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Questions and Answers
Which of the following is NOT a distinguishing feature of syncope?
Which of the following is NOT a distinguishing feature of syncope?
What is the main determinant of Cerebral Perfusion Pressure (CPP)?
What is the main determinant of Cerebral Perfusion Pressure (CPP)?
Why is it important to accurately diagnose the cause of syncope?
Why is it important to accurately diagnose the cause of syncope?
Which of the following scenarios can lead to syncope?
Which of the following scenarios can lead to syncope?
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What is the formula for calculating Cerebral Perfusion Pressure (CPP)?
What is the formula for calculating Cerebral Perfusion Pressure (CPP)?
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What is the most common clinically significant bradyarrhythmia that can lead to cardiogenic syncope?
What is the most common clinically significant bradyarrhythmia that can lead to cardiogenic syncope?
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Which of the following is NOT a type of neurologic cause of syncope?
Which of the following is NOT a type of neurologic cause of syncope?
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In the case of Oreo, a 10-year-old FS Miniature Schnauzer, what was the likely cause of his recurrent episodes of "falling asleep"?
In the case of Oreo, a 10-year-old FS Miniature Schnauzer, what was the likely cause of his recurrent episodes of "falling asleep"?
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Which of the following is a common structural heart disease that can lead to cardiogenic syncope?
Which of the following is a common structural heart disease that can lead to cardiogenic syncope?
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What does CPP stand for in the context of the content provided?
What does CPP stand for in the context of the content provided?
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What is the most common cause of a decreased oxygen carrying capacity, leading to neurologic syncope?
What is the most common cause of a decreased oxygen carrying capacity, leading to neurologic syncope?
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Which of the following can lead to reduced preload causing cardiogenic syncope?
Which of the following can lead to reduced preload causing cardiogenic syncope?
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Which of the following can lead to increased intracranial pressure and subsequent syncope?
Which of the following can lead to increased intracranial pressure and subsequent syncope?
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What is the most prevalent and risky type of syncope?
What is the most prevalent and risky type of syncope?
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Which of the following diagnostic tools is recommended for all cases of syncope, even if no arrhythmia is heard during auscultation?
Which of the following diagnostic tools is recommended for all cases of syncope, even if no arrhythmia is heard during auscultation?
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Which of the following breeds are at high risk for sudden death due to arrhythmogenic cardiomyopathy?
Which of the following breeds are at high risk for sudden death due to arrhythmogenic cardiomyopathy?
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What is the recommended course of diagnostic action when an underlying cause of syncope is not identified and the dog exhibits episodes of increasing frequency?
What is the recommended course of diagnostic action when an underlying cause of syncope is not identified and the dog exhibits episodes of increasing frequency?
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What is the primary reason cardiac disease leads to syncope?
What is the primary reason cardiac disease leads to syncope?
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Which of the following factors can contribute to syncopal episodes?
Which of the following factors can contribute to syncopal episodes?
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Why can a dog's frantic struggle to rise after syncope be misinterpreted?
Why can a dog's frantic struggle to rise after syncope be misinterpreted?
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Which of the following can be useful for ensuring accurate diagnosis of syncope?
Which of the following can be useful for ensuring accurate diagnosis of syncope?
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What distinguishes syncope from a seizure in terms of motor activity?
What distinguishes syncope from a seizure in terms of motor activity?
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Why can differentiating between syncope and seizure be challenging?
Why can differentiating between syncope and seizure be challenging?
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What is NOT a common symptom of syncope?
What is NOT a common symptom of syncope?
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What is the duration of cerebral anoxia that distinguishes syncope from seizure?
What is the duration of cerebral anoxia that distinguishes syncope from seizure?
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Which of these is a potential trigger for syncope?
Which of these is a potential trigger for syncope?
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What is convulsive syncope?
What is convulsive syncope?
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What is the implication of a longer duration of unconsciousness in a suspected syncope or seizure event?
What is the implication of a longer duration of unconsciousness in a suspected syncope or seizure event?
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Which of the following is NOT directly addressed by the text regarding differentiating between syncope and seizure?
Which of the following is NOT directly addressed by the text regarding differentiating between syncope and seizure?
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Which of the following is a common trigger for neurocardiogenic bradycardia?
Which of the following is a common trigger for neurocardiogenic bradycardia?
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Which of the following is NOT a structural heart disease that can lead to syncope?
Which of the following is NOT a structural heart disease that can lead to syncope?
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What type of cardiomyopathy is associated with eccentric hypertrophy?
What type of cardiomyopathy is associated with eccentric hypertrophy?
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What is the most common congenital right-to-left shunt?
What is the most common congenital right-to-left shunt?
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Which of the following is NOT a factor that can limit ventricular filling?
Which of the following is NOT a factor that can limit ventricular filling?
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What is the term used to describe a situation where blood is poorly oxygenated and bypasses the lungs?
What is the term used to describe a situation where blood is poorly oxygenated and bypasses the lungs?
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Ventricular filling is directly related to which of the following?
Ventricular filling is directly related to which of the following?
