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Year 3 Conditions > Syncope > Flashcards

Syncope Flashcards

1
Q

What is difference between loss of consciousness and syncope

A

Loss of consciousness can be divided into syncopal and non syncopal causes
Syncope refers to cutting of perfusion between heart and brain

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2
Q

What can syncope be classified into

A

Cardiac
Reflex
Orthostatic
Cerebrovascular

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3
Q

What happens in reflex syncope

A

Believed to be due to primitive reflex to play dead where in scary situation BP and HR temporarily

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4
Q

What are cerebrovascular causes of syncope

A 
Non cardiac structural causes of loss of brain perfusion
Aortic dissection
Subclavian steal syndrome
Vertebrobasilar insuffiency
TIA
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5
Q

What causes orthostatic syncope

A

When stand there is sudden drop in BP that compensate for by vasoconstriction particularly the veins in the leg

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6
Q

What are reflex causes of syncope

A

Vasovagal
Carotid sinus hypersensitivity
Situational syncope

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7
Q

What causes straining syncope

A

For example in peeing and pooing your BP doesnt adapt in time

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8
Q

Cardiac causes of syncope

A 
Arrythmias
Aortic stenosis
HCM
HB
PE
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9
Q

What causes orthostatic syncope

A

Drugs- anti-sympathetics, anti-hypertensives
Dehydration
Autonomic instability
Baroreceptor dysfunction

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10
Q

Who does baroreceptor dysfunction occur in

A

HTN- fail to accurately control BP

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11
Q

What is described before a vasovagal episode

A 
Odd sensation in stomach
Pallor
Sweaty
Nausea
Knowing going to fall
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12
Q

What does syncope while playing sport/exercising suggest

A

HOCM
Aortic stenosis
Long QT

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13
Q

What does just sitting down or watching tele before syncope suggest

A

Arrythmia

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14
Q

Most common cause of syncope in the elderly

A

Orthostatic due to medications

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15
Q

What medications can cause syncope and how

A

Diuretics- fluid loss
ACEi- fluid loss and vasodilation
Beta blockers- failure to increase HR and BP on standing
A blockers- inability to constrict vessels in legs
CCB- inability to vasoconstrict and some affect heart

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16
Q

What is main concern of syncope in the elderly

A

Leads to morbidity- broken bones, loss of confidence, loss of independance etc
Leads to mortality- bleeds in brain, VTE and infections from prolonged bed rest
Cost of adapting house to new circumstances or affording to go into nursing home

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17
Q

What does syncope with no warning suggest

A

Cardiac

Cerebrovascular ie subclavian steal

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18
Q

Important questions to ask about before syncope

A

Warning Sx?
What doing at the time?
Head injury recently?

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19
Q

What is significant about recent head injury in syncope

A

Subdural bleed

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20
Q

Causes of non-syncopal blackout

A 
Intoxication
Head trauma
Metabolic-hypoglycaemic, HHS, DKA
Epileptic seizure
Psycogenic seizure
Narcolepsy
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21
Q

History of IHD in syncope

A

Ischaemia- HB, arrythmia

Medications- orthostatic

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22
Q

How long do arrythmia syncopes last

A

Seconds

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23
Q

What to ask about for during seizure

A

Tongue biting- epilepsy

Twitching and incontinence- not necessarily can also be arrythmia and vasovagal

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24
Q

Questions to ask about after syncope

A

Confused or weakness- seizure

How long to recover and how?

25
Q

Syncope that lasted minutes

A

Seizure

26
Q

Continuous similar episodes of syncope

A

Epilepsy

27
Q

Syncope followed by weakness in arm

A

Todds paresis

TIA

28
Q

How can diabetes lead to syncope

A

Polyuria-> orthostatic
Vascular disease predisposed
Autonomic dysfunction
Hypoglycaemia

29
Q

How is psyciatric illness relevant to syncope

A

Predisposes to non-epileptic seizures

30
Q

Significance of drug history syncope

A 
Insulin and T2DM hypoglycaemics 
Antihypertensives
Vasodilators
Antiarrythmics
Antidepressants
Warfarin
31
Q

Why are antiarrythmics significant in syncope history

A

Paradoxically predispose to arrythmias

32
Q

Why are antidepressants significant in syncope history

A

TCAs cause hypotension

33
Q

Why is warfarin or DOACs significant in syncope history

A

Increase likelihood of subdural bleed following trauma

34
Q

Significance of recreational drugs in syncope

A

Coacaine arrthymias

35
Q

Significance of alcohol in syncope history

A

Subdural predisposition

LOC leading to bleed

36
Q

Importance of family history syncope

A

Sudden death in under 65 may have been caused by Long QT, WPWS and HOCM

37
Q

What to look for in examination of syncope

A 
Tongue bitten- epilepsy
Pulse and obs- heart problems
Dehydration status- orthostatic
Heart murmur- HCM or aortic stenosis
Focal neurology signs- ICP from bleed or tumour causing seizure
38
Q

Investigations for syncope

A 
Bloods- glucose, U&Es, FBC
ECG
Holter potentially
CT/MRI if epilepsy indicated
Echo if heart implied
39
Q

Why do FBC syncope

A

Anaemia can be contributing factor

40
Q

Why do glucose syncope

A

DM predisposes to cardiac problems and hypos

41
Q

Why do U&Es

A

Urea in absence of creatinine is dehydration

Electrolyte imbalance predisposing to long QT

42
Q

Why is history of mental health significant in blackout

A

TCAs cause hypotension

Predisposed to non epileptic

43
Q

What does history of non stereotyped and inconsistent blackout stories suggest

A

Non epileptic seizures

44
Q

History of BPH in syncope

A

On alpha blockers causing impaired vasoconstriction

45
Q

What is stokes adams attack

A

When LOC due to complete HB

46
Q

What happens if stokes adams attack occurs for more than 15 seconds

A

Twitching due to brain anoxia

47
Q

What happens after a stokes adams attack

A

Facial flushing as flow returned to face

48
Q

How can partial seizures be classsified by lobe based on sx

A

Frontal- motor
Parietal- sensory
Occipital- visual problem
Temporal- deja vu, smells/sounds aura

49
Q

Which heart block is common in fit younger people

A

Mobitz T1

50
Q

What can be investigation for vasovagal syncope

A

Tilt table test

51
Q

What happens in tilt table test

A

Patient laid supine and moved about- posiive test if experience LOC with drop in HR and BP or they experience some symptoms related to vasovagal episodes

52
Q

What is the main problem with anticonvulsant medications

A

Theyre teratogenic

53
Q

Syncope brought on by using arm for a long time

A

Subclavian steal syndrome

54
Q

Syncope brought on when putting tie on

A

Carotid sinus hypersensitivity

55
Q

What is carotid sinus hypersensitivity

A

When the carotid sinus exaggerates response to pressure on it

56
Q

What is test for carotid sinus hypersensitivity

A

Carotid sinus massage while attached to cardiac monitor with IV cannula in place in case go into cardiac arrest instead of syncope

57
Q

What is brugada syndrome

A

Autosomal dominant condition with mutation in calcium sodium channel gene leading to RBBB and ST elevation in V1-V3 predisposing to ventricular dysrythmias

58
Q

ECG changes in brugada syndrome

A

RBBB and ST elevation in V1-V3

59
Q

How to tell from lying vs standing BP if cause is hypovolaemic or autonomic dysfunction

A

In hypovolaemia will be associated tachycardia whereas in autonomic dysfunction will be the same

Year 3 Conditions (33 decks)

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