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Y1 - Cardiovascular > Syncopy > Flashcards

Syncopy Flashcards

1
Q

Define a transient loss of consciousness

A

A state of real or apparent loss of consciousness with loss of awareness

Characterised by:

  • amnesia (for duration of unconsciousness)
  • loss of motor control
  • loss of responsiveness
  • short duration
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2
Q

List some of the characterising features of a transient loss of consciousness

A
  • amnesia (for duration of unconsciousness)
  • loss of motor control
  • loss of responsiveness
  • short duration
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3
Q

Is syncope the only cause of a transient loss of consciousness?

A

No

other things like head trauma, epilepsy etc. can cause it

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4
Q

Define syncope

A

Transient loss of consciousness due to cerebral hypoperfusion

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5
Q

List the characteristics of syncopy

A
  • rapid onset
  • short duration
  • spontaneous full recovery
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6
Q

Define cerebral hypoperfusion

A

Reduced blood perfusion of the brain

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7
Q

List the types of syncope

A
  • Reflex syncope (vasovagal, situational, carotid sinus)
  • Orthostatic hypotension
  • Cardiac syncope
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8
Q

Define reflex syncope

A

Syncope where neural reflexes modify heart rate and/or vascular tone

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9
Q

Describe the basic process that causes reflex syncope

A 
Neural reflexes decrease heart rate and/or vascular tone
-->
Predisposing to a fall in MAP
-->
MAP fall causes cerebral hypotension
-->
Transient cerebral perfusion decreased 
-->
Syncope (or near syncope)
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10
Q

What is the most common type of syncope?

A

Vasovagal syncope

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11
Q

Describe how neural reflexes decrease heart rate and/or vascular tone in reflex syncope

And the effect this has on MAP

A

Heart rate decrease:

  • Vagal stimulation
  • Decreased heart rate
  • Cardiac output decreased
  • MAP decreased

Vascular tone decrease:

  • Decrease in vasomotor tone
  • SVR decrease, venous return decrease, SV decrease
  • Cardiac output and thus MAP decreases
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12
Q

Define vascular tone

A

The degree of constriction of a blood vessel

Decreased tone = vasodilation
Increased tone = vasoconstriction

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13
Q

List the types of reflex syncope

A
  • Vasovagal
  • Situational
  • Carotid sinus
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14
Q

Describe vasovagal reflex syncope

Describe its prodrome

Aversion?

A
  • Due to emotional distress (or orthostatic stress)
  • Typical prodrome (sweating, pallor, nausea)
  • Can be averted during prodrome (lie down - increase venous return)
  • Most common type of syncope
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15
Q

What is the main risk of vasovagal reflex syncope?

A

Injury due to falling over

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16
Q

What is the treatment for vasovagal reflex syncope?

A
  • Education on triggers
  • Avoidance of triggers
  • Adequate hydration
17
Q

Is vasovagal reflex syncope linked to increased mortality?

A

No

18
Q

Describe situational reflex syncope

A
  • Syncope during/immediately after a specific stimulus
    e. g. cough, swallowing, micturition
  • Less common
19
Q

Describe the treatment for situational reflex syncope

A
  • Treat the stimulus (e.g. cough)
  • Advise patient lies down during stimulus (e.g. coughing)
  • Avoid dehydration and excessive alcohol
  • Cardiac pacemaker (if bad)
20
Q

Describe carotid sinus reflex syncope

A

Syncope triggered by mechanical manipulation of the neck

  • more common in elderly, and males
  • associated with atherosclerosis
21
Q

Describe the treatment for carotid sinus reflex syncope

A
  • Cardiac pacemaker
22
Q

What events can predispose to carotid sinus reflex syncope

A
  • head and neck surgery

- radiation of the head and neck

23
Q

Define postural (orthostatic) hypotension

A

Hypotension due to the failure of the baroreceptor reflex to respond to gravitational shifts in blood (usually when standing up)

24
Q

List the risk factors of postural (orthostatic) hypotension

A
  • Age related
  • Medications
  • Certain diseases
  • Reduced intravascular volume
  • Prolonged bed rest
25
Q

What are the signs and symptoms of postural (orthostatic) hypotension?

A
  • syncope
  • lightheadedness
  • dizziness
  • blurred vision
  • faintness
  • falls
26
Q

What is the clinical test for postural (orthostatic) hypotension?

A

Within 3 mins of standing from lying down, either:

  • Systolic Bp drop of 20 mmHg
    or
  • Diastolic Bp drop of 10 mmHg (with symptoms)
27
Q

Describe cardiac syncope

A

Syncope due to a cardiac event that causes a sudden drop in cardiac output

28
Q

List possible causes of cardiac syncope

A
  • Arrhythmias: resulting in bradycardia or tachycardia
  • Acute Myocardial infarction
  • Structural Cardiac Disease: e.g. aortic stenosis, hypertrophic cardiomyopathy
  • Other Cardiovascular Disease: e.g. pulmonary embolism, aortic dissection
29
Q

How does an arrhythmia that causes tachycardia result in the decreased cardiac output seen in cardiac syncope?

A 
The increased HR doesn't allow for complete filling of the ventricles
-->
Stroke volume decreased
-->
Cardiac output decreases
30
Q

Describe findings that suggest cardiac syncope

A
  • Syncope during excretion or when supine
  • Presence of a structural cardiac abnormality or coronary heart disease
  • A family history of sudden death at young age
  • Sudden onset palpitations immediately followed by syncope
  • Findings on ECG suggestive of arrhythmic syncope
31
Q

Describe how to initially evaluate a patient presenting with transient loss of consciousness

A
  • Careful history
  • Any witnesses
  • Fully physical examination
  • Orthostatic blood pressure measurement
  • 12-lead ECG

Y1 - Cardiovascular (19 decks)

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