Syncope and Fatigue DSAs Flashcards
Vertigo
false sense of motion or spinning
Presyncope
prodromal sx of fainting or near fainting
no LOS, often described as tunnel vision
Syncope
clinical syn w/ transient loss of consciousness
disequilibrium
sense of imbalance primarily when walking
HOlter monitor
Continuous ambulatory ECG worn for 24-72 hrs
pt can press button and mark ECG when they feel sx
Event (loop) monitor
ECG that continuously loops its recording tape
pt triggers devise to record when sx arise
worn for weeks to months at a time
What does a tilt-table test help with?
diagnosing vasovagal syncope, orthostatic hypotension, etc
What are the 3 major types of syncope?
cardiac = 20%
reflex = neurally-mediated; vasovagal; 60-70%
orthostatic hypotension syncope = 10-20%
What are the 5 types of orthostatic hypotension syncope?
drug induced
postural thacycardia syndrome
primary autonomic failure (neuro stuff)
secondary autonomic failure (chronic systemic syndromes)
volume depletion
What characterizes hypertrophic cardiomyopathy?
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
What does HCM sound like?
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
What increases the sound of HCM?
valsalva
standing
(NOT sustained handgrip)
How is HCM diagnosed?
family hx or genetic testing
LV wall 15 mm or more on echo
LVOT obstruction is present
What is the tx plan for HCM?
avoid strenuous activity
asymptomatic –> no further tx
Beta blockers or non-dihydropyridine CCBs
diuretics (w/ caution)
ICDs
surgery for severe cases
What are the 2 main surgeries for severe HCM?
myomectomy
alcohol ablation –> infarct proximal interventricular septum
What cause of syncope has the worst outcome?
cardiac cause
50% mortality at 5 yrs
what are the 3 main types of reflex syncope?
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
How do autonomic failure pts present?
have supine hypertension
hypotension when upright
What defines orthostatic vital signs?
drop of 20 mm hg systolic or 10 diastolic w/in 5 min of standing
What is POTS?
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
What are the tilt table results in POTS?
sustained HR incr > 30 bpm or an absolute hr > 120 bpm w/in first 10 min of tilt
NO hypotension
What are 4 inherited risks of PE?
factor 5 leiden mutation
prothrombin mutation
protein C or S def
anti-thrombin deficiency
What oral anticoagulants are preferred for PE tx?
factor Xa inhibitors (rivaroxaban, apixaban, edoxaban)
direct thrombin inhibitors: dabigatran
warfarin
What subcutaneous anticoagulants are used in tx of PE?
LmWH (preferred in pt w/ malignancy, avoid in renal failure)
fondaparinux
What is the preferred anticoagulation tx plan for PE?
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
How long is anticoagulation therapy after a PE?
3 months min
low to mod risk of bleeding –> extend
high bleeding risk –> only 3 mos
What do osmoreceptors sense and where are they?
in anterior hypothalamus
sense increases in serum osmolality –> release ADH
What do baroreceptors and atrial stretch receptors sense?
decreases in Bp or increases in blood volume –> manage ADH release
What does ADH do to the collecting duct?
binds V2 receptor –> AQP-2 inserted into collecting duct –> reabsorb more h2o
What can cause nephrogenic DI?
hereditary seen in children
lithium toxicity
hypercalcemia
hypokalemia
other renal dzs
How do you diagnose DI?
24 hr urine volume collection
urine osm < 300 mOsm/kg
water deprivation test –> see if urine concentrates or not
How do you tx nephrogenic DI?
decreased solute intake
thiazide diuretics
NSAIDs
Vasopressin
What are 5 important non-osmotic stimuli for ADH release to know?
baroreceptors
nausea
hypoxia
pain
medications (opiates, antipsychotics and antidepressants)
what defines hyponatremia?
serum sodium < 135 mEq/L
results primarily from increases in total body water
