TP10.2 - Síncope II

Question 1

Pulmonary Embolism?

Answer 1

• • Clinical presentation varies from asymptomatic to fatal
• • The development of symptoms depends on the embolic burden and the severity of any underlying cardiopulmonary disease
• • The diagnosis of PE is never made in approximately 70% of those who survive the initial event
• • Thus is critical that a high level of suspicion is maintained
• • PE is suspected on the basis of dyspnea, chest pain, presyncope or syncope, and/or hemoptysis.

Question 2

Superior Vena Cava Occlusion?

Answer 2

• • Edema da cabeça, pescoço e naso e orofaringe
• • Inchaço dos MS e Torso
• • Collateralized chest wall veins
• • Cyanotic appearance of skin
• • Sings and symptoms of venous congestion are determined by the duration and extent of venous occlusive disease and the amount of collateral venous circulation that develops
• • Fullness in the head and neck that is exacerbated when bending over or laying flat in bed
• • Severity can be graded by number of pillows used to sleep confortably

Question 3

Aortic Dissection?

Answer 3

• • Syncope may complicate the presentation of acute aortic dissection and its presence often indicates the development of cardiac tamponade or involvement of the brachiocephalic veins.
• • Syncope have higher rate of severe complications

Question 4

Ruptured Abdominal Aortic Aneurism?

Answer 4

• • Older than 50 years with hypotension and/or syncope
• • Presentation can range from sudden onset woth hypotension and colapse to clowly increasing pain over a few days as the -AAA wall as gradually stretched and then torn

Question 5

Cerebrovascular Disease?

Answer 5

• • Global ischemia or systemic hypoperfusion represents only a small fraction of all ischemic strokes from carotid occlusive disease.
• • Neurological symptoms can be varied
• • Result of prolonged cardiogenic shock, dysrhythmias, or cardiac arrest, and treatment should initially focus on correcting cardiac failure and improving perfusion pressure to the brain

Question 6

Carotid Sinus Syndrome and Carotid Sinus Hypersensitivity?

Answer 6

• • CSS presents with syncopal symptoms triggered by manipulation of the carotid sinus that occurs in daily life, resulting in a neurally mediated reflex and bradycardia, and hypotension
• • Carotid sinus hypersensitivity (CSH) is defined as bradycardia or hypotension due to carotid sinus massage or manipulation in patients without a clinical history of such symptoms

Question 7

Long QT Syndrome?

Answer 7

Left thoracic sympathectomy significant reduciton of aborted cardiac arrest and syncope in high risk patients with long QT Syndrome.

Question 8

Takayasus’s Arteritis?

Answer 8

• • Immune arteritis causing inflammation of the aorta, its major branches, and pulmonary arteries.
• • Young women with onset typically in the second or third decade of life
• • Cerebrovascular signs and symptoms are common because of the frequency of aortic arch and branch involvement

Question 9

Moyamoya Disease?

Answer 9

• • Chronic, idiopathic, progressive cerebrovascular disease presenting with internal carotid artery stenosis and occlusion
• • Patients often present due to headache, diziness, palpiations, syncope or hyperventilation