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    Syncope

    Uploaded by

    anishd
    This document provides a mnemonic (WOMAN 3-2-1 PE) to evaluate and classify different causes of syncope. It discusses vasovagal syncope, orthostatic hypotension, mechanical cardiac disorders, arrhythmias, neurogenic causes, and electrolyte abnormalities. For each potential cause, it outlines typical patient presentations, recommended physical exams, diagnostic tests, and treatment approaches. It also briefly discusses pulmonary embolism, psychogenic syncope, and the medication ANRI which was shown in clinical trials to reduce cardiovascular death and hospitalization for heart failure compared to enalapril.

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    © All Rights Reserved
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    Syncope

    Uploaded by

    anishd
    1K views3 pages
    This document provides a mnemonic (WOMAN 3-2-1 PE) to evaluate and classify different causes of syncope. It discusses vasovagal syncope, orthostatic hypotension, mechanical cardiac disorders, arrhythmias, neurogenic causes, and electrolyte abnormalities. For each potential cause, it outlines typical patient presentations, recommended physical exams, diagnostic tests, and treatment approaches. It also briefly discusses pulmonary embolism, psychogenic syncope, and the medication ANRI which was shown in clinical trials to reduce cardiovascular death and hospitalization for heart failure compared to enalapril.

    Original Description:

    Brief Descriptive outline of syncope - wards

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    This document provides a mnemonic (WOMAN 3-2-1 PE) to evaluate and classify different causes of syncope. It discusses vasovagal syncope, orthostatic hypotension, mechanical cardiac disorders, arrhythmias, neurogenic causes, and electrolyte abnormalities. For each potential cause, it outlines typical patient presentations, recommended physical exams, diagnostic tests, and treatment approaches. It also briefly discusses pulmonary embolism, psychogenic syncope, and the medication ANRI which was shown in clinical trials to reduce cardiovascular death and hospitalization for heart failure compared to enalapril.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    1K views3 pages

    Syncope

    Uploaded by

    anishd
    This document provides a mnemonic (WOMAN 3-2-1 PE) to evaluate and classify different causes of syncope. It discusses vasovagal syncope, orthostatic hypotension, mechanical cardiac disorders, arrhythmias, neurogenic causes, and electrolyte abnormalities. For each potential cause, it outlines typical patient presentations, recommended physical exams, diagnostic tests, and treatment approaches. It also briefly discusses pulmonary embolism, psychogenic syncope, and the medication ANRI which was shown in clinical trials to reduce cardiovascular death and hospitalization for heart failure compared to enalapril.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3
    At a glance
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    The document discusses various causes of syncope including vasovagal, orthostatic, arrhythmia, and discusses approaches to diagnosis and treatment.

    The main causes of syncope discussed are vasovagal, orthostatic hypotension, arrhythmia, neurogenic, and psychogenic causes.

    The main diagnostic tests discussed to evaluate syncope include tilt table testing, orthostatic vital sign changes, Holter monitor, event recorder, and CT/MRI imaging.

    Syncope

    Mnemonic
    WOMAN 3-2-1 PE
    VVOMAN PE
    Why do people fall over?
    To increase perfusion to the brain
    Pump, Fluid, Tank metaphor
    Vasovagal (3)
    PG:
    Vasovagal Parasympathetic discharge Cardioinhibitory
    response Bradycardia (AV node) and hypotension (Blood
    vessels)
    Stimulate vasovagal n in 3 ways:
    Visceral organs - defecation, cough, sneeze
    Carotid baroreceptors (stimulates vasovagal n) - tie/shaving
    Psychogenic causes - emotional stress
    Pt presentation
    Situational
    peeing, coughing, fight
    + Prodrome - get dizzy, nauseated, then pass out
    PE
    Carotid massage - systolic BP by 50 pts; or asystole x 3 sec
    Dx: Tilt-Table Test
    Positive if pt experiences sxs a/w BP, HR or arrhythmia while stanidng
    Tx: -blockers - blocks initial upsurge so discharge never happens
    Orthostatic (2)
    PG:
    Volume Down: (4 Ds) Dehydration, Diuresis, Diarrhea, Hemorrhage (anemia)
    Dysfunctional ANS: Elderly people, Diabetics, Parkinsons
    Other: Sepsis/Anaphylaxis/Addisons
    Pt:
    Orthostasis
    Dx: IVF - if fixes, then volume down. If not, then ANS dysfunction(more investigation)
    PE:
    Orthostatic BP;
    Laying down for 3-5 mins; Stand up for 3-5 mins to have them equilibrate
    SBP by 20; DBP by 10; HR by 10-20; or sxs (unable to finish test (not just
    dizzy))
    Tx: IVF/Re-transfuse. Steroids if that fails
    Mechanical Cardiac - Valve Disorders
    Pt: On exertion without prodrome
    PE: murmur

    Dx: Echo
    Tx: Tx underlying Mechanical Dz
    Arrhythmia
    Pt: Sudden onset; No prodrome
    PE: no finding
    Dx: EKG on trying to capture it - observe for 23 hours = Holter Monitor
    If negative, consider Event Recorder and Loop Recorder for 1 month
    Tx: AICD or Arrhythmia Meds
    Neurogenic
    Pt: Sudden onset; No Prodrome
    Super rare - only assess when r/o every other cause
    PE: sometimes will present with FND
    Dx: can get U/S of neck, but CT/MR angiogram to look at BV at back of brain
    Tx: Medical Management, Stenating/Carotid Endarterterectomy if Stenosis > 70%
    Psych
    Pt. pres: faking it
    PE: Face-palm maneuver (only if in front of you)
    Electrolytes
    Dx: BMP
    Na, Ca = AMS
    K, Mg = Arrhythmias
    Pulm Embolism - not a common consideration
    Would likely cause death, not syncope, because compromises ventricular outflow
    Dx: Wells Criteria - CT spiral or V/Q
    Electrolytes
    Pt: none
    PE: none
    OTHER Stuff
    Goal: To determine whether this is cardiogenic syncope or not. Cardiogenic syncope kills
    people.
    Syncope vs Seizure
    Both are + LOC
    Length of time to recover: Syncope = rapid return; Seizure = Post-ictal state

    ANRI
    Valsartan/Sacubitril (Angiotensin Receptor Blocker + Neprilysin Inhibior)
    used instead of ACE-i in pts with HFrEF
    SE: Angioedema, Kidney issues, Low BP, hyperkalemia, theoretical risk of dementia
    (Neprilysin inhibition amyloid plaques)
    Cost: $4650/person
    Paradigm Trail: compared valsartan/sacubitril to enalapril
    Tx with enalparil then valsartan/sacubirl then randomly assigned with long-term tx
    Trial ended early because because reduction in primary endpoint of CV death or HF
    ANRI was shown to reduce
    Endpoint of V death or hospitalization to HF

    CV Death
    First Hospitalization for worsening HF
    All cause mortality
    Mechanism:
    Valsartan xAT2 x Aldosterone vasodilation ECF volume
    Sacubitril x neprilysin (endopeptidase that degrades vasoactive peptides, including
    Natruiretic, Bradykinin, and adrenomedullin) peptides BV dilation and reduction
    of ECF volume via sodium excretion

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