12. MTB Step 3 - Syncope Evaluation

Question 1

SYNCOPE EVALUATION

What are the (3) Criteria that the Management of Syncope is based on?

Answer 1

1. Loss of Consciousness:
   
   • ​​Sudden vs. Gradual
2. Regaining Consciousness:
   
   • ​​Sudden vs. Gradual
3. Cardiovascular Exam:
   
   • ​​Normal vs. Abnormal

*SEE PICTURE FOR FLOWCHART*

Question 2

SYNCOPE EVALUATION

What are (6) Exams that should be performed on Syncope Evaluation?

Answer 2

1. Cardiovascular and Neurological exams
2. ECG
3. Cardiac Enzymes (Troponins, CK-MB)
4. Chemistries (glucose)
5. Oximeter
6. CBC

Question 3

SYNCOPE EVALUATION

How should you Manage the Special Circumstance of Syncope + MURMUR?

Answer 3

Echocardiogram

Question 4

SYNCOPE EVALUATION

How should you Manage the Special Circumstances of Syncope + FOCAL NEUROLOGIC FINDINGS?

Answer 4

CT Scan Head

Question 5

SYNCOPE EVALUATION

How should you Manage the Special Circumstances of Syncope + HEAD TRAUMA DUE TO SYNCOPE?

Answer 5

CT Scan Head

Question 6

SYNCOPE EVALUATION

How should you Manage the Special Circumstances of Syncope + HEADACHE?

Answer 6

CT Scan Head

Question 7

SYNCOPE EVALUATION

How should you Manage the Special Circumstances of Syncope + SEIZURE (described or suspected)?

Answer 7

CT Scan Head

and

EEG

Question 8

SYNCOPE EVALUATION

What is the Mechanism of Syncope caused by a Brainstem Stroke only?

Answer 8

• The brainstem controls sleep and wake in the brain.
• Only stroke or TIA of the posterior circulation can cause syncope.
• Vertebral/basilar circulation is synonymous with the posterior or brainstem circulation.
• There is no place in the circulation of the middle cerebral artery that can cause syncope.

Question 9

SYNCOPE EVALUATION

If the Diagnosis is NOT clear after moving the clock forward to obtain the initial results, what are (6) Tests that should be done on Further Management?

Answer 9

1. Holter Monitor (outpatients)
2. Telemetry (inpatients)
3. Repeat CK-MB & Troponins 4 hours after initial
4. Urine & Blood Toxicology screens
5. TILT TABLE Testing to diagnose Neurocardiogenic (Vasovagal) Syncope
6. ELECTROPHYSIOLOGIC Testing

Question 10

SYNCOPE EVALUATION

What Percentage of Mortality from Syncope is from Cardiac causes?

Answer 10

> 80%

The most important thing to do in Syncope is to EXCLUDE a Cardiac cause (i.e., Arrhythmia)

Question 11

SYNCOPE EVALUATION

TREATMENT

What is the Treatment if a Ventricular Dysrhythmia is diagnosed as the cause of Syncope?

Answer 11

Implantable Cardioverter/Defibrillator

Question 12

SYNCOPE EVALUATION

DIAGNOSIS

Which (4) Diagnostic Test should you order for Syncope?

Answer 12

1. ECG
2. Troponin, CK-MB
3. Echocardiogram
4. Head CT