Syncope

Question 1

acronym for causes of blackouts

Answer 1

Reflex
Orthostatic hypotension
Cardiac

Question 2

Cardiac causes of blackouts

Answer 2

1. Arrhythmias
   - Stokes-Adams Attacks
   - Brady , Tachy arrhythmia
2. Structural - weak heart (LVF, tamponade), block (AS, HCM, PE)

Question 3

Reflex causes of blackouts

Answer 3

1. vasovagal
   - triggered by emotional or orthostatic stress
2. situational
   - cough, sneeze, micturition
3. carotid sinus hypersensitivity

Question 4

Orthostatic hypotension causes

Answer 4

• Volume depletion
• Drug induced
• Primary autonomic failure (eg LB Dementia or PD + ANS disturbance)
• Secondary autonomic failure (eg DM, amyloidosis)

Question 5

arterial causes of blackouts

Answer 5

• Vertebrobasilar insufficiency: migraine, TIA, CVA,subclavian steal
• Shock
• Hypertension: phaeochromocytoma

Question 6

general investigations for blackouts

Answer 6

1. lying and standing BP (>20/10 difference after 3 min → postural hypotension)
2. ECG ± 24hr ECG
3. U+E, FBC, Glucose
4. Tilt table
5. EEG, sleep EEG
6. Echo, CT, MRI brain

Question 7

Triggers for cardiogenic syncope

Answer 7

exertion, drugs, unknown

Question 8

symptoms before cardiogenic syncope

Answer 8

palpitations, chest pain, dyspnoea

Question 9

symptoms during cardiogenic syncope

Answer 9

pale, slow/absent pulse, clonic jerks may occur

Question 10

symptoms after cardiogenic syncope

Answer 10

rapid recovery

Question 11

investigations for cardiogenic syncope

Answer 11

• ECG
• 24hr ECG
• Echo

Question 12

triggers for vasovagal syncope

Answer 12

prolonged standingheatfatiguestress

Question 13

symptoms before vasovagal syncope or postural hypotension

Answer 13

• Gradual onset: secs→mins
• Nausea, pallor, sweating, tunnel vision, tinnitus
• Cannot occur lying down

Question 14

symptoms during vasovagal syncope or postural hypotension

Answer 14

• Pale, grey, clammy, brady

- Clonic jerks and incontinence can occur, but no tongue biting

Question 15

symptoms after vasovagal syncope or postural hypotension

Answer 15

rapid recovery

Question 16

investigations for vasovagal syncope or postural hypotension

Answer 16

tilt-table testing

Question 17

triggers for postural hypotension

Answer 17

standing up

Question 18

triggers for arterial causes of blackout

Answer 18

• arm elevation (subclavian steal)- migraine

Question 19

symptoms of arterial blackout

Answer 19

same as vasovagal+ diplopia, nausea, dysarthria

Question 20

investigations for arterial blackout

Answer 20

• MRA

- duplex vertebrobasilar circulation

Question 21

symptoms of hypoglycaemic syncope

Answer 21

tremor, hunger, sweating, lightheadedness→ LOC

Question 22

triggers for epileptic causes of blackout

Answer 22

flashing lightsfatiguefasting

Question 23

symptoms before epileptic blackout

Answer 23

e.g. aura in complex partial seizures – feelingstrange, epigastric rising, deja/jamias vu, smells, lights,automatisms

Question 24

symptoms during epileptic blackout

Answer 24

Tongue biting, incontinence, stiffness→jerking,eyes open, cyanosis, ↓SpO2

Question 25

symptoms after epileptic blackout

Answer 25

headache, confusion, sleeps, Todd’s palsy

Question 26

investigations for epileptic blackout

Answer 26

EEG↑ se prolactin at 10-20min

Question 27

triggers for drop attacks

Answer 27

nil

Question 28

symptoms before drop attacks

Answer 28

no warning

Question 29

symptoms during drop attacks

Answer 29

sudden weakness of legs causes older womanto fall to the ground.

Question 30

symptoms after drop attacks

Answer 30

no post-ictal phase

Question 31

Examples of primary autonomic failure

Answer 31

``` pure autonomic failure, multiple system atrophy, Parkinson's disease with autonomic failure, Lewy body dementia ```

Question 32

Examples of secondary autonomic failure

Answer 32

diabetes, amyloidosis, spinal cord injuries

Question 33

Drugs causing orthostatic hypotension

Answer 33

alcohol, vasodilators, diuretics, beta-adrenergic blockers

Question 34

Drug Rx of severe vasovagal

Answer 34

``` Fludrocortisone (Na/H2o retension) Alpha agonist (Midodrine) ```

Question 35

Driving restriction after syncope

Answer 35

Advise pt to contact DVLA and document in notes It is them to decide how long for