Types of Syncope - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-11-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Info Types of Syncope

Hi friends
I need your help to differentiate between the following:
Situational syncope, Orthostatic syncope, Vasovagal syncope, Postural syncope, and Cardiac syncope.

Thanks
Reply With Quote Quick reply to this message



  #2  
Old 02-12-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,106 Times in 1,049 Posts
Reputation: 2126
Default

Types and Causes of syncope
Neurally-mediated reflex syncopal syndromes
_ Vasovagal faint (common faint)
_ Carotid sinus syncope
–situational faint
–acute haemorrhage
–cough, sneeze
–gastrointestinal stimulation (swallow, defaecation, visceral
pain)
–micturition (post-micturition)
–post-exercise
–others (e.g. brass instrument playing, weightlifting,
post-prandial)
_ Glossopharyngeal and trigeminal neuralgia
Orthostatic
_ Autonomic failure
–Primary autonomic failure syndromes (e.g. pure autonomic
failure, multiple system atrophy, Parkinson’s disease with
autonomic failure)
–Secondary autonomic failure syndromes (e.g. diabetic
neuropathy, amyloid neuropathy)
–Drugs and alcohol
_ Volume depletion
–Haemorrhage, diarrhoea, Addison’s disease
Cardiac arrhythmias as primary cause
_ Sinus node dysfunction (including bradycardia/tachycardia
syndrome)
_ Atrioventricular conduction system disease
_ Paroxysmal supraventricular and ventricular tachycardias
_ Inherited syndromes (e.g. long QT syndrome, Brugada
syndrome)
_ Implanted device (pacemaker, ICD) malfunction
drug-induced proarrhythmias
Structural cardiac or cardiopulmonary disease
_ Cardiac valvular disease
_ Acute myocardial infarction/ischaemia
_ Obstructive cardiomyopathy
_ Atrial myxoma
_ Acute aortic dissection
_ Pericardial disease/tamponade
_ Pulmonary embolus/pulmonary hypertension
Cerebrovascular
_ Vascular steal syndromes
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (02-12-2013), sadaf1987 (07-20-2015)
  #3  
Old 02-12-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,106 Times in 1,049 Posts
Reputation: 2126
Default

Syncope can be classified as

- Neurally-mediated (reflex syncope),
- Secondary to orthostatic hypotension or
- Secondary to cardiac causes.

1. Reflex syncope traditionally refers to a heterogeneous group of conditions in which
cardiovascular reflexes that are normally useful in controlling the circulation become
intermittently inappropriate, in response to a trigger.

2. Orthostatic intolerance syndromes are a common cause of syncope in elderly
population, and are usually secondary to autonomic failure, to the use of vasodilator
drugs or to volume depletion.

3. Arrhythmias are the most common cause of cardiac syncope, but structural
cardiovascular disease can also cause syncope in some circumstances.


Reflex (neurally mediated) syncope may be due to vasovagal syncope, which is mediated by emotional distress such as fear or physical pain. Situational syncope describes syncope that occurs with a fixed event such as micturition, deglutition, exercise induced, and carotid sinus syncope. These causes tend to be more benign and do not predict poor outcomes.
Vasovagal syncope is the most common type in young adults but can occur at any age. It usually occurs in a standing position and is precipitated by fear, emotional stress, or pain (eg, after a needlestick). Autonomic symptoms are predominant. Classically, nausea, diaphoresis, fading or "graying out" of vision, epigastric discomfort, and light-headedness precede syncope by a few minutes. Syncope is thought to occur secondary to efferent vasodepressor reflexes by a number of mechanisms, resulting in decreased peripheral vascular resistance. It is not life threatening and occurs sporadically.
Situational syncope is essentially a reproducible vasovagal syncope with a known precipitant. Micturition, defecation, deglutition, tussive, and carotid sinus syncope are types of situational syncope. These stimuli result in autonomic reflexes with a vasodepressor response, ultimately leading to transient cerebral hypotension. These are not life-threatening but can cause morbidity. The treatment involves avoidance of the precipitant when possible and the initiation of counter maneuvers when anticipated.

