Syncope

Question 1

Syncope

what would decide the likely differentials

Answer 1

Neurology ( balance, vision, evidence of tongue biting
Cardiac ( chest pain, SOB, palpitations, postural)
Medication related - anxiety, palpitations, is it happening repeatedly since a med was changed? Too much anti-HTN agent?
Metabolic - hypoglycaemia

Question 2

Workup of syncope

Answer 2

Bloods
- FBC - anaemia
- glucose
- U+E - abnormal electrolytes hyperkal or hyponatraemia
ECG - may be normal if it was a transient arrhythmia so important to do Telemetry

• lying + standing BP
• lying down for 5 mins check BP then stand up and check BP in first min of standing, repeat that standing after 3 mins
  an abnormal drop would by drop of 20+ in systolic BP or below 90, drop in diastolic of 10
• could do head CT
• ECHO structural defect in heart

Question 3

Define syncope

Answer 3

Syncope istemporary loss of consciousness because of decreased cerebral perfusion

Question 4

Pre syncope

Answer 4

Pre syncope refers to light-headedness where the person thinks they are about to black out but they don’t actually lose consciousness

Question 5

What from history + exam might indicate the cause?

Answer 5

• tongue biting, post syncope exhaustion -> neuro
• murmur on exam -> syncope is a symptom of Aortic stenosis
• are they diabetic?