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Yr 3 Cardiovascular > Vasovagal Syncope > Flashcards

Vasovagal Syncope Flashcards

1
Q

What is the criteria for postural hypotension?

A

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

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2
Q

Who is postural hypotension more common in?

A

Elderly

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3
Q

What are the drugs that can cause postural hypotension?

A
  • vasodilators
  • diuretics
  • negative inotropes (beta blockers, CCB and antiarrhythmic medication)
  • anti-depressants
  • opiates
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4
Q

What is the aetiology of postural hypotension?

A
  • medication
  • dehydration (alcohol, diabetes insipidus)
  • chronic hypertension (loss of baroreceptor receptors)
  • sepsis
  • adrenal insufficiency
  • autonomic nervous system dysfunction (eg Parkinson’s)
  • BPPV
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5
Q

What are the clinical features of postural hypotension?

A
  • dizziness
  • syncope
  • falls
  • fractures
  • sometimes precipitated by coughing or defecting
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6
Q

when is postural hypotension more likely to occur?

A
  • after meals or exercise
  • in warm environments
  • can occur several minutes AFTER standing up
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7
Q

what are the investigations for postural hypotension?

A

lying and standing blood pressure measuring

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8
Q

What are the complications of postural hypotension?

A
  • bone fractures
  • concussion
  • postprandial hypotension (low BP 30 mins to 2 hrs after eating)
  • shock
  • organ failure
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9
Q

What is the conservative management of postural hypotension?

A

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
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10
Q

what are the differential diagnosis for postural hypotension?

A
  • vertigo (spinning sensation and loss of balance)
  • hypoglycaemia (shakiness, hunger, confusion and sweating)
  • cardiac arrhythmias (palpitations, chest pains and SOB)
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11
Q

what is syncope?

A

a transient loss of consciousness with rapid onset, short duration and complete recovery

  • medical term for fainting
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12
Q

What is the 3 major criteria to define syncope?

A
  1. Loss of consciousness
  2. Loss of consciousness must be transient
  3. It is caused by global cerebral hypoperfusion (drop in BP)
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13
Q

What is the European Society of Cardiology classification for syncope?

A
  1. Rapid onset
  2. Short duration
  3. Spontaneous and complete recovery
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14
Q

how is syncope classified?

A
  1. reflex syncope (most common)
  2. orthostatic syncoppe
  3. cardiac syncope
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15
Q

What are the 3 types of reflex syncope?

A
  1. Vasovagal (triggered by emotion, pain or stress aka fainting)
  2. Situational (triggered by cough, micturition of GIT)
  3. Carotid sinus syncope
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16
Q

What is reflex syncope?

A

Fainting resulting from certain stressful triggers which lead to sudden drop in blood pressure and heart rate.

17
Q

What is orthostatic syncope?

A

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

18
Q

what causes orthostatic syncope?

A

-Autonomic failure eg Parkinson’s disease, diabetic neuropathy

  • Drugs eg diuretics, alcohol and vasodilators
  • Volume depletion eg haemorrhage or diarrhoea
19
Q

what is cardiac syncope?

A

a transient loss of consciousness due to inadequate cardiac output > CEREBRAL HYPOPERFUSION

20
Q

what are the 2 types of cardiac syncope?

A
  1. Structural
  2. Arrhythmias
21
Q

What are the clinical features of vasovagal syncope?

A
  • a clear trigger and warning prior to collapse
  • narrowing of vision
  • sweating and nausea
  • time to lower themselves to the floor without injury
22
Q

what is important to ask about pre-collapse when someone has an episode of syncope?

A
  • lightheaded
  • palpitations
  • chest pain
  • SOB
  • exertional syncope = RED FLAG
23
Q

what is important to ask about during collapse when someone has an episode of syncope?

A
  • pallor (any colour change?)
  • abrupt onset (significant injury is more likely)
  • seizure activity
  • tongue biting or incontinence (UNLIKELY)
24
Q

can movement occur during collapse for syncope?

A

YES

  • anoxic jerks can occur during syncope episodes
  • movement does NOT mean a seizure has occurred
25
Q

what is important to ask about after collapse when someone has an episode of syncope?

A

recovery time (a rapid recovery occurs with syncope)

26
Q

what is important to get when investigating syncope?

A

A COLLATERAL HISTORY OF BEFORE, DURING AND AFTER COLLAPSE

27
Q

what are the clinical features of blackout due to seizure?

A
  1. Lateral tongue-biting
  2. Urinary incontinence
  3. Long post-octal period
  4. Residual neurological deficit
  5. Seizure activity
28
Q

what are the investigations for syncope?

A
  • 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
29
Q

what should happen for patients with suspected cardiac syncope?

A

urgent referral to cardiology for assessment within 24hrs

Yr 3 Cardiovascular (28 decks)

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