47 - Syncope

Question 1

syncope aka _____

Answer 1

fainting

Question 2

What drugs can cause syncope?

Answer 2

• antihypertensives
• alcohol
• PD (parkinson’s disease) drugs
• diuretics
• nitrates
• PDE5 inhibitors

Question 3

Describe Vasovagal syncope

Answer 3

• occurs from an upright posture held for more than 30 seconds or with exposure to emotional stress, pain or medical setting
• associated with hypotension and relative bradycardia and is followed by fatigue

Question 4

Vasovagal syncope:

Non-pharms

Answer 4

• increase salt intake (3-5g/day)
• increase fluids (up to 2.5 L/day)
• if they don’t have HTN or HF
• use physical counter-pressure maneuvers
• pacemaker therapy is convtroversial

Question 5

Vasovagal syncope:

List 4 pharmacological options

Answer 5

• Fludrocortisone
• Midodrine
• Paroxetine
• Metoprolol

Question 6

Vasovagal syncope:

When should you try Fludrocortisone?

Answer 6

if salt supplements are ineffective

*the goal of this drug is fluid retention so may precipitate HF

Question 7

Vasovagal syncope:

How does midodrine work?

Answer 7

it is an alpha agonists - so increases venous return

Question 8

Vasovagal syncope:

SSRIs are of uncertain benefit but _____ showed benefit

Answer 8

paroxetine

Question 9

Vasovagal syncope:

BBs are no longer first line. Metoprolol may be effective in patients > _____ yo

Answer 9

42

Question 10

Describe Orthostatic hypotension

Answer 10

drop in SBP > 20 mmHg or DBP > 10 mmHg when assuming an upright posture

Question 11

Orthostatic hypotension:

non-pharms

Answer 11

• remove hypotensive and volume-depleting drugs if possible
• increase salt and fluid intake if not CI
• elevate the head of the bed
• avoid hemodynamic stress (getting up too quickly, eating large meals, being in sauna/hot bath, or intensive exercise)

Question 12

Orthostatic hypotension:

List 4 pharmacological options

Answer 12

• Fludrocortisone
• MIdodrine
• Pyridostigmine
• Non-selective BBs (propranolol, timolol, nadolol)

Question 13

Orthostatic hypotension:

Midodrine can cause what?

Answer 13

supine HTN and shivering

Question 14

Orthostatic hypotension:

How does pyridostigmine work?

Answer 14

• acetylcholinesterase inhibitor

- can be given alone or in combo with midodrine

Question 15

Orthostatic hypotension:

How does BBs help with orthostatic hypotension?

Answer 15

blocks vasodilatory B2 receptors and reduces or abolish the fall in BP upon standing in patients with orthostatic hypotension

Question 16

Tips:

Use fludrocortisone if patient healthy and _____

Answer 16

normotensive

Question 17

Tips:

Use BB if patient > ____ yo

Answer 17

40

Question 18

Tips:

Use midodrine if _____ fails

Answer 18

fludrocortisone