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Ashley's - Paramedicine III > Week 3 - Syncope / Weakness / Dizziness > Flashcards

Week 3 - Syncope / Weakness / Dizziness Flashcards

1
Q

Syncope

Syncope definition

Can they seize?

What is the pt like after the syncope?

A

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

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2
Q

Weakness

What does weakness infer?

A

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

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3
Q

Dizzy/Vertigo

What words/phrases would a pt use to describe their experience?

You should use

A

Vertigo (the illusionary sense of movement)

Weakness/fainting

Lightheadedness

Unsteadyness

OPQRST

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4
Q

CABG

A

Coronary, Artery, Bypass, Graft

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5
Q

Syncope

What are the key findings?

A

Generalized loss of blood flow to the brain (not focal)

Sudden

Brief

Transient

Fully resolved

Returns to normal neurological status

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6
Q

Faint Score

A
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7
Q

Memory Aid - BLOOD

4 Pre’s

2 Dx

3 Q’s

A

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

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8
Q

CHESS Mnemonic

A
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9
Q

San Francisco Syncope Rule

A
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10
Q

Syncope - 3 P’s

What are the 3 P’s?

What are the red flags of cardiac syncope?

A

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

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11
Q

Syncope

What are the causes?

A
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12
Q

Syncope - ECG changes

What are the ECG changes that might present during syncope?

A
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13
Q

Syncope

What other conditions may present with syncope?

A

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

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14
Q

Syncope Expected Findings

What could be the causes?

What is hypertrophic cardiomyopathy? What would the ECG have?

A

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

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15
Q

What is aortic stenosis?

What are some symptoms?

A

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

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16
Q

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

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

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17
Q

Brugada Syndrome

What is the disorder and it’s effects?

A

a genetic disorder that can cause a dangerous irregular heartbeat
the ventricles beat fast and irregularly - preventing blood from circulating correctly in your body

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18
Q

Vertebrobasilar Artery Disease/Insuffciency

What is it?

What does atherosclerosis = ?

What are plaques made of? What are their complications?

A

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

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19
Q

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?

A

10th cranial nerve

pneumogastric nerve

parasympathetic NS

sensory and motor

20
Q

By what is the heart parasympathetically controlled by?

Which side innervates the sinoatrial node?

When hyperstimulated what happens?

A

Vagus nerve

AND

Thoracic ganglia

the right vagus branch

the left vagal branch predisposes the heart to conduction block at atrioventricular node

21
Q

Vaso-vagal Syncope

Who does it affect?

What could it lead to?

A

Young children and women more than other groups

temporary loss of bladder control under moments of extreme fear

22
Q

Vaso-vagal Syncope

What happens?

A

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)

23
Q

Atropine

What is it used for?

Classification and mechanism of action?

A

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

24
Q

Micturition Syncope

Explain it to me

What’s the rare cause?

A

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

25
Q

What does the different colors of urine mean?

A
26
Q

Pheochromocytoma

What is it and what happens?

What’s a key finding?

A

a rare tumor usually arising from the adrenal medulla that causes

Secretion of extra Epinephrine & Norepinephine

orthostatic hypotension

27
Q

Postural Hypotension​

What’s the other more common name and what it is?

What are the treatments?

A

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

28
Q

Paraganglioma of the Carotid Bulb​

What is it?

A

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

29
Q

Takotsubo-like Cardiomyopathy

What is it?

Other names?

A

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

30
Q

POTS – Postural Tachycardia Syndrome ​

What is it?

Who does this affect?

A

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

31
Q

Stokes-Adams Syndrome

What is it?

A

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

32
Q

Narcolepsy​

What is it?

What are the complications and symptoms?

A

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

33
Q

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

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

34
Q

Hyperventilation

What your DDX?

12

A

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

35
Q

Dizziness Differential

Peripheral?

Central?

A

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

36
Q

Dizziness Differentials

Systemic?

A

Cardiac arrhythmia

Cardiac Valvular Disease

Orthostatic Hypotension

Alcohol Intoxication

Sleep Deprivation

Toxin Exposure

Hypoglycemia

Autonomic Dysfunction

Hyperventilation

Panic / Anxiety

37
Q

Dizziness - unsteady causes?

What are common symptoms of balance disorders?

A

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

38
Q

What are the common Balance disorders?

A
39
Q

Vertigo

What is it?

What is associated with?

What does it indicate?

A

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

40
Q

Benign Paroxysmal Positional Vertigo (BPPV)​

What is it?

Causes?

A

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)

41
Q

Labyrinthitis

What is a labyrinth and how does it work, in context to the ears?

What is labyrinthitis?

A

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

42
Q

Ménière’s Disease

What is it?

cause?

What does it do?

A

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)

43
Q

Vestibular Neuronitis

What is it?

Who does it affect?

A

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

44
Q

Perilymph Fistula

What is it?

Most notable symptoms?

A

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

45
Q

Motion Sickness - Sea Sicknes - Car Sickness

What is it?

What are the symptoms?

A

a very common disturbance of the inner ear that is caused by repeated motion

nausea
vomiting
dizziness
sweating
a sense of feeling unwell

46
Q

Mal de Débarquement Syndrome (MdDS)

What is it?

A

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

47
Q

Show me the image of the brain

A

Ashley's - Paramedicine III (16 decks)

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