Syncope

Question 1

What is syncope?

Answer 1

It is a transient loss of consciousness (TLOS) due to changes in hyperfusion, hypotension, reflex, or cardiac related.
It can have a rapid onset, with spontaneous recovery.

Question 2

What are the 3 neurally mediated syncope types?

Answer 2

1. Vasovagal: emotion, pain
2. Situational: GI stimulated, cough/sneeze, swallowing
3. Non-classical forms: without triggers

Question 3

What is carotid sinus syndrome?

Answer 3

It is the overstimulation of the carotid sinus baroreceptor (located in the neck).
Avoid tight collars.
Common in males, and falls.

Question 4

What is orthostatic syndrome?

Answer 4

It is sudden change in blood pressure due to dehydration or change in posture.
Most common in elderly, diabetics, alcoholics & Parkinson’s disease.

Question 5

How can cardiac syncope occur?

Answer 5

1. Bradycardia
2. AV blockage
3. Tachycardia of ventricular origin
4. Sudden BP drop (possible PE)

Question 6

What occurs in POTS syndrome?

Answer 6

POTS syndrome: postural tachycardia syndrome

• Increased heart rate cannot compensate for the low peripheral resistance.
• This can cause palpitations & fatigue.
• It can be due to surgery, or neurological events.

Question 7

What occurs in syncope in terms of fluid movement & BP?

Answer 7

Abrupt fall in BP can lead to cerebral hypoperfusion.

Fluid shifts & decreased blood returns to the heart.

Question 8

What is done during the initial evaluation of someone with suspected syncope?

Answer 8

1. Physical exam
2. 12 lead ECG
3. Blood tests
4. Arterial blood gases taken
5. Collateral history

Question 9

What is the carotid sinus massage & what shows a positive test for syncope?

Answer 9

Pressure is applied at the carotid split site, causing hypotension & slowness of the heart
Positive test = >3 secs of asystole and/or a decrease in BP

Question 10

What is the active standing test & what shows a positive test for syncope?

Answer 10

Patient stands still for 5 mins.

Positive test = if BP falls within 3mins.

Question 11

What is the gold standard test for neurocardiogenic syncope?

Answer 11

The tilt table test.

Question 12

What are the non-pharmacological treatments for syncope?

Answer 12

1. Avoid triggers
2. Increase fluid intake
3. Educate patient
4. Increase salt intake if patient has low heart disease risk
5. Cross legs/hand gripping/arm tensing can increase BP in syncopal attack & delay/prevent LOC.

Question 13

What are the 3 available drugs used to manage syncope?

Answer 13

1. Fludrocortisone
   - Sensitises adrenal receptors
   - 50mcg starting dose
   - Check for hyperkalaemia
2. Midodrine
   - A2 agonist
   - Most effective
3. Droxidopa
   - Improves dizziness in hypotension
   - Decreases falls