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19 Cards in this Set
- Front
- Back
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Wait, what is syncope?
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a sudden, transient loss of consciousness with spontaneous recovery that is associated with a loss of postural tone and is distinct from other causes of loss of consciousness.
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What are common causes of syncope?
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Neurocardiogenic, aka vasodepressor or vasovagal syncope (fainting)
Primary arrhythmias (HR less than 35 or greater than 180), AV blocks, WPW. |
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Why do pediatrics and young patients get syncope?
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High prevalence of neurocardiogenic, conversion reaction, and primary arrhythmias (LQTS and WPW)
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Why do middle aged patients get syncope
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-Neurocardiogenic is most common
-deglutition, micturation, cough syncope -orthostasis (due to dehydration) -panic disorders |
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Why do elderly patients get syncope?
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obstructions to cardiac output which will decrease cerebral perfusion and yield a loss of consciousness. There is also a risk of pulmonary embolism.
cardiac arrhythmias occur more frequently in the elder patient and you need to look for underlying cardiac disease |
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What is the most critical part of a evaluation?
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the HISTORY. focus on the identification of syncope and if it's cardiac in origin.
The three elements of history are: -what was occuring before the even? -description of the event -orientation and level of consciousness after the event Also consider polypharmacy |
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Things to consider when thinking about history prior to the syncopal episode
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position of pt, prodromal symptoms, palpatations, chest pain, pt's activity
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Pt presentation during and after the syncopal episode
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witness report, length of time the patient was out, abnormal movements, relationship of the pt regaining consciousness and orientation
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What is the San Francisco Syncope Rule?
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It's used for predicting the risk of serious outcomes. risk factors include:
-systolic pressure less than 90mmHg -SOB -EKG non sinus rhythm/changes -hx of CHF -hematocrit level less than 30% |
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Which patients should be considered high risk? low risk?
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pts older than 60 with hx of CV disease should be considered at a high risk of an adverse outcome.
Pts younger than 45 w/o CV disease or other risk factors should be considered at low risk of adverse outcome. |
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If you are suspected with vasovagal or situational syncope, what level risk are you?
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low risk of adverse outcomes.
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What about syncope during exercise in younger patients without an obvious benign cause?
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they are at increased risk.
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Pts with evidence of CHF on physical examination are
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at high risk for adverse outcomes.
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physical exam findings of outflow obstruction is
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considered at higher risk of adverse outcomes.
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Patient with CAD and sudden death
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is directly proportional to the severity of the left ventricular dysfunction
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Syncope and V-Tach
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are associated. thanks. in regards to nonischemic dilated cardiomyopathy, the DDx of syncope should include bradycardia, tachy, orthostatic hypotension, pulmonary embolism
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What is an important cause of sudden death in young patients?
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hypertropic cardiomyopathy. occurence is 1:500 individuals. there is an outflow obstruction, so the coronary arteries aren't perfused adequately.
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When do you ADMIT a pt with syncope to the hospital?
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-history of CHF or ventricular arrhythmias
-ass'd chest pain or acute coronary syndrome -evidence of CHF or valvular heart disease on PE -EKG findings of ischemia, arrhythmia, prolonged QT, BBB |
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when do you CONSIDER admission?
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-older than 60
-hx of coronoary artery disease/CHD -family hx of unexpected/sudden death -exertional syncope in young pts. |
