Week 3 - Syncope / Weakness / Dizziness Flashcards
Syncope
Syncope definition
Can they seize?
What is the pt like after the syncope?
Temporary/transient loss of consciousness associated with loss of postural tone, insufficient blood flow to the brain.
Also called fainting or “passing out” - usually occurs due to hypotension
They can have BRIEF seizure activity
The pt is NOT altered or post-ictal afterwards
Weakness
What does weakness infer?
A decrease in physical strength or energy
Many different symptoms and presentations
May represent neuromuscular weakness, fatigue, malaise, or pressyncope
Hx and physical exam is key to help narrow the differential
It’s often mutlifocal
Dizzy/Vertigo
What words/phrases would a pt use to describe their experience?
You should use
Vertigo (the illusionary sense of movement)
Weakness/fainting
Lightheadedness
Unsteadyness
OPQRST
CABG
Coronary, Artery, Bypass, Graft
Syncope
What are the key findings?
Generalized loss of blood flow to the brain (not focal)
Sudden
Brief
Transient
Fully resolved
Returns to normal neurological status
Faint Score
Memory Aid - BLOOD
4 Pre’s
2 Dx
3 Q’s
Previous hx of heart disease predisposition i.e. blood pressure LESS then 90 over LESS than 180 = high troponin
Dx of cardiac syncope
Dx of vasovagal syncope
Abnormal QRS axis = duration of GREATER then 130ms and/or QT is GREATER then 480ms
CHESS Mnemonic
San Francisco Syncope Rule
Syncope - 3 P’s
What are the 3 P’s?
What are the red flags of cardiac syncope?
Posture e.e prolonged standing
Provoking factors e.g. medical procedure
Prodomal symptoms e.g. sweating
ECG changes
SOB
Murmer
Syncope on exertion
Sudden death in the family
Age GREATER then 65y old with absent 3P’s
Syncope
What are the causes?
Syncope - ECG changes
What are the ECG changes that might present during syncope?
Syncope
What other conditions may present with syncope?
Myocardial Infarction
Dysrhythmias
Hypertrophic Cardiomyopathy
Pericardial Tamponade
Stroke
Subarachnoid Hemorrhage
Aortic Stenosis
Thoracic Aortic Dissection
Pulmonary Embolism
Abdominal Aortic Aneurysm
Gastrointestinal bleeding/Shock/Hypovolemia
Ectopic Pregnancy
Toxicological
Sepsis
Syncope Expected Findings
What could be the causes?
What is hypertrophic cardiomyopathy? What would the ECG have?
Insufficient blood supply to the brain
Change in vasomotor tone
Transient change in HR
Transient change in BP
Transient reduction in blood flow to the brain
May appear pale and diaphoretic
Witnessess may report a fainting
a disease in which the heart muscle becomes thickened (hypertrophied) - comes with few if any symptoms
dagger-like Q waves in inferior and lateral leads
What is aortic stenosis?
What are some symptoms?
a type of heart valve disease (valvular heart disease) in which the one between the left ventricle and the body’s main artery (aorta) is narrowed and doesn’t open fully thus restricting bloodflow from the heart to the rest of the body.
Chest pain
Fatigue
SOB
Fainting/lightheadedness
Heat murmur
Heart palpitations
WPW-Wolf Parkinson White Syndrome
What is it and what does it commonly cause in infants/children?
What kind of waves are created on an ECG?
What are the common symptoms AND rates?
a syndrome describing an additional electrical pathway in the heart that leads to periods of rapid HR
Causes tachycardia
Delta waves
160-220-300
Chest pain or tightness
Dizziness
Lightheadedness
Syncope
Palpitations
SOB
Brugada Syndrome
What is the disorder and it’s effects?
a genetic disorder that can cause a dangerous irregular heartbeat
the ventricles beat fast and irregularly - preventing blood from circulating correctly in your body
Vertebrobasilar Artery Disease/Insuffciency
What is it?
What does atherosclerosis = ?
What are plaques made of? What are their complications?
a condition characterized by poor blood flow to the posterior (back) portion of the brain, which is fed by two vertebral arteries that join to become the basilar artery
(fainting or syncope can occur)
reduced blood flow
deposits of cholesterol, calcium, and other cellular components
block the flow of blood to the brain
Vagus Nerve is the ? cranial nerve also called ? that interfaces with the ? control of the heart, lungs, and digestive tract
Comprsises what kind of fibers?
