Syncope Randoms

Question 1

Pathology of syncope:

Answer 1

Reduced cerebral perfusion for 5-15 seconds or reduction in cerebral perfusion by 35%

Question 2

Syncope likely occurs secondary to this

Answer 2

Drop in CO

Question 3

Improvement in this helps to resolve sxs

Answer 3

Cerebral perfusion (place pt. In reclined posture and elevate legs)

Question 4

MC causes of syncope? (3)

Answer 4

Vasovagal
Cardiac dysrhythmias
Orthostatic hypotension
(40% cause unknown leaving ED)

Question 5

Vasovagal etiologies for syncope: (3)

Answer 5

Carotid sinus syndrome
Situational (coughing/sneezing, delectation or urination)
Emotional distress (fear/pain)

Question 6

Orthostatic hypotension etiologies for syncope: (2)

Answer 6

• volume depletion (dehydration, vomiting, diarrhea, hemorrhage)
• secondary to drugs (diuretics, Etoh, BP meds- BB or CCB, and vasodilators)

Question 7

Cardiac etiologies for syncope: (4)

Answer 7

• bradycardia (SSS, pacemaker fx, 2nd and 3rd AV block)
• tachycardia (Ventricular arrhythmias/SVTs)
• PEA
• structural dz (valve dz, MI, HCM)

Question 8

Other etiologies for syncope: (3)

Answer 8

1- PE
2- pulmonary HTN
3- aortic dissection

Question 9

Most dangerous form of syncope

Answer 9

Cardiac related syncope

Question 10

Elderly cardiac structural related etiology of syncope:

Answer 10

Aortic stenosis

Question 11

cardiac structural related etiology of syncope in the young:

Answer 11

HCM

Question 12

Dx test fro aortic stenosis:

Answer 12

Echocardiogram

Question 13

Tx for aortic stenosis:

Answer 13

VALV
Valve replacement
Anti-hypertensive meds
Lipid lowering agents
Verify HF management

Question 14

Common electrolyte abnormalities resulting in syncope

Answer 14

Potassium, sodium, calcium

Question 15

Brugada syndrome ekg changes:

Answer 15

Pseudo-RBBB and ST elevation (V1 and V2)
Type 1: shark fin appearance
Type 2: saddle appearance
- T wave inversion
- Wide QRS

Question 16

Acquired prolonged QT syncope etiologies:

Answer 16

• antiarrhythmia
• antiemetic
• psych
• macrolides

Question 17

Commotio cordis etiology:

Answer 17

Chest wall impact leading to v-fib or sudden cardiac death
MC males <15 y.o.
Impacts during ventricular repolarization
Objects ~40 mph

Question 18

In orthostatic hypotension sxs resolve w/in

Answer 18

3 minutes of postural change; >20 SBP

Question 19

Carotid sinus hypersensitivity should be considered in these sub-groups:

Answer 19

1- elderly
2- pts. W/ ischemic heart dz
3- pts. W/ head/neck malignancies

Question 20

Neurological syncope etiologies: (5)

Answer 20

1- subclavian steal
2- TIA
3- SAH
4- basilar artery spasm (atypical migraine)
5- vertebrobasilar atherosclerotic dz

Question 21

Describe psychiatric syncope secondary to hyperventilation pathophysiology and dx testing:

Answer 21

Hypercarbia, leading to cerebral vasoconstriction and decreased perfusion
Wave form Capnography (End tidal CO2)
Dx of exclusion

Question 22

Reports of 5 or more syncopal episodes in 1 year is likely:

Answer 22

Vasovagal or psychogenic etiologies

Question 23

Syncope preliminary tests:

Answer 23

EKG and urine pregnancy test

Question 24

Syncope diagnostic, secondary and tertiary diagnostic tools

Answer 24

• continuous bedside cardiac monitoring
  2- orthostatic vitals and labs (troponin, BMP, CBC, ddimer)
  3- echocardiogram

Question 25

Tilt table tests confirm:

Answer 25

Vasovagal syncope secondary to parasympathetic stimulation

Last 10-45 minutes

Question 26

Describe the San Francisco syncope rules:

Answer 26

• ID risk for cardiac and mortality w/in 1 year of a syncopal event
• CHESS: only require one for prompt admission; high risk for syncopal episode w/in next year
  C- hx of CHF
  H- hematocrit <30%
  E- abnormal ECG
  S- SOB
  S- triage SBP <90 mm Hg