Evaluation
Broken hearts
Causes
Cases
Cases
Spinning
100
These tests are indicated when the suspected etiology of the syncope is cardiac.
What is echocardiography, prolonged electrocardiographic monitoring, stress testing, and/or electrophysiologic study and implantable loop recorder.
100
These tests are indicated when the suspected etiology of the syncope is cardiac.
What is echocardiography, prolonged electrocardiographic monitoring, stress testing, and/or electrophysiologic study and implantable loop recorder.
100
Name the leading diagnosis.
45yo truck driver who cannot drive.
•Severe “dizziness” for 2 days
•Nauseas and vomiting, Whenever he opens his eyes, feels like everything is moving, Prefers to lie still with eyes closed, Recent URI, No hearing loss or tinnitus
Exam:
•HEENT: TMs normal
•CV: RRR, no murmurs
•Neuro:
•Spontaneous unilateral nystagmus to right
•Gait—veers toward the left but can walk
What is vestibular neuritis
100
What are the two broad categories of vertigo?
What is peripheral and central?
Slide 11
200
This test should be ordered on all patients with syncope.
What is an EKG.
200
Name the side effect of these drugs that can cause a potentially lethal reason for syncope.
- A – AntiArrhythmics (Amiodarone, Sotalol, Flecainide)
- A – AntiAnginals (Ranolazine)
- B – AntiBiotics (Fluoroquinolones, Macrolides, Aminoglycosides)
- C – AntiCychotics (Haloperidol, Quetiapine, Risperidone)
- D – AntiDepressants (SSRIs, TCAs)
What is prolonged QT syndrome and/or torsades
200
15 year old missing school for dizzy spells
•Describes as spinning sensation, often triggered by movement, Lasts hours, sometimes days, Associated with nausea and vomiting and photophobia, Often seems to occur around time of menstruation.
•PMH: Chronic headaches
•Meds: NSAIDs, APAP as needed
•FH: Migraines in mother, CVA in grandmother
•PE: No abnormal findings including neurologic exam and gait
What is a vestibular migraine.
200
Name and describe the four broad categories of "dizziness."
What is
1. presyncope – feeling of passing out.
2. Vertigo – false sense of motion.
3. Dysequilibrium – feeling of imbalance.
4. Non-specific dizzness (sometimes referred to as lightheadedness) often a vague description from patients, can be from psychiatric causes
slide 14
300
Define orthostatic hypotension.
Orthostatic hypotension is defined as a drop in blood pressure of at least 20 mm Hg systolic or 10 mm Hg diastolic within three minutes of standing.
Primary: Multiple system atrophy; pure autonomic failure; Parkinson’s disease
300
Name the most common cause of syncope and the most common cause of cardiac syncope.
What is vasovagal and arrhythmias.
*tele
300
Name the most concerning etiology of syncope.
Cardiac (structural or electrical)
300
These physical exam tests might help differentiate vertigo of vestibular neuritis from a CVA.
What are HINTS
Head impulse-Nystagmus-Test-of-Skew
Nystagmus that is bidirectional, purely vertical or purely torsional is concerning for stroke. Skew deviation (supranuclear vertical eye misalignment, or vertical strabismus) is assessed with the cover/uncover test. Any patient with one or more of these signs should be evaluated for stroke. Using HINTS, stroke can be detected 100% sensitivity and 96% sensitivity.
400
This is the most well validated clinical decision making tool/calculation for serious outcomes in syncope patients.
What is the San Francisco Syncope Rule (SFSR)
Predicts “serious outcome” (death, MI, arrhythmia, PE, CVA, SA hemorrhage, hemorrhage, ED return visit) at 7 and 30 days.
400
This is the most well validated clinical decision making tool/calculation for serious outcomes in syncope patients.
What is the San Francisco Syncope Rule (SFSR)
Predicts “serious outcome” (death, MI, arrhythmia, PE, CVA, SA hemorrhage, hemorrhage, ED return visit) at 7 and 30 days.
400
Benign positional vertigo is caused by a canalith in this anatomical location
what is posterior semicircular canal
400
These two classes of medications that may be useful for the treatment of vestibular neuritis.
What are antiemetics and antihistamines.
*only use the first few days!
Insufficient evidence for steroids. Vestibular rehab best.
500
Unlike other causes of peripheral vertigo-the disease, which has the following diagnostic criteria, may respond well to a short burst of steroids.
A. ≥ two definitive spontaneous episodes of vertigo 20 min or longer
B. Audiometrically documented hearing loss on at least one occasion
C. Tinnitus or aural fullness in the treated ear
D. Other causes excluded
What is Meniere's disease
•Goals: decrease frequency/severity of vertigo, improve balance, preserve hearing and QOL
•Acute: Symptomatic meds, steroid
•Prophylaxis:
•Diet: Decrease salt, caffeine, alcohol, MSG, nicotine
•Diurectics: eg, triamterene-hydrochlorothiazide (Dyazide) 37.5–25 mg
•Educate: No “cure” but most can get good improvement of vertigo
Vertigo can respond to steroids, treat allergic rhinitis incase contributory