Syncope - full summary Flashcards
What is meant by syncope?
Transient loss of consciousness due to cerebral hypo perfusion, characterised by rapid onset, short duration and spontaneous, complete recovery
What is meant by a transient loss of consciousness?
a state of real or apparent loss of consciousness with loss of awareness, characterised by amnesia for the period of unconsciousness, loss of motor control, loss of responsiveness and of a short duration
What are the 3 main types of syncope?
Reflex syncope
Orthostatic hypotension
Cardiac syncope
What testing is required in cases of syncope?
Careful history
Orthostatic blood pressure measurement
12 lead ECG
What is meant by reflex syncope?
Syncope caused by neural modification heart rate and/or vascular tone, causing a fault in arterial blood pressure of sufficient severity to affect cerebral perfusion
What are the 3 types of reflex syncope?
Vasovagal syncope
Situational syncope
Carotid sinus syncope
What is vasovagal syncope?
Syncope triggered by emotional or orthostatic stress
What are some prodromes of vasovagal syncope?
Pallor
Sweating
Nausea
What are some actions that can control vasovagal syncope?
Leg crossing
Adoption of a horizontal gravity neutralisation position
How is vasovagal syncope treated?
Education
Reassurance
Trigger avoidance
Adequate hydration
What is situational syncope?
Syncope that occurs during or immediately after a trigger
What are some possible triggers of situational syncope?
Cough
Micturition
Swallowing
What are some treatment options in situational syncope?
Removal of trigger (e.g. cough)
Lying down
Avoiding dehydration
Decreasing alcohol intake
Cardiac pacing (If indicated)
What is carotid sinus syncope?
This is syncope caused by manipulation of the carotid sinus
What are some possible causes of carotid sinus syncope?
Mechanical manipulation of the neck
Shaving
Tight collars
Who is most susceptible to carotid sinus syncope?
Elderly males
Those with previous neck or head surgery
Those with coronary artery atherosclerosis
What is the treatment for carotid sinus syncope?
Cardiac pacing
What is orthostatic hypotension?
This is syncope that occurs from a failure of baroreceptor response to gravitational shifts in blood, when moving from horizontal to vertical
What are some risk factors for orthostatic hypotension?
Age
Certain medications
Certain diseases
Prolonged bed rest
What is a positive orthostatic blood pressure test for orthostatic hypotension?
A positive result is indicated by a drop in blood pressure within 3 minutes of standing from a lying position of:
- > 20mmHg drop in systolic BP
- > 10mmHg drop in diastolic BP + symptoms
What are some symptoms of orthostatic hypotension?
Dizziness
Lightheadedness
Blurred vision
Faintness
Falls
What is cardiac syncope?
Syncope caused by a cardiac event, resulting in a sudden drop in cardiac output
What are some possible causes of cardiac syncope?
Arrhythmia
Acute MI
Structural cardiac disease
Cardiovascular diseases
What are some features that may be suggestive of cardiac syncope?
Syncope when supine
Syncope during excretion
Presence of structural abnormalities
Sudden palpitations
Family history of early sudden death
