Syncope

Question 1

Syncope

Answer 1

The abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery.

Question 2

Syncope is a ______ and NOT a ______

Answer 2

Symptom

Diagnosis

Question 3

Pre-Syncope

Answer 3

lightheadedness without LOC

Question 4

Drop Attack

Answer 4

loss of posture without LOC

Question 5

Seizure

Answer 5

Tonic-Clonic Movements that start WITH LOC (vs hypoxic myoclonus which can occur with syncope), post-ictal recovery period

Question 6

Vasodepressor Syncope

AKA Vasovagal/Neurocardiogenic

Answer 6

• Most common
• Pain/Noxious Stimuli
• Situational (micturation, cough, defecation)
• Carotid Sinus
• Hypersensitivity (CSH)
• Fear
• Prolonged heat exposure

Question 7

Cardiovascular Syncope

Answer 7

• Most dangerous
• Arrhythmia – Tachycardia/Bradycardia
• Mechanical – Aortic Stenosis, HOCM

Question 8

Orthostatic Hypotension Syncope

Answer 8

• Drugs: BP meds - Vasodilators, Diuretics, Alpha blockers
• Autonomic Insufficiency (Parkinsons, DM, Adrenal Insufficiency)
• Hypovolemia: Dehydration, Blood loss, infection

MOA- going from sitting to standing, blood pools in legs, low profusion to brain

Question 9

Neuro / Functional / Psychiatric -

Answer 9

Psuedosyncope

TIA or Vertibro-basilar Insufficiency

Question 10

Vasovagal-

Answer 10

Vagal tone increases, peripheral vasodilation, preload decreases and brief period of time, blood to head is low, supply of heart catches up and profuse brain adequately

Question 11

Vasodepressor Syncope is due to

Answer 11

excessive vagal tone

-Vasovagal Hypotension: Initiated by stressful, painful situation

Question 12

Situational Vasovagal Syncope: Associated with activity that may cause ________

Answer 12

increase in vagal tone

Micturation Syncope
After Defecation
Post Prandial (after eating)

Question 13

Carotid Sinus Hypersensitivity:

Answer 13

• Common in Elderly
• Sensitive Baroreceptors in Carotid body – when activated can decrease HR and drop BP = possible Syncope
• May occur with pressure on neck – tight collar, turning neck

Question 14

During syncope EKG may show

Answer 14

Large pauses (usually old patients)

Question 15

Orthostatic Syncope

Answer 15

Common in Elderly

Essentially Pooling of blood in LE – while standing or sitting up – leading to decreased Preload = Syncope

Question 16

Causes of orthostatic Syncope

Answer 16

• Autonomic Insufficiency, ex: DM Neuropathy

- Hypovolemia: Dehydration (from decreased thirst or infections) or Blood loss, Alpha Blockers, Diuretics

Question 17

Orthostatic BP Measurement:

Answer 17

• Measure same arm
• Measure while patient laying, sitting and standing
• Wait 5min between change of position

Question 18

Orthostatic BP Measurement is positive if

Answer 18

• a drop in BP of 20 mmhm or more, OR
• a drop in diastolic BP of 10 or more, OR
• pt is experiencing lightheadedness or dizziness (abnormal)

Question 19

KNOW: Diabetic neuropathy often presents as

Answer 19

orthostatic hypotension

Question 20

Mechanical causes of cariogenic syncope

Answer 20

Valvular problems (aortic or pulmonic stenosis)
Structural problems (HOCM, severe cardiomyopathy, myxoma)

Question 21

Arrhythmias that can cause cariogenic syncope

Answer 21

Tachycardia (SVT, VT, VF)

Bradycardia (Sinus, AV blocks, AV dissociation)

Question 22

During aortic stenosis, t

Answer 22

• LV outflow tract gradient secondary to stenosis of Aortic Valve (lower pressure in aorta than normal, higher pressure in LV than normal)
• Aortic Stenosis likely secondary to senile degeneration/ bicuspid aortic valve
• Syncope from Aortic stenosis= poor prognosis

Question 23

CO=

Answer 23

SV x HR

Question 24

Murmur heard with AS

Answer 24

• crescendo-decrescendo systolic ejection murmur
• LV pressure > aortic P
• Loudest at heart base
• Radiates to carotids
• Pulses are weak w/ delayed peak
• can lead to SAD: syncope, angina, dyspnea
• often age related calcification

Question 25

Hypertrophic Obstructive Cardiomyopathy

Answer 25

walls of atria, ventricles and septum are all enlarged (can lead to syncope), not pumping enough blood out bc ventricles and atria are small due to hypertrophic muscle

Question 26

SA/AV node dysfunction will show _____ on EKG

Answer 26

long pauses

Question 27

SVT (supraventricular tachycardia) will show ____ on EKG

Answer 27

narrow QRS complex

Question 28

Vasodepressor Syncope is usually associated with

Answer 28

premonitory symptoms – Nausea, Diaphoresis -Ask for activity pt was doing at the time -can use tilt table testing

Question 29

If suspecting cariogenic cause, ask

Answer 29

ask for palpitations, SOB any prior episodes

Question 30

Treatment for orthostatic syncope

Answer 30

Avoid dehydration Encourage oral hydration Volume expanders – Fludricortisone Vasoconstrictor – Midodrine

Question 31

Bradycardia Tx

Answer 31

Adjust medications | Evaluate for Pacemaker placement

Question 32

Tachycardia Tx

Answer 32

- Beta Blocker or Calcium channel blocker | - EP study or ablation if needed