Reisert: Dizziness and Syncope Flashcards Preview

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Flashcards in Reisert: Dizziness and Syncope Deck (44)
1

Having disturbed ambulation

Associated sx: 

Changes in vision

Orthostasis

....just about anything else 

Dizziness 

2

Change in blood pressure and cerebral blood flow due to transient low blood pressure 

Orthostasis 

3

Alteration in normal response to standing 

May occur with aging due to loss of vascoconstriction (With standing, blood falls to feet adn you get dizzy or pass out)

Orthostasis 

4

Lie for 10 mins, stand for at least 2 mins though response in worst case may last 10 mins

 

Test of orthostasis 

5

Fall in systolic BP > ____ mmHg

Fall in diastolic BP > ____ mmHg 

Increase in heart rate ______ beats per min

With orthostasis 

20

10

10-25

6

___% of people have orthostasis 

24%

7

Mineralcorticoids like fludrocortisone

Midodrine

Atomoxetine

Pyridostigime 

Droxidopa: new med approved 2015

Tx for Orthostasis 

8

Loss of buffers to remain conscious

Syncope prodrome 

Fainting 

9

Cardiac

Neurological

Simple (anxiety, stress)

 

Causes of syncope 

10

What is the most common type of syncope?

Simple fainting from anxiety/stress 

11

Arrythmia/dysrrhythmia

Heart block

Aortic stenosis (severe)

Medications (orthostasis)

MOST WORRISOME 

Cardiac causes of syncope 

12

Echocardiogram

Electrophysiological study 

Signal average EKG 

Cardiac syncope workup 

13

Implantable cardiac defbrillator 

Anti-arrhythmics less so 

Tx of true cardiac syncope 

14

Impaired vestibular system

May be due to disturbance of inner ear

Altered head position in space --> aleration of CN VIII

Some say room spinning or they feel like they are spinning 

Vertigo 

15

Visiual imput

Somatosensory input (skin, joints, muscles, spinal cord)

Cerebellum

Cerebrum 

Normal balance maintenance 

16

What happens to people with true syncope?

They get injured! 

17

Alerations of eye movement with oscillation to lateral gaze 

 

Nystagmus 

18

Two types of vertigo?

Physiologic 

Pathologic 

19

Abnormal input to stabilize (car sickness)

Unfamiliar head position (sea sickness)

Unusual head position (painting ceiling)

Spinning

Physiologic causes of ______?

Vertigo 

20

  • Disturbance of vision
  • Disturbance of somatosensory system
  • Disturbance of vestibular system
  • CNS tries to correct
    • Change in frequency of normal firing (homeostasis is disrupted), unequal signal results, abnormal head sensation
  • Worse with rapid head movement
  • Often nausea and ataxia

Pathological causes of _____?

Vertigo 

21

MOA of Fludrocortisone?

Causes fluid retention

22

Table that goes up in down

Indication: Patient that is having repeat syncope 

To test of orthostasis 

Tilt table test

23

What should you think of when you see a young athelete pass out on the field?

hypertrophic cardiomyopathy

24

Loss of bowel/bladder control

Bite tongue

More common in seizures or syncope?

SEIZURES!

25

Triad of aortic stenosis 

Syncope, chest pain, dyspnea

26

Most common cause of orthostatic HTN?

Dehydration!

27

Fast phase of nystagmus goes away from lesion (affected side)

Rotation goes away from affected side

Falling toward side of lesion

Patterns of vertigo 

28

2-3 beats at when look extreme left or right 

Is this normal or abnormal (mystagmus)?

Normal!

29

Acute labrynthitis

Vestibular neruitis

Causes of _____ vertigo

Idiopathic 

30

Idiopathic

Infection (HSV 1)

Trauma 

Ischemia (nausea and vomiting)

Drugs (Alcohol, Aminoglycoside antibx)

 

Causes of significant vertigo

31

Cochlear disease

Progressive hearing loss (low frequency)

Tinnitus

Dizziness

Meniere's disease 

32

Etiology unknown

Possibly infection, autoimmune, inflammatory, demyelization, tumor, trauma 

Meniere's disease 

33

Diuretics (Hydrochlorothiazide)

Very low salt restriction, <1g per day 

Tx for Meniere's Disease 

34

Unilateral hearing loss

Tinnitus

Schwannoma or meningioma 

Acoistic neuroma 

35

What CN does acoustic neuroma effect?

CN VIII

36

What is the diagnostic test of choice for Acoustic neuroma?

MRI

37

Due to changes in head position

No clear known cause

May last months

Benign Positional Vertigo 

38

What maneuver can you do to treat BPPV?

Epley maneuver

39

H&P

Orthostatic vitals

Swivel chair

Cardiac testing

Provocative tests: head shaking, Frenzel glasse

Evaluation of dizzy patient 

40

  • EKG
    • Rules out heart block
  • Echocardiogram
    • Rules out structural heart disease (cardiomyopathy)
  • Holter monitor
    • 24 hour hear monitor
    • Tape recording device
    • Good for symptomatic evaluation (palpitations) and tachycardia
  • Event monitor
    • Wear up to a month
    • Trans-telephonic transmission of data
  • Exercise stress testing (low yield)
  • Electrophysiologic study (EP study)
    • Looks for risk for Ventricular tachycardia
  • Tilt table test for orthostatic hypotension

Cardiac testing for syncope 

41

Treat cause if known

Bed rest

Vestibular rehabilitation (PT)

Medications: Vesticular suppresants (Meclizine, Dimenhydrinate, Promethazine), Benzodiazepines (Diazepam), Steroids

Epley maneuver (BPPV)

Treatment for dizziness 

42

Alteration when the vestibular sense, visual sense, and somatosensory sense are not congruent 

Sea sickness/motion sickness

43

Principle sx: nausea/vomiting

Other sx: Dizziness, salvation, diaphoresis, and malaise.

May look pale

Sea sickness/motion sickness 

44

Antihistamines like dimenhydrinate 

Anticholinergics like scopalamine

both are SEDATING 

Tx for sea sickness/motion sickness