Syncope

Question 1

Define syncope

Answer 1

temporarily losing consciousness due to disruption of blood flow to the brain, often leading to a fall

Question 2

What is syncope also known as?

Answer 2

vasovagal episodes

fainting

Question 3

What is the root cause of vasovagal attack (nervous system)

Answer 3

ANS fails to regulate blood flow to the brain

Question 4

explain how fainting occurs including the words parasympathetic and sympathetic nervous system

Answer 4

vagus nerve - stimulus eg temp/emotion/pain
parasympathetic NS activated and counteracts sympathetic NS which keeps smooth muscle in blood vessels constricted
hypoperfusion

Question 5

Do patients remember the event and prodromal phase?

Answer 5

yes

Question 6

prodrome - what symptoms?

Answer 6

hot or clammy 
sweaty 
heavy 
dizzy/lightheaded
vision blurry 
headache

Question 7

What is important to get an accurate history?

Answer 7

collateral history

Question 8

Collateral history - what may they say?

Answer 8

sudden lose consciousness
fall to ground
unconscious few seconds
twitch/shaking can mix it up with seizure

Question 9

postictal phase vs following a faint

Answer 9

postictal is prolonged, confusion, drowsiness, irritable and disorientated

Question 10

incontinence?

Answer 10

possible

Question 11

primary syncope causes

Answer 11

dehydration/missed meals
standing warm environment
sudden surprise/pain/blood

Question 12

secondary causes

Answer 12

hypoglycaemia 
anaemia 
infection 
anaphylaxis 
arrhythmias

Question 13

syncope vs seizure

Answer 13

syncope = prolonged upright position, upright, sweating before, visual change, return of consciousness quickly 
seizure = epilepsy aura, head turning, tonic clonic, tongue biting, cyanosis, >5mins

Question 14

Investigations

Answer 14

ECG
24 hour ECG
echo 
bloods 
lying and standing bp

Question 15

management

Answer 15

avoid dehydration
avoid standing still for long periods
sweating/dizziness - lie or sit down