Syncope

Question 1

What is a general definition of syncope?

Answer 1

• sudden loss of consciousness and postural tone due to insufficient blood supply to the brain

Question 2

What are some causes of syncope?

Answer 2

Vasovagal:

Cardiac: arrhythmias, organic heart disease, aortic stenosis, myocardial ischaemia

Question 3

What is a prodrome?

Answer 3

• what the patient noticed immediately prior to the event

Question 4

What is a colateral history?

Answer 4

A witness’ account of the event useful if the patient cannot recall or was not conscious for a part/all of the occurence

Question 5

What are some important elements of the cardinal features to ask about syncope?

Answer 5

• Prodrome
• Quality
• Time Course
• Precipitating Factors
• Relieving Factors
• Associated Features
• Period after the event
• Past History
• Colateral History

Question 6

How would you differentiate between a vasovagal syncope and a cardiac syncope based on prodrome?

Answer 6

Vasovagal: feeling light-headed, wobbly legs, vision going dim/blurry, noises sounding distant; may remember the beginning of the collapse

Cardiac: usually not present/lack of prodrome

Question 7

How would you differentiate between a vasovagal syncope and a cardiac syncope based on Quality?

Answer 7

Vasovagal & Cardiac: Loss of postural tone; convulsive movements can occur although usually only a few jerks

Question 8

How would you differentiate between a vasovagal syncope and a cardiac syncope based on Time Course?

Answer 8

Vasovagal & Cardiac: usually less than 30 seconds of unconsciousness

Question 9

How would you differentiate between a vasovagal syncope and a cardiac syncope based on Context?

Answer 9

Vasovagal: usually doesn’t occur when sitting or lying

Cardiac: Can occur at any time

Question 10

How would you differentiate between a vasovagal syncope and a cardiac syncope based on Precipitating factors?

Answer 10

Vasovagal: fasting, pain, emotional events, prolonged standing, heat etc.

Cardiac: Not usually a clear precipitating factor (may be pathological)

Question 11

How would you differentiate between a vasovagal syncope and a cardiac syncope based on Associated features?

Answer 11

Vasovagal & Cardiac: Sweaty, pallor, no frothing at the mouth, incontinence of urine may occur although this is not common

Question 12

How would you differentiate between a vasovagal syncope and a cardiac syncope based on Period after the event?

Answer 12

Vasovagal & Cardiac:

• rapid recovery
• rarely confused afterwards
• injury may have occured (if protective relfexes are preserved, they could be faking)

Question 13

How would you differentiate between a vasovagal syncope and a cardiac syncope based on past history?

Answer 13

Vasovagal: may have encountered syncopal evnts before

Cardiac: cardiac disease; risk factors

Question 14

How would a seizure differ from syncopal events?

Answer 14

• common during seizure for incontinence of urine to occur

- recovery is not always fast after a seizure and confusion may occur immediately after the event

Question 15

What is the genera layout for a full medical history?

Answer 15

1. Intoduction & Permission
2. Name (What do you prefer to be called?), Age, Occupaton
3. Opening Question
4. Cardinal Features (3&4 are the history of presenting complaint)
5. PMHx
6. Medications
7. Allergies
8. FHx
9. Social Hx