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33 Cards in this Set
- Front
- Back
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what is syncope cause by?
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global hypoperfusion and focal hypoperfusion of the reticular activating system
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Things to differentiate syncope from?
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siezures, vertigo, coma, drop attacks
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Hemodynamics during syncope?
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CO drops, SVR drops, MAP drops
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4 causal agents of syncope?
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reflex mediated, cardiac, orthostatic, cerebrovascular
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Types of reflex mediated syncope?
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vasovagal syncopy (faint), carotid sinus (hypersensitivity), situational, glossopharyngeal/trigeminal neuralgia
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Primary vs secondary orthostatic syncope?
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Prim: multi system atrophy, autonomic failure
Secondary: Parkinsons, vol depletion, meds, DM/neuropathy |
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cardiac syncope?
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mechanical/structural, arrythmia, sinus node dysfunction
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Vascular steal syndrome?
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retrograde blood flow in the vertebral artery associated with subclavian occlusion/stenosis
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causes of cerebrovascular syncope?
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vertebrobasilar (TIA), vascular steal, seizure, migraine
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High risk cardiac findings in syncope?
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valve hrt dz, prior mi, prior cabg, heart failure, artificial pacemaker
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High risk brain findings in syncope?
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seizure, stroke, brain tumor, meningitis, brain injury
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most specific and sensitive ways to eval syncope?
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History and phys
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H/P of syncope the acount must include?
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circumstances surrounding the episode, precipitating factors, activity the pt was involved in prior to event, patients position when it occured, prior fainting, dizziness, light-headed, vertigo, weakness, diaphorisis
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duration of symptoms preceeding a syncopal episode?
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vasovagal: 2.5 min
arrythmia: 3 sec |
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Exstensive review of systmes should be conducted on ___ during a syncope exam?
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cardiac, neurological, metabolic, medication, psychiatric
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ROS of cardiac should include?
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murmurs, rule out cardiovascular causes, difference in pulse pressures of each arm, subclavian steal, aortic dissection
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ROS of Neuro should include?
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parkinsons, orthostatic hypotension, epilepsy, narcolepsy
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ROS of metabolic disorders should include?
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DM, hypoglcemia
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ROS of medictions should include?
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antihypertensives, antidepressants, antiarrythmias, QT prolonging agents
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Tachycardia may indicate?
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pulmonary embolism, hypovolemia, tachyarrythmia, ACS
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Bradycardia may point to?
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vasodepressor cause of syncope, cardiac conduction defect, ACS
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occurs in 70% of patients experiencing true syncope?
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dizziness, light-headed, faintness
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changes in BP and heart rate may indicate?
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orthostatic cause of syncope
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ECG abnormalities suggesting syncope?
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bifasicular block, QRS duration >0.12 sec, mobitz type 1, pre-excited QRS complex, prolonged QT interval, RBBB, neg t waves (epsilon waves)
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additional testing in syncope?
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CT, MRI, EEG, carotid ultrasonagraphy (these should be ordered when nuero exam suggests it) Holter monitor, ECG, exercise test, EP study, HUTT
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look at life threatening causes, non as well
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??
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MCC of non-life threatening syncope?
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vasovagal
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Probable seizure cause?
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CT scan, EEG if event within pas 24hrs, neuro consult
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probable cardiac syncope?
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admit to telemetry, obtain ECG, cardio consult, EP consult if: previous MI, LVEF <40%, LBBB/IVCD on ECG, Hx of recurrent VT
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Probable orthostatis syncope?
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<40: eval blood loss, eval relative hypovolemia, discharge
>40: blood loss, polypharm likely, eval for hypvol, discharge |
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Other syncopal causes above 40 below 40?
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below dischage home is H/P and ECG are unremarkable.
above consider 24 hr monitoring, if no dysrhythmias and normal ECG discharge home |
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How is global cerebral perfusion maintained?
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feedback system involving CO, SVR, arterial pressure, volume status, cerebrovascular resistance.
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Life threatening causes of syncope
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Cardiac dysrhythmias: Long QT, brady/tachy, WPW
Cardiac outflow: Cardiac ischemia PE, dissection, hemmorhage |