Syncope due to orthostatic hypotension can occur through several mechanisms. Pure autonomic failure can be associated with Parkinson's disease or dementia. Secondary autonomic insufficiency can be due to diabetes, uremia, or spinal injury. Drugs such as alcohol cause orthostatic intolerance and medications such as vasodilators and antidepressants block orthostatic reflexes. Volume depletion due to blood loss, vomiting, diarrhea, poor oral intake, and diuretics also cause orthostatic syncope.
Dehydration and decreased intravascular volume contribute to orthostasis. Orthostatic syncope describes a causative relationship between orthostatic hypotension and syncope. Orthostatic hypotension increases in prevalence with age as a blunted baroreceptor response results in failure of compensatory cardioacceleration. In elderly patients, 45% of these cases are related to medications. Limited evidence suggests that polydipsia may reduce recurrences. Orthostasis is a common cause of syncope and tends to be recurrent. Bedside orthostatics cannot exclude this as an etiology; if suspected, patients should be referred to a primary care provider for outpatient tilt-table testing.

Cardiac (cardiopulmonary) syncope may be due to vascular disease, cardiomyopathy, arrhythmia, or valvular dysfunction and predicts a worse short-term and long-term prognosis. Obtaining an initial ECG is mandatory if any of these causes are possible for the differential diagnosis.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (02-12-2013), biyaa (02-12-2013), excellence (02-28-2015), heartbeat (02-12-2013), pkul85 (12-10-2013), SOBE223 (04-24-2014), venky2600 (02-12-2013)
 
  #4  
Old 02-12-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 623
Threads: 111
Thanked 424 Times in 264 Posts
Reputation: 434
Default

Quote:
Originally Posted by Novobiocin View Post
Syncope can be classified as

- Neurally-mediated (reflex syncope),
- Secondary to orthostatic hypotension or
- Secondary to cardiac causes.

1. Reflex syncope traditionally refers to a heterogeneous group of conditions in which
cardiovascular reflexes that are normally useful in controlling the circulation become
intermittently inappropriate, in response to a trigger.

2. Orthostatic intolerance syndromes are a common cause of syncope in elderly
population, and are usually secondary to autonomic failure, to the use of vasodilator
drugs or to volume depletion.

3. Arrhythmias are the most common cause of cardiac syncope, but structural
cardiovascular disease can also cause syncope in some circumstances.


Reflex (neurally mediated) syncope may be due to vasovagal syncope, which is mediated by emotional distress such as fear or physical pain. Situational syncope describes syncope that occurs with a fixed event such as micturition, deglutition, exercise induced, and carotid sinus syncope. These causes tend to be more benign and do not predict poor outcomes.
Vasovagal syncope is the most common type in young adults but can occur at any age. It usually occurs in a standing position and is precipitated by fear, emotional stress, or pain (eg, after a needlestick). Autonomic symptoms are predominant. Classically, nausea, diaphoresis, fading or "graying out" of vision, epigastric discomfort, and light-headedness precede syncope by a few minutes. Syncope is thought to occur secondary to efferent vasodepressor reflexes by a number of mechanisms, resulting in decreased peripheral vascular resistance. It is not life threatening and occurs sporadically.
Situational syncope is essentially a reproducible vasovagal syncope with a known precipitant. Micturition, defecation, deglutition, tussive, and carotid sinus syncope are types of situational syncope. These stimuli result in autonomic reflexes with a vasodepressor response, ultimately leading to transient cerebral hypotension. These are not life-threatening but can cause morbidity. The treatment involves avoidance of the precipitant when possible and the initiation of counter maneuvers when anticipated.