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What is the term for a situation where increased pressure in the pulmonary arteries leads to impaired ventricular filling?
What is the term for a situation where increased pressure in the pulmonary arteries leads to impaired ventricular filling?
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Which of the following is a potential cause of reduced preload?
Which of the following is a potential cause of reduced preload?
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What is the term for the condition where increased intracranial pressure can lead to syncope by affecting blood flow to the brain?
What is the term for the condition where increased intracranial pressure can lead to syncope by affecting blood flow to the brain?
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Which of the following is a risk factor for heart failure patients experiencing syncope?
Which of the following is a risk factor for heart failure patients experiencing syncope?
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Which of the following can potentially lead to a decrease in stroke volume?
Which of the following can potentially lead to a decrease in stroke volume?
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Which of the following is a common trigger for situational syncope?
Which of the following is a common trigger for situational syncope?
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Which breed is predisposed to neurocardiogenic bradycardia?
Which breed is predisposed to neurocardiogenic bradycardia?
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Which of the following conditions is associated with an increased risk of death?
Which of the following conditions is associated with an increased risk of death?
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Flashcards
Syncope
Syncope
Sudden, transient loss of consciousness with loss of postural tone.
Cerebral Blood Flow
Cerebral Blood Flow
The flow of blood in the brain, critical for consciousness.
Cerebral Perfusion Pressure (CPP)
Cerebral Perfusion Pressure (CPP)
The pressure that drives blood flow to the brain; calculated as CPP = MAP - ICP.
Mean Arterial Blood Pressure (MAP)
Mean Arterial Blood Pressure (MAP)
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Intracranial Pressure (ICP)
Intracranial Pressure (ICP)
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CPP
CPP
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Cardiogenic causes
Cardiogenic causes
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Bradyarrhythmia
Bradyarrhythmia
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Cardiogenic syncope
Cardiogenic syncope
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Tachyarrhythmia
Tachyarrhythmia
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Increased ICP
Increased ICP
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Metabolic causes
Metabolic causes
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Ventricular arrhythmias
Ventricular arrhythmias
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Convulsive Syncope
Convulsive Syncope
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Complex Partial Seizures
Complex Partial Seizures
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Minimum Data Base
Minimum Data Base
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Thoracic Auscultation
Thoracic Auscultation
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Holter Monitor
Holter Monitor
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High-Risk Breeds
High-Risk Breeds
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Cerebral Perfusion Pressure (CPP) Causes
Cerebral Perfusion Pressure (CPP) Causes
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Situational Syncope
Situational Syncope
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Transient Hypoperfusion
Transient Hypoperfusion
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Seizure Characteristics
Seizure Characteristics
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Prodromal Symptoms
Prodromal Symptoms
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Duration of Symptoms
Duration of Symptoms
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Recovery Patterns
Recovery Patterns
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Differentiating Syncope and Seizure
Differentiating Syncope and Seizure
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Arrhythmogenic right ventricular cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
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Pulmonary hypertension
Pulmonary hypertension
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Structural heart disease
Structural heart disease
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Dilated cardiomyopathy (DCM)
Dilated cardiomyopathy (DCM)
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Hypertrophic cardiomyopathy (HCM)
Hypertrophic cardiomyopathy (HCM)
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Obstructive lesions
Obstructive lesions
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Right to left shunting
Right to left shunting
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Tetralogy of Fallot
Tetralogy of Fallot
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Neurocardiogenic bradycardia (NCB)
Neurocardiogenic bradycardia (NCB)
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Left ventricular filling
Left ventricular filling
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Cardiac output (CO)
Cardiac output (CO)
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Inadequate ventricular filling
Inadequate ventricular filling
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Cerebral perfusion
Cerebral perfusion
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Study Notes
Syncope
- Syncope is a sudden, temporary loss of consciousness caused by a drop in blood pressure and a decrease in cerebral blood flow
- The loss of consciousness is associated with a loss of postural tone, and recovery is usually spontaneous
- Syncope is a serious clinical sign that may indicate a serious cardiac problem
- It can lead to injuries and distress for owners
Learning Objectives
- Define syncope and its features
- Understand the pathophysiology of syncope
- Identify differential diagnoses of syncope
- Develop a plan for patient evaluation of syncope
Syncope Defined
- Sudden, transient loss of consciousness
- Spontaneous recovery
- Important because could be a premonitory sign of a serious cardiac problem
- Can impact quality of life
- Can lead to injuries
- Difficult to treat without clear cause of the event
- 33-50% dogs, 25-42% of people with syncope are discharged without diagnosis
CPP = MAP - ICP
- Cerebral perfusion pressure (CPP) is a critical determinant for cerebral blood flow
- CPP is determined by mean arterial pressure (MAP) and intracranial pressure (ICP)
- A reduction in CPP can trigger syncope, which may be due to a decreased MAP or increased ICP
Cardiogenic, Non-cardiogenic and Metabolic Syncope
- Cardiogenic: Reduced cardiac output (CO)
- Arrhythmias (brady/tachy)
- Reduced preload (Cardiac Tamponade, Hypovolemia)
- Structural heart disease (Cardiomyopathy, Congenital Heart Disease)
- Non-cardiogenic: Increased ICP (intracranial pressure)
- Cerebral edema
- Brain tumors
- Inflammation
- Vascular obstruction
- Metabolic: Changes in oxygen or nutrient delivery unrelated to perfusion
- Anemia
- Hypoglycemia
- Other conditions like seizures and weakness
Cardiogenic (Reduced Cardiac Output)
- Arrhythmias (bradycardia, tachycardia)
- Reduced preload (Cardiac tamponade, Hypovolemia)
- Structural heart disease (Cardiomyopathy, Congenital Heart Disease)
Bradyarrhythmia Leading to Syncope
- A pause in cardiac rhythm greater than 6-8 seconds can lead to loss of consciousness
- Fixed, low heart rate can cause syncope with exertion
- Decreased heart rate results in decreased cardiac output
- Decreased stroke volume
Bradyarrythmia Presenting Information
- Oreo, 10-year-old Miniature Schnauzer presented to ER with recurrent episodes of "falling asleep"
- The two ECGs show bradycardia
Tachyarrhythmia
- Brutus, 9 year old MN Boxer
- Owner reports he plays too hard and falls over
- His ECG and Holter monitor show tachycardia
How to Diagnose Syncope
- Historical findings
- Physical examination
- Step-wise diagnostic plan
Historical Findings (Example Questions)
- What was the animal doing just before the event occurred?
