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Questions and Answers
What is syncope characterized by?
What is the main difference between vasovagal syncope and psychogenic pseudosyncope?
What is the general term for the risk stratification category that includes electrolyte imbalance and anemia?
What is the treatment for syncope caused by orthostatic hypotension?
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What is the purpose of an implanted defibrillator?
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What is the difference between consciousness and wakefulness?
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What is the cause of syncope in vasovagal reflex?
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What is the term for the interaction between the ascending reticular activating system (ARAS) and the hemisphere?
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What is the term for the emotional response that leads to syncope?
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What is the term for the symptoms that occur before syncope?
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Study Notes
Consciousness and Syncope
- Consciousness requires both awareness and wakefulness, involving the interaction between the ascending reticular activating system (ARAS) and the hemisphere
- The ARAS is responsible for arousal, while the hemisphere provides content with different locations having different contents
Syncope
- Transient loss of consciousness due to hypoperfusion, which can last up to 20 seconds
- A part of a larger group of transient loss of consciousness, including status epilepticus
- Causes of syncope:
- Cardiac: arrhythmia, obstructions, and structural defects, with no damage to the nerves
- Neurological: involves neurological deficit
- Vasovagal reflex: psychogenic, triggered by pain or emotions, affecting the medullary vasomotor centre
- Situational syncope: coughing, defecating, urinating, and post-exercise
- Carotid sinus syndrome: triggered by pressure on the carotid sinus
- Psychogenic: hypotension, orthostatic, and drug-induced
- Volume depletion: dehydration and anaemia
- Autonomic failure: postural tachycardia
Symptoms and Risk Stratification
- Prodrome: dizziness, lightheadedness, visual and auditory disturbances, neurological deficit, and diaphoresis
- Risk stratification:
- High-risk: arrhythmia, electrolyte imbalance, anaemia, hypotension, and cardiac structural defects
- Low-risk: normal cardiac conditions, neurogenic or orthostatic hypotension
Management
- Leg-raise to reduce pressure on the body
- Treatment based on cause:
- Non-cardiac: vasovagal, conservative, and medication (β-blocker, SSRI, proamatine)
- Orthostatic hypotension: gradual change in position, compression stockings, rehydration, and avoiding diuretics and vasodilation
- Cardiac: pacemaker, implanted defibrillator, and supportive treatment (ECG, echocardiography, EEG, and 6-minute walk test)
Psychogenic Syncope
- Transient loss of consciousness and postural tone, followed by spontaneous recovery
- Causes:
- Vasovagal: sudden drop in heart rate and blood pressure
- Volume depletion
- Medication
- Cardiovascular: dysrhythmia and other cardiac issues
- Psychogenic panic attacks
Psychogenic Pseudosyncope
- Apparent loss of consciousness in the absence of impaired cerebral perfusion
- No changes to physiology, but manifestation of CNS pathology without lesions
- Intense neuronal firing due to cognitive function affecting organ function, triggered by psychic conflicts
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Description
Learn about the components of consciousness, including awareness and wakefulness, and understand syncope, a transient loss of consciousness due to hypoperfusion.