10th cranial nerve
pneumogastric nerve
parasympathetic NS
sensory and motor
By what is the heart parasympathetically controlled by?
Which side innervates the sinoatrial node?
When hyperstimulated what happens?
Vagus nerve
AND
Thoracic ganglia
the right vagus branch
the left vagal branch predisposes the heart to conduction block at atrioventricular node
Vaso-vagal Syncope
Who does it affect?
What could it lead to?
Young children and women more than other groups
temporary loss of bladder control under moments of extreme fear
Vaso-vagal Syncope
What happens?
you syncope due to extreme emotional distress - called neurocardiogenic syncope
Your HR and BP drop suddenly (your brain obviously loses enough oxygen to keep you conscious)
Atropine
What is it used for?
Classification and mechanism of action?
Bradycardia
muscarinic receptor antagonist that is used to inhibit the effects of excessive vagal activation on the heart, which is manifested as sinus bradycardia and AV nodal block
Micturition Syncope
Explain it to me
What’s the rare cause?
one strains to increase the flow of urine, it stimulates the vagus nerve - decreasing HR and thus BP
(usually more pronounced in elderly men with large prostates)
Paraprostatic pheochromocytoma
What does the different colors of urine mean?
Pheochromocytoma
What is it and what happens?
What’s a key finding?
a rare tumor usually arising from the adrenal medulla that causes
Secretion of extra Epinephrine & Norepinephine
orthostatic hypotension
Postural Hypotension
What’s the other more common name and what it is?
What are the treatments?
Orthostatic hypotension, a form of low blood pressure that happens when you stand up from sitting or lying down.
Drinking enough water
NOT drinking alcohol
Avoiding overheating
Elevating the head of your bed
Avoiding crossing your legs when sitting
Standing up slowly
Paraganglioma of the Carotid Bulb
What is it?
a growth on the side of your neck in the area where the carotid artery splits off into smaller blood vessels that carry blood to your brain
Takotsubo-like Cardiomyopathy
What is it?
Other names?
A temporary heart condition that is brought on by stress. It has the same symptoms as a heart attack but is not caused by any underlying cardiovascular disease
It is also known as stress cardiomyopathy, apical ballooning, or broken heart syndrome.
Apical ballooning
Broken Heart Syndrome
Stress cardiomyopathy
POTS – Postural Tachycardia Syndrome
What is it?
Who does this affect?
A genetic disorder characterized by orthostatic intolerance—too little blood returning to the heart when moving from a lying down to standing up position.
This syndrome affects 1 in 100 people, and is generally diagnosed between ages 15 and 50. It is most frequently seen in young women, less than 35 years of age.
The cause of this disease is poorly understood, but researchers suspect that the syndrome may have more than one cause.
1in100 people
Age 15-50y old
Women LESS then 35y old
Stokes-Adams Syndrome
What is it?
A periodic fainting spell in which there is intermittent complete heart block or other high-grade arrhythmia that results in loss of spontaneous circulation and inadequate blood flow to the brain
Narcolepsy
What is it?
What are the complications and symptoms?
chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles.
Unwillingly fall asleep even during activities
Sudden muscle weakness while awake - can’t move
Vivid dream-like images or hallucinations
AND
Total paralysis just before falling asleep or just waking up
Cataplexy
What is it?
What triggers it?
it is the 1st symptom to appear in narcolepsy, usually it’s misdiagnosed as a seizure disorde
A sudden loss of muscle tone while a person is awake leads to weakness and a loss of voluntary muscle control.
The symptoms of cataplexy may appear weeks or even years after the onset of EDS. Some people may only have one or two attacks in a lifetime, while others may experience many attacks a day. In about 10 percent of cases of narcolepsy, cataplexy is the first symptom to appear and can be misdiagnosed as a seizure disorder
sudden-strong emotions like laughter, fear, anger, stress, or excitement
Hyperventilation
What your DDX?
12
Arrhythmia or myocardial infarction
Stroke or seizure
Asthma exacerbation
Pneumothorax
Pulmonary embolism
Ketoacidosis (eg, diabetic ketoacidosis)
Hyperthyroidism
Acute panic attack / panic disorder
Congestive heart failure
Pleural effusion
Pneumonia (bacterial, viral)
Interstitial lung disease
Dizziness Differential
Peripheral?
