Cardio - Syncope & Miscellaneous (Final)

syncope

loss of consciousness that is transient, self-limited, due to acute global cerebral hypoperfusion of rapid onset and followed by spontaneous and complete recovery

pre-syncope

includes the prodromal symptoms of syncope without loss of consciousness -- lightheadedness, faintness, weakness, fatigue, visual/auditory disturbances, sweating

neurally mediated syncope

transient change in reflexes responsible for maintaining cardiovascular homeostasis; temporary failure of BP control; MC type of syncope; includes vasovagal, situational, carotid sinus hypersensitivity

vasovagal

common faint, often provoked by certain triggers (pain, blood, needles, extreme emotional distress)

situational

specific localized stimuli (violent coughing, micturition, defecation, laughing, swallowing, provoking reflex vasodilation and bradycardia)

carotid sinus hypersensitivity

triggers include neck movement, wearing neckties, shaving, or other activities that press upon carotid sinus; more common in elderly

midodrine, fludrocortisone

treatment for recurrent/refractory syncope

orthostatic hypotension

reduction in SBP of >20mmHg or DBP of >10mmHg within 3 minutes of standing; failure of sympathetic vasoconstriction; lack of compensatory HR increase

neurogenic orthostatic hypotension

autonomic dysfunction of other organ systems leads to orthostatic hypotension: Shy-Drager syndrome, Parkinson's, dementia w/lewy bodies, peripheral neuropathies, spinal cord issues, brain stem lesions, CVA, multiple sclerosis

iatrogenic orthostatic hypotension

orthostatic hypotension caused by meds: antihypertensives, adrenoreceptor blockers, nitrates, TCA, dopamine receptor agonists, ED drugs, diuretics

cardiogenic syncope

syncope caused by arrhythmia and/or structural heart disease, most likely to have a bad outcome; causes: bradyarrhythmias, ventricular tachyarrhythmias, long QT syndrome, Brugada syndrome, valvular/ischemic/cardiomyopathy/mass/effusion of heart

cataplexy

loss of muscular tone, but maintain consciousness, post strong emotional stimulus

myxoma

MC primary cardiac tumor in adults, benign, more often left sided, may have murmur or "tumor plot" of auscultation

ECHO, MRI

diagnostic tools for cardiac tumors

surgical excision

treatment for myxomas

papillary fibroelastoma

2nd MC primary cardiac tumor, 80% found on heart valves, multiple hair-long fronds of tumor

sarcoma

majority of primary malignant cardiac tumors

metastatic

MC malignant cardiac tumor

coronary heart disease

leading cause of death in T2DM

SGLT2i, GLP-1 agonists

diabetic medications that offer CV protection

pulmonary embolism

clot in the lungs; presents with dyspnea, cough, hemoptysis, tachypnea, rales, tachycardia

CTA

first line diagnostic if suspected PE

pulmonary angiogram

gold standard diagnostic for PE, invasive

VQ scan

alternate diagnostic for PE if unable to undergo CT

Wells criteria

objectifies risk for PE

PERC rule

can rule out PE if completely negative

d-dimer

lab test used to rule out PE in low/intermediate suspicion cases

heparin + warfarin or DOAC

anticoagulation therapy for PE

IVC filter

can be used for PE if anticoagulation contraindications or recurrence

thrombectomy

last resort treatment for hemodynamically unstable, large proximal PE

hypertrophic cardiomyopathy

MCC sudden cardiac death in athletes

athlete's heart

non-pathologic compensatory heart changes to increase CO due to demand; biventricular hypertrophy (mild <15mm) and mild-moderately dilated LV, maintained diastolic function