Syncope in Adults Flashcards
What is syncope?
Transient, brief, and abrupt loss of consciousness
Absence of postural tone
Complete and rapid recovery
Benign and self-limited
Can urinary incontinence happen with syncope?
Yes, especially in older people
Can injuries like tongue biting happen with syncope?
Yes, but more common in seizures
Is there a post-ictal phase in syncope?
No
What are the common causes of syncope?
Vasovagal
Arrhythmia
Neurology/psychiatric disease
Unexplained/idiopathic
What are common cardiac causes of cardiac syncope?
Aortic stenosis
What is the pathophysiology of vasovagal syncope?
Drop in BP > increase in SV > heart contracts against less-filled left ventricle > mechanoreceptors detect this > send info to tractus solitarius in brainstem > decreases sympathetic drive to heart, and increases vagal tone > vasodilation and bradycardia > decreased cerebral perfusion > syncope
What are non-syncope conditions that could be mistake for syncope?
Fall TIA - Neurological signs need to be present Cardiac arrest Presyncope - Prodromal symptoms - Light headedness - Dizziness
What can syncope and headache indicate?
Red flag; eg: subarachnoid haemorrhage
What are the symptoms associated with syncope due to a subarachnoid haemorrhage?
Prolonged LOC
Most commonly with seizures
Prolonged recovery
What can syncope and chest pain indicate?
Cardiac ischaemia
Arrhythmia
What can syncope and dyspnoea indicate?
PE
What does the initial evaluation of syncope involve?
Is it syncope or something else
What is the aetiology?
Is there high risk of CV event/death?
What is the usual duration of loss of consciousness in syncope?
Brief
Usually around 30 sec
Can be up to couple of min
What is the usual duration of loss of consciousness in cardiac syncope?
About 10 sec
What is recovery like after syncope?
Complete
Rapid
What are associated symptoms that suggest vasovagal syncope?
Nausea
Pallor
Diaphoresis
Hot environment
What are associated symptoms that suggest arrhythmia?
Sudden collapse
What are associated symptoms that suggest pulmonary embolism?
SOB
What are associated symptoms that suggest epilepsy?
Urine/faecal incontinence
Auras
What are the precipitating factors of situational syncope?
Cough Swallowing Crowded Standing Post-prandial Fear Pain Urinating/defaecating
What is carotid sinus syncope?
Hyper-sensitive baroreceptors
More common in elderly
How is carotid sinus syncope tested?
Carotid sinus massage whilst ECG running
Looking for extreme bradycardia and symptoms
What is tilt table testing?
Tilt table, head up to 70 degrees
Tilt for 45 min
Monitor
- HR
- BP
- ECG
Give vasodilator challenge halfway - GTN/isoprenaline
Look for symptoms
Vasodilator syncope >50 mmHg drop with syncope
Cardio-inhibitory syncope >3 sec of asystole/>10 sec of extreme bradycardia (<35 bpm)
What is the most common cause of left axis deviation?
Ischaemic heart disease
What are the causes of QT prolongation?
Hypomagnesaemia Hypokalaemia Hypocalcaemia Raised intracranial pressure Altered conscious state Hereditary Hypothermia Drugs
What is prolongation of the QT interval associated with?
Increased risk of polymorphic VT = torsades de pointes
