syncope and sudden death Flashcards
def. syncope
loss of cons. due to insuff. bloodflow to the brain
what are the 2 questions to ask self
- did the patient faint?
2. why did the patient faint?
4 most common causes from most to least
- neurally mediated - vasovagal
- orthostatic - drugs, ANS failure
- cardiac arrythmia - can be fatal
- structural cardio-pulmonary
- acute MI, aortic stenosis, pulm HT
most important part of syncope evaluation
HX
what are Hx signs of neurogenic
- nausea, pallor, fatigue before or after
- Phx or emotional stress, hedydration
- long Hx of them, that began before 3
other Hx things and what they might mean
abrupt, severe, quick recovery - VT
syncope DURING effort - stenosis, ischemia, HCM
family history of sudden death - long QT
4 major parts of Hx
- circumstances of most recent event
- more remote events
- other disease, esp cardiac
- fam. Hx
KEY part of Hx
GO back and ask eye-witnesses
most important question
was it vasopressor or arrhythmia
what is neurally mediated
- simple faint
- hot/crowded, ETOH, dehydrated, stress
- postdrome frequent - minutes to hours fatigue
what are 4 parts of diagnostic plan
- intial exam - easy and cheap
- Hx
- ECG
- Phx - montitoring
- holter - not useful
- event - if have Sx 2x weeks
- insertable loop - invasive and expensive - imaging
- look for stuctural - special tests
6 times should be worried
- > 65
- with injury
- DURING excercise
- sitting or lying down
- with little or no warning
- family Hx of sudden death
what is an ECG that should make you act now
not a normal ECG
- lots of things can be wrong with it
use of neuro imaging
useless
what is sudden death
unexpected death due to cardiac causes occuring in ashort period of time
- ususally due to arrhythmias
- half of all cardiac deaths
