Vasovagal Syncope Flashcards
What is the criteria for postural hypotension?
a decrease in systolic blood pressure of > 20mmHG and a decrease in diastolic blood pressure of > 10mmHG within 3 minutes of standing from sitting or supine
Who is postural hypotension more common in?
Elderly
What are the drugs that can cause postural hypotension?
- vasodilators
- diuretics
- negative inotropes (beta blockers, CCB and antiarrhythmic medication)
- anti-depressants
- opiates
What is the aetiology of postural hypotension?
- medication
- dehydration (alcohol, diabetes insipidus)
- chronic hypertension (loss of baroreceptor receptors)
- sepsis
- adrenal insufficiency
- autonomic nervous system dysfunction (eg Parkinson’s)
- BPPV
What are the clinical features of postural hypotension?
- dizziness
- syncope
- falls
- fractures
- sometimes precipitated by coughing or defecting
when is postural hypotension more likely to occur?
- after meals or exercise
- in warm environments
- can occur several minutes AFTER standing up
what are the investigations for postural hypotension?
lying and standing blood pressure measuring
What are the complications of postural hypotension?
- bone fractures
- concussion
- postprandial hypotension (low BP 30 mins to 2 hrs after eating)
- shock
- organ failure
What is the conservative management of postural hypotension?
DEPENDS ON THE UNDERLYING CAUSE first line =
- adequate hydration
- evaluate polypharmacy
- reduce adverse outcomes from falls (eg fall alarm, soft flooring)
- behavioural changes (rising and sitting slowly)
- compression stockings
- 2nd line = fludrocortisone or midodrine
what are the differential diagnosis for postural hypotension?
- vertigo (spinning sensation and loss of balance)
- hypoglycaemia (shakiness, hunger, confusion and sweating)
- cardiac arrhythmias (palpitations, chest pains and SOB)
what is syncope?
a transient loss of consciousness with rapid onset, short duration and complete recovery
- medical term for fainting
What is the 3 major criteria to define syncope?
- Loss of consciousness
- Loss of consciousness must be transient
- It is caused by global cerebral hypoperfusion (drop in BP)
What is the European Society of Cardiology classification for syncope?
- Rapid onset
- Short duration
- Spontaneous and complete recovery
how is syncope classified?
- reflex syncope (most common)
- orthostatic syncoppe
- cardiac syncope
What are the 3 types of reflex syncope?
- Vasovagal (triggered by emotion, pain or stress aka fainting)
- Situational (triggered by cough, micturition of GIT)
- Carotid sinus syncope
What is reflex syncope?
Fainting resulting from certain stressful triggers which lead to sudden drop in blood pressure and heart rate.
What is orthostatic syncope?
Orthostatic syncope, also known as postural syncope, postural hypotension, or orthostatic hypotension, is a condition where your blood pressure drops suddenly due to a quick change in position, such as standing up after lying down
what causes orthostatic syncope?
-Autonomic failure eg Parkinson’s disease, diabetic neuropathy
- Drugs eg diuretics, alcohol and vasodilators
- Volume depletion eg haemorrhage or diarrhoea
what is cardiac syncope?
a transient loss of consciousness due to inadequate cardiac output > CEREBRAL HYPOPERFUSION
what are the 2 types of cardiac syncope?
- Structural
- Arrhythmias
What are the clinical features of vasovagal syncope?
- a clear trigger and warning prior to collapse
- narrowing of vision
- sweating and nausea
- time to lower themselves to the floor without injury
what is important to ask about pre-collapse when someone has an episode of syncope?
- lightheaded
- palpitations
- chest pain
- SOB
- exertional syncope = RED FLAG
what is important to ask about during collapse when someone has an episode of syncope?
- pallor (any colour change?)
- abrupt onset (significant injury is more likely)
- seizure activity
- tongue biting or incontinence (UNLIKELY)
can movement occur during collapse for syncope?
YES
- anoxic jerks can occur during syncope episodes
- movement does NOT mean a seizure has occurred
what is important to ask about after collapse when someone has an episode of syncope?
recovery time (a rapid recovery occurs with syncope)
what is important to get when investigating syncope?
A COLLATERAL HISTORY OF BEFORE, DURING AND AFTER COLLAPSE
what are the clinical features of blackout due to seizure?
- Lateral tongue-biting
- Urinary incontinence
- Long post-octal period
- Residual neurological deficit
- Seizure activity
what are the investigations for syncope?
- bedside = ECG or 24hr tape if paroxysmal arrhythmia is suspected, BP, lying and standing BP
- bloods = FBC, U+Es, LFTs
- imaging = TTE for structural causes of cardiac syncope
what should happen for patients with suspected cardiac syncope?
urgent referral to cardiology for assessment within 24hrs
