10 terms
MedConversations

Approach to syncope

STUDY
PLAY
What is syncope?
Transient LOC with loss of postural tone (ie unconscious collapse) with spontaneous return to baseline
What is the mechanism of syncope?
Global hypoperfusion of both the cerebral cortices or focal hypoperfusion of the reticular activating system.
Broad causes of syncope
Neurocardiogenic (or reflex)
Orthostatic
Cardiac
Does HR go up or down in neurocardiogenic syncope?
Down (it's usually a vaso-vagal response - mediated by parasympathetics)
Does HR go up or down in orthostatic syncope?
Up
Causes of orthostatic syncope?
1. Primary Autonomic failure (for example, Parkinson's Disease)
2. Secondary: autonomic peripheral neuropathies - (common in diabetes)
3. Iatrogenic
4. Volume depletion
Causes of cardiac syncope?
1. Arrhythmias: eg. bradycardia, VT, brugada and other inherited chanelopathies...pacemaker dysfunction
2. Structural issues: eg. HOCM, valvular disease
Principles of history-taking in syncope - what four parts of the story do you need to find out about?
Background (FHx, PHx)
Before
During
After
What red flags on history are suggestive of cardiac syncope?
Background: risk factors
Before: exertional, chest pain, supine, no warning/prodrome
After: instantaneous recovery
What red flags on history are suggestive of seizure?
Background: PHx epilepsy, not taking medications, precipitants that lower seizure threshhold (eg. no sleep, alcohol withdrawal)
Before: prodrome
During: tonic phase before rhythmic, clonic activity, head deviation or unusual posturing during the episode, loss of bladder or bowel control
After: tongue biting, postictal confusion/disorientation (usually >30min)
YOU MIGHT ALSO LIKE...
22 terms
Syncope
40 terms
Patho II wk 1
54 terms
EMT Chap 15 Neurologic Emergencies 2012
54 terms
EMT Chap 15 Neurologic Emergencies 2012