Syncope and Autonomic Dysfunction Flashcards
syncope is A transient loss of ___ due to global ___ __
syncope is A transient loss of consciousness due to global cerebral hypoperfusion
in Syncope, most people will have __ spells per life, with the first one often in ___.
in Syncope, most people will have 3 spells per life, with the first one often in teens.
outcomes of acute care presentation of syncope
- 25% of cases had an associated cardiac morbidity.
4 classifications of syncope
- obstructive
- arrhthmic
- orthostatic hypotension
- vasomotor instability
one of the most common causes of obstructive syncope
- aortic stenosis (not enough blood flow systemically including brain)
- pulmonary emboli (also blocking blood flow)
for bradycardia arrhthmia, ___ ___ is the most common cause
for tachycardia arrhthmia, ___ __ is the most common.
for bradycardia arrhthmia, COMPLETE HEART BLOCK is the most common cause
for tachycardia arrhthmia, VENTRICULAR TACHYCARDIA is the most common.
causes of orthostatic hypotension resulting in syncope
- initial orthostatic hypotension
- volume depletion
- hypotensive drugs
- autonomic neuropathies
common examples of vasomotor instability
vasomotor instability is a mix of hypotension and bradycardia.
- vasovagal syncope
- carotid sinus syncope
- inferior MI syncope
- situational syncope
DDx of syncope
- aski, is it really syncope?
Vertigo
Dizziness
Sleep
Coma
Epileptic seizures (Convulsive activity, Tongue biting, Trauma) Characteristic prodromes Cardiac arrest
causes of ventricular tachycardia
- structural heart disease
- torsade de pointes.
two syndromes of syncope
- orthostatic hypotension
- vasovagal syncope
Causes of inirital orthostatic hypotension
definition of classic orthostatic hypotension
Drop in BP >20/10 mm Hg between
supine and standing measured after 1 minute upright
a cause of orthostatic hypotension can be due to volume depletion. What signs would show this?
- poor intake, diarrhea, polyuria.
- low JVP, skin tenting, dry mouth
- HR rises as BP falls
Drugs that can cause orthostatic hypotension
- alpha and beta blockers that. lower BP
- vasofilators, diuretics, nitrates (lower BP)
a cause of orthostatic hypotension can be caused by an autnomic neuropathy. What signs would show this?
- associated with difficulties with sweating, urination, defecation, digestion , sex.
- primary or secondary– diabetese, autoimmune, parkinson’s MSA.
- heart rate usually incariant as BP drops (should increase if BP drops)
treatment for orthostatic hypotension
Treatment if irreversible
Sleep with headup 15 degrees
Support stockings
Maximize salt and fluid if BP tolerates
Physical counterpressure
Florinef (fludrocortisone)
Midodrine (amatine)
most common cause of syncope
vasovagal
outline the physiological model of vasovagal syncope that causes reflex hypotension and bradycardia
note;
diagnostic tools for syncope
- careful history
- ECG
- Tilt Table test
- implantable lloop recorder
outline the chances of fainting again
- the more you have fainted, the more likely you are to faint again.
1 spell; 20% recurrence rate
6 syncopal spells; 60% recurence rate.
- syncope comes in clusters with gaps
general first line measures for syncope
- teach patients with normal blood pressure to increase salt and fluid intake
- teach all patients to act on their prodrome with physical manoeuvres- shuffling and leg crossing, lying down, squatting, isometric leg crossing
in addition to general treatment, what are some active treatments to consier for syncope
- fludrocortisone:Intended to increase venous volume Only case report series of effectiveness Limited by hypokalemia, edema, supine HTN, headache
- beta blockers:
- Block the effect of adrenaline
- Not effective in patients under 40
•May be effective in patients over 40
3. Midodrine: prodrug esembles norepinephrine. Increases blood pressure. Alpha1 adrenergic agonist– intended to cause venoconstriction and vasoconstriction. Helps some of the very frequent fainters. Limited by supine hypertenson, headache, piloerection.
Non invasive treatment of vasovagal syncope:
age range to consider using betablockers
use metaprolol as a non invasive treatment of vasovagal syncope in patients >40 years, especially with co-morbidities such as hypertension
what is a conversion syndrome collapse
a collapse without hypotension or epilepsy. Usually young, mostly female. Physical manifestations of inner stress.
- for females; often sexual assault survivors, family abuse, pretty awful stuff.
males; often work stress, or a failed life.
conversion syndrome collapse treatment.
these are the most highly distressed patients.
