Syncope

Question 1

Pathophysiology of vasovagal episode

Answer 1

1. Vagus nerve receives a strong stimulus → + PNS
2. PNS causes cerebral vessels to dilate → BP in cerebral circulation drops
3. Hypoperfusion to brain tissue → syncope

Question 2

List 4 triggers of a vasovagal response

Answer 2

1. emotional event
2. painful sensation
3. change in temperature
4. sight of blood

Question 3

List 4 prodromal signs and symptoms of syncope

Answer 3

1. Hot or clammy
2. Sweaty
3. Heavy
4. Dizzy or lightheaded
5. Vision going blurry or dark
6. Headache

Question 4

How may a witness describe a patients episode of syncope?

Answer 4

1. Suddenly losing consciousness and falling to the ground
2. Unconscious on the ground for a few seconds to a minute
3. May be some twitching, shaking or convulsion activity, can be confused with a seizure

Question 5

List 4 causes of Primary syncope (simple fainting)?

Answer 5

1. Dehydration
2. Missed meals
3. Extended standing in a warm environment
4. Vasovagal response to a stimuli

Question 6

List 4 secondary causes of syncope

Answer 6

1. Hypoglycaemia
2. Dehydration
3. Anaemia
4. Infection
5. Anaphylaxis
6. Arrhythmias
7. Valvular heart disease
8. Hypertrophic obstructive cardiomyopathy

Question 7

List 6 comparisons of a syncope episode vs a seizure

Answer 7

Question 8

List 4 things we must examine following an episode of syncope

Answer 8

1. Physical injuries?
2. Concurrent illness eg. infection or gastroenteritis?
3. Neurological and cardiac examination
4. Lying and standing BP

Question 9

Management of a confirmed simple vasovagal episode

Answer 9

Reassurance and simple advice to:

1. Avoid dehydration
2. Avoid missing meals
3. Avoid standing still for long periods
4. When experiencing prodromal symptoms, have some water or something to eat and wait until feeling better