Syncope and Fatigue DSAs

Question 1

Vertigo

Answer 1

false sense of motion or spinning

Question 2

Presyncope

Answer 2

prodromal sx of fainting or near fainting

no LOS, often described as tunnel vision

Question 3

Syncope

Answer 3

clinical syn w/ transient loss of consciousness

Question 4

disequilibrium

Answer 4

sense of imbalance primarily when walking

Question 5

HOlter monitor

Answer 5

Continuous ambulatory ECG worn for 24-72 hrs

pt can press button and mark ECG when they feel sx

Question 6

Event (loop) monitor

Answer 6

ECG that continuously loops its recording tape

pt triggers devise to record when sx arise

worn for weeks to months at a time

Question 7

What does a tilt-table test help with?

Answer 7

diagnosing vasovagal syncope, orthostatic hypotension, etc

Question 8

What are the 3 major types of syncope?

Answer 8

cardiac = 20%

reflex = neurally-mediated; vasovagal; 60-70%

orthostatic hypotension syncope = 10-20%

Question 9

What are the 5 types of orthostatic hypotension syncope?

Answer 9

drug induced

postural thacycardia syndrome

primary autonomic failure (neuro stuff)

secondary autonomic failure (chronic systemic syndromes)

volume depletion

Question 10

What characterizes hypertrophic cardiomyopathy?

Answer 10

left vent hypertrophy w/out clear secondary cause

most cases from genetic mutations (AD)

most pts have no sx or only minor sx –> can have presyncope or syncope, particularly during or immediately follwoing exertion

can have arrhythmias or SCD

Question 11

What does HCM sound like?

Answer 11

S4 may be present

systolic murmor

*squatting increases intensity of all murmors except mitral valve prolapse and HCM

valsalva and standing increase MVP and HCM

Question 12

What increases the sound of HCM?

Answer 12

valsalva

standing

(NOT sustained handgrip)

Question 13

How is HCM diagnosed?

Answer 13

family hx or genetic testing

LV wall 15 mm or more on echo

LVOT obstruction is present

Question 14

What is the tx plan for HCM?

Answer 14

avoid strenuous activity

asymptomatic –> no further tx

Beta blockers or non-dihydropyridine CCBs

diuretics (w/ caution)

ICDs

surgery for severe cases

Question 15

What are the 2 main surgeries for severe HCM?

Answer 15

myomectomy

alcohol ablation –> infarct proximal interventricular septum

Question 16

What cause of syncope has the worst outcome?

Answer 16

cardiac cause

50% mortality at 5 yrs

Question 17

what are the 3 main types of reflex syncope?

Answer 17

carotid sinus hypersensitivity and syn: triggered by stim of carotid A baroreceptor from mechanical forces, seen in old men w/ atherosclerosis

situational syncope: triggered by micturition, defecation, sneezing, etc

vasovagal: prolonged sitting or standing, emotional stress or fear, pain, heat

Question 18

How do autonomic failure pts present?

Answer 18

have supine hypertension

hypotension when upright

Question 19

What defines orthostatic vital signs?

Answer 19

drop of 20 mm hg systolic or 10 diastolic w/in 5 min of standing

Question 20

What is POTS?

Answer 20

postural tachycardia syndrome

form of orthostatic intolerance in response to postural changes

autonomic reflexes are preserved, but there is an exaggerated increase in HR w/ position chgs –> redist of blood –> reduced cerebral flow

no hypotension present on tilt table test

Question 21

What are the tilt table results in POTS?

Answer 21

sustained HR incr > 30 bpm or an absolute hr > 120 bpm w/in first 10 min of tilt

NO hypotension

Question 22

What are 4 inherited risks of PE?

Answer 22

factor 5 leiden mutation

prothrombin mutation

protein C or S def

anti-thrombin deficiency

Question 23

What oral anticoagulants are preferred for PE tx?

Answer 23

factor Xa inhibitors (rivaroxaban, apixaban, edoxaban)

direct thrombin inhibitors: dabigatran

warfarin

Question 24

What subcutaneous anticoagulants are used in tx of PE?

Answer 24

LmWH (preferred in pt w/ malignancy, avoid in renal failure)

fondaparinux

Question 25

What is the preferred anticoagulation tx plan for PE?

Answer 25

DOACs

warfarin if contraindication fo DOACS or renal impairment

LMWH preffered agent in pt w/ underlying malignancy or pts that can’t take oral meds

Question 26

How long is anticoagulation therapy after a PE?

Answer 26

3 months min

low to mod risk of bleeding –> extend

high bleeding risk –> only 3 mos

Question 27

What do osmoreceptors sense and where are they?

Answer 27

in anterior hypothalamus

sense increases in serum osmolality –> release ADH

Question 28

What do baroreceptors and atrial stretch receptors sense?

Answer 28

decreases in Bp or increases in blood volume –> manage ADH release

Question 29

What does ADH do to the collecting duct?

Answer 29

binds V2 receptor –> AQP-2 inserted into collecting duct –> reabsorb more h2o

Question 30

What can cause nephrogenic DI?

Answer 30

hereditary seen in children

lithium toxicity

hypercalcemia

hypokalemia

other renal dzs

Question 31

How do you diagnose DI?

Answer 31

24 hr urine volume collection

urine osm < 300 mOsm/kg

water deprivation test –> see if urine concentrates or not

Question 32

How do you tx nephrogenic DI?

Answer 32

decreased solute intake

thiazide diuretics

NSAIDs

Vasopressin

Question 33

What are 5 important non-osmotic stimuli for ADH release to know?

Answer 33

baroreceptors

nausea

hypoxia

pain

medications (opiates, antipsychotics and antidepressants)

Question 34

what defines hyponatremia?

Answer 34

serum sodium < 135 mEq/L

results primarily from increases in total body water