Syncope Vs Cardiac Disorder Flashcards
Major causes of reduced conscious level
Acute diffuse bilateral disease -
Diffuse ischaemia
Head injury
Brains Stem disorders
Reticular activating system
Compression/raised pressure with shift/ herniation
Brain stem strokes or TIAs
Epilepsy
Generalised seizures
Temporal lobe seizures
Dissociative
Drug induced and metabolic
Uncomplicated faint other word
Vasovagal syncope
Features suggestive of uncomplicated faint?
Posture Provoking factors (pain, micturation,coughing) Prodromal symptoms (sweating, or feeling warm, ringing in ears, vision black outs)
Uncomplicated faint looks like
Pale + sweaty
Falls and lies still
But may have brief anoxic myclonic jerks
Quick recovery , tired and headache+ not confused
ECG in uncomplicated faint?
If examination normal ECG
If ECG normal then no further action
No EEG
Cardiac syncope is
Red flag/ urgent
Cardiac syncope red flag
Syncope in older person 65>
Family history of sudden cardiac death in under 40s
New or unexplained breathlessness
Chest pain or palpitations
A heart murmur
Heart failure
CARDIAC syncope ECG abnormality
Conduction abnormality
Evidence of a long QT >450ms or short QT <350ms
ST segment or T wave abnormalities
Indications for diagnosis of cardiac syncope
Suspected or know. important heart disease
ECG suggesting arrhythmic syncope
Syncope during exercise
Syncope causing severe injury
Family history of sudden death under 40
Syncope when supine
Indications for treatment for cardiac syncope
Life threatening arrhythmia
Syncope related to structural cardiopulmonary disease
CIED implantation required
Other reasons for I dictations for hospital admissions
Sudden palpitations before syncope
High suspicion or cardiac syncope
Recurrent episodes
Lack of available home care
Postural hypotension other name
Orthostatic syncope
Postural hypotension test?
Explained
Head up tilt table testing
Fast (under 2hours)
Continuous ECG and BP measurements
Tilt them to 20-45 degrees