Syncope due to orthostatic hypotension can occur through several mechanisms. Pure autonomic failure can be associated with Parkinson's disease or dementia. Secondary autonomic insufficiency can be due to diabetes, uremia, or spinal injury. Drugs such as alcohol cause orthostatic intolerance and medications such as vasodilators and antidepressants block orthostatic reflexes. Volume depletion due to blood loss, vomiting, diarrhea, poor oral intake, and diuretics also cause orthostatic syncope.
Dehydration and decreased intravascular volume contribute to orthostasis. Orthostatic syncope describes a causative relationship between orthostatic hypotension and syncope. Orthostatic hypotension increases in prevalence with age as a blunted baroreceptor response results in failure of compensatory cardioacceleration. In elderly patients, 45% of these cases are related to medications. Limited evidence suggests that polydipsia may reduce recurrences. Orthostasis is a common cause of syncope and tends to be recurrent. Bedside orthostatics cannot exclude this as an etiology; if suspected, patients should be referred to a primary care provider for outpatient tilt-table testing.

Cardiac (cardiopulmonary) syncope may be due to vascular disease, cardiomyopathy, arrhythmia, or valvular dysfunction and predicts a worse short-term and long-term prognosis. Obtaining an initial ECG is mandatory if any of these causes are possible for the differential diagnosis.
I think,vasovagal syncope is checked by tilt table testing not the orhtostatic hypotension ?

Does situational syncope has also autonomic symptoms before passing out
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (02-12-2013), salem (02-13-2013)
  #5  
Old 02-12-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,106 Times in 1,049 Posts
Reputation: 2126
Default

Quote:
Originally Posted by aknz View Post
I think,vasovagal syncope is checked by tilt table testing not the orhtostatic hypotension ?
Quote:
The tilt-table test is a simple, noninvasive, and informative test first described in 1986 as a diagnostic tool for patients with syncope of unknown origin.................. tilt-table testing is particularly helpful in confirmation of the etiology of syncope dysfunction of the autonomic nervous system, encompassing primary or secondary dysautonomias, postural orthostatic tachycardia syndrome (POTS), and vasodepressor or vasovagal syncope...............................Consider tilt-table testing in patients with signs or symptoms suggestive of orthostatic hypotension, vasodepressor or vasovagal syncope, postural orthostatic tachycardia, or when other causes of syncope have been eliminated.
Quote:
Originally Posted by aknz View Post
Does situational syncope has also autonomic symptoms before passing out
Not usually
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (02-12-2013), heartbeat (02-12-2013), venky2600 (05-04-2013)
  #6  
Old 02-12-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Default

Thanks my friends..Novobiocin and aknz
Very helpful..So i need to read this topic for several times to digest all the important concepts.
Reply With Quote Quick reply to this message
  #7  
Old 02-13-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,106 Times in 1,049 Posts
Reputation: 2126
Default

There is some good discussion here, here and here about this topic.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (02-13-2013), excellence (02-28-2015), heartbeat (02-13-2013), pkul85 (12-10-2013), sadaf1987 (07-20-2015), starbuckscoffee (11-14-2015), venky2600 (05-04-2013)
  #8  
Old 02-13-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 623
Threads: 111
Thanked 424 Times in 264 Posts
Reputation: 434
Default

Quote:
Originally Posted by Novobiocin View Post
There is some good discussion here, here and here about this topic.
Novobiocin you are always helping......I really appreciate you.
Best of luck
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, Clinical-Signs

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Interesting Question about Syncope tyagee USMLE Step 2 CK Forum 3 03-05-2012 02:27 PM
Most common cause of syncope Seetal USMLE Step 2 CK Forum 5 10-30-2011 10:41 AM
syncope amberafzal USMLE Step 2 CK Forum 4 09-21-2011 11:23 AM
The different types of Syncope busterbee USMLE Step 2 CK Forum 3 07-24-2011 12:59 AM
Syncope Case Homer88 USMLE Step 2 CK Forum 4 03-21-2010 02:06 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)