- How long did the event last?
- Did the animal lose consciousness during the event?
- Did the animal have motor activity during the event?
- Is the animal currently taking medication?
- Has the animal shown any unusual behavioral changes recently?
Transient Loss of Consciousness vs. Seizure
- Syncope: Characterized by a sudden loss of consciousness, associated with loss of postural tone and rapid recovery of normal mentation
- Seizure: Physical manifestations of abnormal, excessive cerebral electrical activity with varying degrees of behaviors (jerking, stiffening)
- Duration of cerebral anoxia can help distinguish between syncope and seizure
- <5 seconds usually suggestive of syncope
- 5-15 seconds can be either syncope or seizure, further evaluation needed -> >15 seconds likely a seizure
Syncope vs. Seizure (Differentiation Difficulties)
- Convulsive syncope
- Complex partial seizures
- History can be misleading
- Encouraging owners to video episodes helpful
Physical Examination/Diagnostics
- Careful physical examination, thoracic auscultation, ECG, possibly thoracic radiographs, etc
- Determine the presence of heart disease
Diagnostic Plan (Minimum Database)
- Blood pressure measurement
- PCV/TS, glucose
- Urine specific gravity
- Chemistry panel (BUN/creatinine, glucose, potassium)
- 24-hour ambulatory ECG (Holter monitor)
Diagnostic Plan (Additional Diagnostics)
- Breeds at risk for sudden death from arrhythmogenic cardiomyopathy (e.g., Boxer dogs, Doberman pinschers)
- Breed predisposed to tachy/bradyarrhythmias (e.g., Labrador Retrievers and some spaniel breeds)
- Exertional syncope
- Increasing frequency episodes
- Dogs that do not return to normal between episodes
Cardiac Tamponade Resulting in Reduced Preload
- This happens when fluid collects around the heart, reducing the space the heart has to fill
- The condition will reduce the preload
Pulmonary Hypertension Leads to Reduced Preload
- Increased pressure in pulmonary arteries strains right ventricle
- Decreased CO due to impairment of left ventricular filling
Structural Heart Disease: Cardiomyopathies
- Dilated Cardiomyopathy (DCM)
- Eccentric hypertrophy, poor systolic function, reduced contractility
- Hypertrophic Cardiomyopathy (HCM)
- Concentric hypertrophy, reduced LV filling space, reduced compliance
Structural Heart Disease: Obstructive Lesions
- Left obstructions: Aortic stenosis, Intracardiac tumors, dynamic outflow obstructions (SAM with HCM)
- Increase afterload
- Right obstructions: Pulmonary valve stenosis, Heartworm disease, pulmonary thromboembolism
- Decrease venous return
Congenital Right-to-Left Shunting
- Communication between the right and left sides of the heart, causing a direction of blood flow to bypass the lungs
- Oxygen-depleted (poorly oxygenated) blood enters the systemic circulation causing desaturation of the systemic circulation,
- Desaturated hemoglobin (hypoxia)
- Sludgy blood (polycythemia)
Neurally Mediated Reflexes
- Benign Conditions where cardiovascular reflexes respond to a stimuli leading to sudden drop in blood pressure
- Neurocardiogenic Bradycardia
- Extreme excitement, exercise, emotional stress
- Situational Syncope
- Events that stimulate vagus nerve stimulation (cough, urination, defecation)
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Description
Test your knowledge on the distinguishing features of syncope, its causes, and its relation to cerebral perfusion pressure. This quiz covers important concepts regarding neurological and cardiogenic aspects of syncope, as well as relevant clinical scenarios. Dive into the critical determinants and consequences of this medical condition.