Syncope

Question 1

Define syncope

Answer 1

• Transient LOC and postural tone

- Secondary to cerebral hypoperfusion

Question 2

What differentiates syncope from seizure?

Answer 2

Loss of tone

Question 3

What is pre/near syncope?

Answer 3

Incomplete LOC/tone with recovery to baseline

Question 4

MC causes of syncope in under 65 yo pts

Answer 4

1. Neurally mediated (35%)
2. Cardiac
3. Orthostatic

Question 5

MC causes of syncope in over 65 yo pts

Answer 5

1. Neurally mediated (44%)
2. Orthostatic
3. Cardiac

Question 6

MC causes of syncope in children

Answer 6

1. Neurally mediated (80%)
2. Cardiac
3. Psych/OD

Question 7

Define neurally mediated syncope

Answer 7

• Reflexes that control circulatory homeostasis become dysfunctional
• Causes vasodilation, bradycardia, fall in BP

Question 8

Etiology of neurally mediated syncope

Answer 8

• Vasovagal (stress, fear)
• Carotid sinus sensitivity
• Situational (cough, BM, wt lifting, etc.)

Question 9

Diagnosis of neurally mediated syncope

Answer 9

• Based on history

- Carotid sinus massage if suspicious hx

Question 10

Define orthostatic syncope

Answer 10

Abnormal fall in SBP over 20 mm Hg after standing that results in global cerebral hypoperfusion

Question 11

Etiology of orthostatic syncope

Answer 11

• Volume depletion
• Meds
• Autonomic failure
• Septic shock

Question 12

Diagnosis of orthostatic syncope

Answer 12

• Check orthostatics 2 mins after standing

- Positive: pulse increases 20-30 bpm OR SBP decreases by 20-30 mm Hg

Question 13

Define cardiovascular syncope

Answer 13

Cerebral hypoperfusion 2/2 cardiac inability to supply adequate flow

Question 14

Clinical decision making tools for syncope

Answer 14

• SF syncope rule
• ROSE rule
• OESIL

Question 15

When is tilt table testing indicated?

Answer 15

If suspect autonomic nervous system dysfunction, POTS, vasovagal syncope