Central?
Meniere’s Disease
Acute Otitis Media
Perilymphatic Fistula CNS Trauma
Cholesteatoma
Viral Labyrinthitis
Bacterial Labyrinthitis
Vestibular Neuronitis Motion sickness
Ototoxicity
Otologic Surgery
Otologic Injury / Trauma
Otosyphilis
Benign Paroxysmal Positional Vertigo
Acoustic Neuroma
Brainstem CVA
Carotid Stenosis
CNS Neoplams
Multiple Sclerosis
Vertebrobasilar Insufficiency
Medication Overdose
Presbystasis
Psychogenic Disorder
Arnold-Chiari Malformation
CNS Infection
Seizure Disorder
Migraine
Dizziness Differentials
Systemic?
Cardiac arrhythmia
Cardiac Valvular Disease
Orthostatic Hypotension
Alcohol Intoxication
Sleep Deprivation
Toxin Exposure
Hypoglycemia
Autonomic Dysfunction
Hyperventilation
Panic / Anxiety
Dizziness - unsteady causes?
What are common symptoms of balance disorders?
Inner Ear
Balance Disorders
Motion Sickness
Labyrinthitis
Vestibular System Issues
Dizziness or vertigo
Falling or a feeling as if you are going to fall
Lightheadedness, fainting, or a floating sensation
Blurred vision
Confusion or disorientation
Nausea and vomiting
Diarrhea
Changes in blood pressure and heart rate
Fear
Anxiety
Panic
What are the common Balance disorders?
Vertigo
What is it?
What is associated with?
What does it indicate?
an abnormal sensation that is described by a person as a feeling that they are spinning, or that the world is spinning around them- could come with intense nausea and vomiting
This feeling may be associated with loss of balance to the point that the person walks unsteadily or falls. Vertigo itself is a symptom or indicator of an underlying balance problem, either involving the labyrinth of the inner ear, or the cerebellum of the brain.
Loss of balance to the point that the person walks unsteadily or falls
a problem involving the labyrinth of the inner ear
OR
a problem involving the cerebellum of the brain
Benign Paroxysmal Positional Vertigo (BPPV)
What is it?
Causes?
a brief, intense episode of vertigo that occurs because of a specific change in the position of the head
A person also may experience BPPV when he or she rolls over in bed. BPPV sometimes may result from a head injury or aging.
Rolling over in bed (if you have it)
Heda injury (could get it)
Aging (could get it)
Labyrinthitis
What is a labyrinth and how does it work, in context to the ears?
What is labyrinthitis?
the labyrinth, which is made of bone and soft tissue has semicircular canals and otolithic organs within the labyrinth to help maintain our balance. It also has cochlea within the labyrinth to enable us to hear
An infection or inflammation of the inner ear that causes dizzeness and loss of balance - frequently associated with an URTI
Ménière’s Disease
What is it?
cause?
What does it do?
it’s associated with a change in fluid volume within parts of the labyrinth of the ear.
unknown
causes episodes of vertigo, irregular hearing loss, tinnitus, and a feeling of fullness in the ear (stuffed up ear)
Vestibular Neuronitis
What is it?
Who does it affect?
an inflammation of the vestibular nerve and may be caused by a virus - it’s a paroxysmal attack of severe vertigo.
It affects young to middle-aged adults, and often follows a nonspecific upper respiratory infection
Young to middle-aged adults often following a non-specific UPTI
Perilymph Fistula
What is it?
Most notable symptoms?
a leakage of inner ear fluid into the middle ear. It can occur after a head injury, drastic changes in atmospheric pressure, physical exertion, ear surgery, or chronic ear infections.
Dizziness
Nausea
Unsteadiness when walking or standing, increasing with activity and decreasing with rest
Motion Sickness - Sea Sicknes - Car Sickness
What is it?
What are the symptoms?
a very common disturbance of the inner ear that is caused by repeated motion
nausea
vomiting
dizziness
sweating
a sense of feeling unwell
Mal de Débarquement Syndrome (MdDS)
What is it?
a balance disorder in which a person feels as if he or she is continuously rocking or bobbing - usually occuring after a cruise/boat travel
Show me the image of the brain
