Cardiovascular Syncope Management

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is facilitated with finometry?

Carotid sinus syndrome diagnosis

Surgical implantation of a pacemaker

Continuous non-invasive beat-to-beat blood pressure monitoring (correct)

Invasive blood pressure monitoring

What is indicated if a patient is cardio-inhibitory?

Abdominal binders and compression stockings

Ambulatory blood pressure monitoring

Head-up tilt sleeping

A pacemaker (correct)

What can help aid venous return if venous pooling is an issue?

Abdominal binders and compression stockings (correct)

Finometry

Head-up tilt sleeping

A pacemaker

What is an important risk modification to consider in older adults?

Implementing head-up tilt sleeping Signup and view all the answers

What can identify nocturnal hypertension?

Ambulatory blood pressure monitoring Signup and view all the answers

What is a useful test in patients with dual diagnoses of OH and hypertension?

Ambulatory blood pressure monitoring Signup and view all the answers

What is the duration of vertigo typically associated with psychogenic causes?

Years Signup and view all the answers

What does a positive skew test in a HINTS test indicate?

Central cause of vertigo Signup and view all the answers

Which of the following is a characteristic of a patient with nystagmus and a peripheral cause of vertigo?

Nystagmus in one direction, no skew, and a positive head impulse test Signup and view all the answers

What is the primary purpose of the HINTS examination?

To distinguish between central and peripheral causes of vertigo Signup and view all the answers

What is the difference between vertigo and dizziness?

Vertigo is a false sense of motion, while dizziness is not necessarily a false sense of motion Signup and view all the answers

What is the primary challenge in taking a history of a patient with vertigo?

Difficulty in obtaining accurate information due to the patient's symptoms Signup and view all the answers

What is the primary purpose of identifying nocturnal hypertension in patients with OH?

To evaluate the effectiveness of pharmacologic treatments Signup and view all the answers

What is the recommended approach for evaluating carotid sinus syndrome in patients over 40 years old?

Carotid sinus massage with passive upright tilting if initial results are negative Signup and view all the answers

What is the primary distinguishing feature of central vertigo compared to peripheral vertigo?

Sudden onset of symptoms Signup and view all the answers

What is the recommended investigation for a patient with a new cardiac murmur in the aortic area?

Echocardiogram to evaluate structural cardiac causes Signup and view all the answers

What is the purpose of carotid sinus massage in evaluating reflex syncope?

To identify carotid sinus syndrome Signup and view all the answers

What is the characteristic of syncope in patients with carotid sinus syndrome?

Syncope accompanied by asystole lasting longer than 3 seconds Signup and view all the answers

What is the recommended approach for evaluating a patient with syncope of unknown origin?

Initial investigations to rule out high-risk cardiac causes Signup and view all the answers

What is the purpose of taking a patient history in evaluating vertigo?

To rule out central or peripheral causes of vertigo Signup and view all the answers

What is the characteristic of reflex syncope in patients over 40 years old?

Syncope accompanied by a normal physical examination and ECG Signup and view all the answers

What is the recommended investigation for a patient with an abnormal ECG revealing a conduction abnormality?

In-hospital cardiac monitoring with external loop recorders Signup and view all the answers

Study Notes

Blood Pressure Monitoring

Continuous non-invasive beat-to-beat blood pressure monitoring can be facilitated with finometry, which involves a device placed on the arm.
This allows for more frequent blood pressure monitoring.

Reflex Syncope

Reflex syncope should be considered in the absence of heart disease and with head rotation or carotid sinus pressure.
Carotid sinus syndrome is a type of reflex syncope associated with neck movements like head turning, shaving, tight collars, etc.
All patients over 40 years of age who experience syncope of an unknown origin should be evaluated for carotid sinus syndrome (CSS) with carotid sinus massage (CSM).
Carotid sinus pressure or head rotation, which may be brought on by tumors, shaving, or tight collars, or turning the head, are CSS triggers.
CSS can be identified by a carotid sinus massage lasting 10 seconds that results in syncope accompanied by asystole lasting longer than 3 seconds and/or a drop in systolic blood pressure of more than 50 mm Hg.

Diagnosis and Treatment

Abdominal binders and compression stockings can help aid venous return if venous pooling is an issue.
Head-up tilt sleeping helps avoid nocturnal hypotension.
An ambulatory blood pressure monitor (ABPM) is a useful test in patients with dual diagnoses of OH and hypertension.
An ABPM can identify nocturnal hypertension which can especially occur with pharmacologic treatments for OH.

Vertigo

Vertigo is a false sense of motion and perhaps a sensation of spinning.
Vertigo is categorized as peripheral or central.
Vertigo is not a phobia of heights and is not necessarily dizziness.
The HINTS examination is a test that carefully assesses eye movements to determine if vertigo is of a central cause, such as a stroke, or a peripheral cause, such as vestibular neuronitis.

HINTS Test

A worrying HINTS test that suggests a central cause for vertigo is either bidirectional nystagmus, a positive skew test, or a negative head impulse test.
In a person with nystagmus, a HINTS test would have nystagmus in one direction, no skew, and a positive head impulse test.

Orthostatic Hypotension (OH)

Even though a case initially suggests orthostatic hypotension, initial investigations must be carried out to rule out high-risk cardiac causes.
If a new cardiac murmur was detected in the aortic area during physical examination, a structural cardiac cause like aortic stenosis would have to be considered and an echocardiogram would be appropriate.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the management of cardioinhibitory and vasodepressive mechanisms in reflex syncope and orthostatic hypotension. It includes topics such as finometry, tilt testing, and pacemaker indications. Test your knowledge of cardiovascular syncope management!