Syncope Flashcards
what are the categories of syncope?
neurally mediated
cardiac
orthostatic hypotension
what are the subtypes of neurally mediated syncope?
vasovagal syncope
carotid sinus syndrome
situation syncope
what causes cardiac syncope?
arrhythmias
structural cardiac diseases
what are the subtypes of orthostatic hypotension syncope?
initial (immediate)
classic
delayed
neurogenic
what category of syncope is most common?
neurally mediated syncope
what conditions mimic syncope?
seizures sleep disturbances trauma metabolic/toxic disorders psychogenic/pseudo-syncope
what needs to be assessed in patients that present with syncope?
hx of CHF hematocrit EKG ask about SOB BP
what is the pathophysiology of syncope?
reduced cardiac output
what is the clinical presentation of neurally mediated syncope?
dizziness diaphoresis pallor palpitations nausea dilated pupils urinary incontinence possible
what is the clinical presentation of orthostatic hypotension induced syncope?
reduction in systolic BP or diastolic BP within 3 minutes of standing (autonomic failure)
lightheadedness, dizziness, or presyncope within postural change
what is the clinical presentation of cardiac syncope?
often occurs suddenly without warning symptoms
occurs while supine or during exertion
can be preceded by palpitations
what is the most important tool in diagnosing the category of syncope?
history
what diagnostic testing should be performed on a patient presenting with syncope?
EKG
orthostatic vitals
CBC and CMP
only get cardiac enzymes is sus of cardiac cause
when is tilt table testing useful?
suspected: VVS delayed OH convulsive syncope vs epilepsy dx of pseudo-syncope
when should you order a stress test for syncope?
pts with exertional syncope
when should you order a TTE for syncope?
suspected structural heart disease
when should you order an EPS for syncope?
suspected arrhythmia
when would you give a patient a holter monitor?
symptoms recur within 24-72 hours
when would you give a patient an event monitor?
symptoms recur within 2-6 weeks
when would you give a patient an external loop recorder?
symptoms recur within 2-6 weeks
when would you give a patient an internal monitor?
recurrent, infrequent, unexplained syncope of suspected arrhythmic origin
what is the treatment plan for cardiac syncope?
treat the underlying cardiac disorder
