the period of consciousness, loss of motor control . loss of responsiveness and a short duration

Question 3

Causes of transient loss of consciousness

Answer 3

Head traumatic (traumatic TLOC)
Syncope
Epileptic seizures (ambiliant)
TLOC mimics (e.g. psychogenic pseudo-syncope, psychogenic pseudo- seizures)
Other causes

Question 4

Definition of syncope

Answer 4

Transient loss of consciousness due to celebral hypoperfusion, characterised by rapid onset, short duration and spontaneous complete recovery

Question 5

What are the 3 categories of syncope?

Answer 5

Reflex Syncope
Orthostatic Hypotension
Cardiac Syncope

Question 6

What is reflex syncope?

Answer 6

syncope in which neural reflexes modify heart rate (cardioinhibition) and/or vascular tone (vasodepression) hence causing MAP to fall causing systemic hypotension. When of sufficient severity to affect celebral perfusion causing a transient period of celebral hypoperfusion resulting in syncope or near syncope

Question 7

How is cardioinhibition carried out?

Answer 7

The reflex causes increased vagal stimulation decreasing heart rate (bradycardia) and cardiac output

Question 8

What are the subtypes of reflex syncope?

Answer 8

Vasovagal Syncope (VVS)
Situational Syncope
Carotid sinus syncope (CSS)

Question 9

What is the most common type of syncope?

Answer 9

Vasovagal syncope

Question 10

what triggers vasovagal syncope?

Answer 10

faint triggered by 
emotional distress (pain, fear, blood pobia etc.) or 
orthostaatic stress

Question 11

how is vasodepression carried out

Answer 11

depression of sympathetic activity to blood vessels. This decreases systemic vascular resistance (Vasodilatation), venous return, stroke volume and CO

Question 12

What are the clinical signs associated with VVS?

Answer 12

typical prodrome (pallor, sweating, nausea)

Question 13

What can avert VVS if the patient thinks they are going to faint?

Answer 13

adopting a horizontal position (neutralising gravity)
leg crossing
- these increase venous return

Question 14

What is the main risk associated with VVS?

Answer 14

risk of injury

Question 15

Treatment of VVS

Answer 15

education
reassurance
avoidance of triggers (if possible)
adequate hydration

Question 16

What is Situational reflex syncope?

Answer 16

Faint during or immediately after a specific trigger e.g. cough, swallowing etc.

Question 17

Treatment of Situational reflex syncope

Answer 17

treat the cause if possible 
advise the patient lie down 
avoid dehydration
avoid excessive alcohol
Cardiac permanent pacing - for patients who the fainting is negatively affecting their life and can't be prevented in another way

Question 18

Carotid Sinus Reflex Syncope

Answer 18

fainting triggered by mechanical manipulation of the neck

Question 19

what group is most prone to CSS

Answer 19

elderly males
people who have had head and neck surgery or radiation
It is also associated with atherosclerosis in the carotid artery

Question 20

what is the treatment of CSS?

Answer 20

Cardiac permanent pacing

Question 21

What is postural (orthostatic) hypotension?

Answer 21

Syncope resulting from failure of Baroreceptor responses to gravitational shifts in blood, when moving from horizontal to vertical position

Question 22

What are the risk factors for postural hypotension?

Answer 22

Age related
Medications
Certain diseases
Reduced intravascular volume
Prolonged bed rest

Question 23

Positive result for postural hypotension

Answer 23

A drop, within 3 minutes of standing from lying position:
in systolic blood pressure of at least 20 mmHg (with or without symptoms) or
a drop in diastolic blood pressure of at least 10 mm Hg (with symptoms)

Question 24

What is Cardiac Syncope?

Answer 24

Syncope caused by a cardiac event resulting in a sudden drop in cardicac output

Question 25

Examples of cardiac events which can cause CSS

Answer 25

Arrythmias - resulting in bradycardia or tachycardia
Acute MI
Structural cardiac disease e.g. aortic stenosis, hypertrophic cardiomyopathy
Other CV disease e.g PE, aortic dissection

Question 26

Factors which indicate Cardiac Syncope

Answer 26

Syncope when supine
Syncope during excretion
Presence of a structural cardiac abnormality or CHD
Family history of sudden death at young age
Sudden onset of palpitations immediately followed by syncope
ECG suggesting arrhythmic syncope