Week 20a - Palpitations and Syncope Flashcards
what is syncope
loss of consciousness due to reduced cerebral perfusion
may also be used to refer to any transient loss of consciousness
what does pre-syncope refer to
light headedness when someone feels they may be about to lose consciousness
key elements in syncope history
ensure understanding of what patient means
details description of timing, what patient was doing, what they experienced, how long they were unconscious for and how they felt afterwards
obtain witness account if possible
past medical history
common causes of syncope
CV syncope - arrhythmia, structural heart disease
postural or orthostatic hypotension
neurally mediated - epilepsy
vasovagal/neural reflex syncope
drug intoxication
hypoglycaemia
normal rhythms
sinus rhythm
sinus tachycardia
sinus bradycardia
sinus arrhythmia
when will sinus tachy occur
when exercising
fever/infection
dehydration
when will sinus brady occur
at rest (young people)
when will sinus arrhythmia occur
changes in heart rate due to respiration
common arrhythmias - too fast
atrial fibrillation - most common clinical arrhythmia
ventricular tachy
common arrhythmias - too slow
heart block
common arrhythmias - intermittent
supraventricular tachy
paroxysmal AF
ectopic beats - most common arrhythmia
supraventricular tachy (SVT)
intermittent rapid tachy with abrupt onset anf offset
narrow complex tachy
presentation of SVT
palpitations
light headedness
nausea
chest pain
SOB
usually haemodynamically stable
treatment of SVT
activation of vagus nerve in ANS would increase blockade at AV node
- vagus nerve parasympathetic acetylcholine acting on muscarinic receptors
- can be activated by carotid sinus massage, Valsalva manoeuvre, cold water on face, or modified Valsalva maoeuvre
if vagal manoeuvres dont work, give IV adenosine - slows conduction through AV node
treatment of SVT
activation of vagus nerve in ANS would increase blockade at AV node
- vagus nerve parasympathetic acetylcholine acting on muscarinic receptors
- can be activated by carotid sinus massage, Valsalva manoeuvre, cold water on face, or modified Valsalva maoeuvre
if vagal manoeuvres dont work, give IV adenosine - slows conduction through AV node
