Syncope and Syncopal Prodrome

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Questions and Answers

What is the primary goal of pharmacologic interventions in the treatment of cardiac disease?

To increase orthostatic tolerance

To alleviate intractable symptoms

To reduce cardiac output

To improve cardiac function (correct)

Which of the following agents is NOT used to increase orthostatic tolerance?

Erythropoietin

Fludrocortisone acetate

Pyridostigmine

Warfarin (correct)

What is the primary distinction between delirium and dementia?

Underlying etiology

Severity of cognitive impairment

Type of cognitive abilities affected

Duration of symptoms (correct)

What is the primary difference between vertigo and light-headedness?

Vertigo is a sense of rotation, while light-headedness is a pre-syncopal sensation Signup and view all the answers

What is the primary characteristic of confusion?

Reduced comprehension and coherence Signup and view all the answers

What is the primary distinction between dizziness and vertigo?

Dizziness is an imprecise symptom, while vertigo is a specific sensation Signup and view all the answers

What is the primary reason for hospitalization or intensive evaluation of syncope?

Presence of high-risk features Signup and view all the answers

What is the most common hallmark of a generalized seizure?

Tonic-clonic movements Signup and view all the answers

What is the primary purpose of measuring blood pressure and heart rate in a patient with syncope?

To determine the presence of orthostatic hypotension Signup and view all the answers

What is the primary benefit of raising the head of the bed in the management of syncope?

Reduces supine hypertension Signup and view all the answers

What is the primary indication for performing an ECG in a patient with syncope?

Suspicion of syncope due to an arrhythmia Signup and view all the answers

What is the primary purpose of patient education in the management of syncope?

To instruct about staged moves from supine to upright Signup and view all the answers

What is the primary difference between syncope and seizure in terms of loss of consciousness?

Loss of consciousness in seizure lasts longer than 5 minutes Signup and view all the answers

What is the primary goal of non-pharmacologic interventions in the management of syncope?

To expand intravascular volume Signup and view all the answers

What is the primary pathology underlying syncope?

Transient global impairment of cerebral blood flow Signup and view all the answers

What is the primary difference between syncope and seizures?

Causes of loss of consciousness Signup and view all the answers

What is the typical presyncopal symptom in syncope?

Dizziness or lightheadedness Signup and view all the answers

Which of the following is a characteristic of orthostatic hypotension?

Reduction in systolic blood pressure of at least 20 mmHg Signup and view all the answers

What is the primary mechanism underlying neurally mediated syncope?

Episodic vasodilation (or loss of vasoconstrictor tone) and bradycardia Signup and view all the answers

What is the primary cause of cardiac syncope?

Arrhythmias and structural heart disease Signup and view all the answers

What is the primary characteristic of bradyarrhythmias that cause syncope?

Severe sinus node dysfunction Signup and view all the answers

What is the primary benefit of tilt table testing in orthostatic hypotension?

Diagnosis of orthostatic hypotension Signup and view all the answers

Study Notes

Syncope

Transient, self-limited loss of consciousness due to acute global impairment of cerebral blood flow
Onset is rapid, duration is brief, and recovery is spontaneous and complete
Must be distinguished from other causes of transient loss of consciousness, such as seizures, vertebrobasilar ischemia, and hypoxemia

Syncopal Prodrome (Presyncope)

Common, but may not always occur
Typical symptoms include dizziness, lightheadedness, faintness, weakness, fatigue, and visual and auditory disturbances

Causes of Syncope

Divided into three categories:
- Neurally mediated syncope (vasovagal syncope)
- Orthostatic hypotension
- Cardiac syncope

Neurally Mediated Syncope (Vasovagal Syncope)

Heterogeneous group of reflexes causing episodic vasodilation and bradycardia
Results in temporary failure of blood pressure control
Includes peripheral chemoreceptor system for control of respiratory activity

Orthostatic Hypotension

Defined as a reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within 3 min of standing or head-up tilt on a tilt table
Characteristic symptoms include lightheadedness, dizziness, and presyncope (near-faintness) occurring in response to sudden postural change
Tilt table testing can be used to diagnose

Cardiac Syncope

Caused by arrhythmias and structural heart disease
Arrhythmias include bradyarrhythmias and ventricular tachyarrhythmias
Structural heart disease includes hypertrophic obstructive cardiomyopathy and aortic stenosis

Approach to the Patient with Syncope

Initial evaluation should include a detailed history, thorough questioning of eyewitnesses, and a complete physical and neurologic examination
Blood pressure and heart rate should be measured in the supine position and after 3 min of standing to determine whether orthostatic hypotension is present
An ECG should be performed if there is suspicion of syncope due to an arrhythmia or underlying cardiac disease

Diagnosis and Treatment

Syncope is easily diagnosed when characteristic features are present
Diagnostic confusion can occur with seizure, tonic-clonic movements, incontinence of urine, and tongue biting
Treatment of cardiac disease depends on the underlying disorder and may include nonpharmacologic interventions, pharmacologic interventions, and physical countermeasures

Other CNS Manifestations

Confusion: a mental and behavioral state of reduced comprehension, coherence, and capacity to reason
Delirium: an acute confusional state
Dizziness: an imprecise symptom used to describe a variety of sensations, including vertigo, light-headedness, faintness, and imbalance
Vertigo: a sense of spinning or other motion
Dementia: an acquired deterioration in cognitive abilities that impairs the successful performance of activities of daily living

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Description

Learn about the symptoms and characteristics of syncope, a transient loss of consciousness, and its precursor syncopal prodrome. Understand the differences between syncope and other conditions.