Practice Paper 1: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell in Get ahead! Medicine, 2016
The term ‘syncope’ describes the sudden loss of consciousness. Presyncope is a feeling of light-headedness. Vasovagal syncope occurs when there is excessive activation of the parasympathetic nervous system in response to certain stimuli, such as heat, fear and stress. The parasympathetic activity causes systemic vasodilatation and bradycardia, which triggers profound hypotension and cerebral hypoperfusion. Collapse is often preceded by a feeling of faintness, nausea, sweating and ringing in the ears. Occasionally, witnesses may describe the patient twitching and a loss of urinary incontinence, which may be confused with seizure activity. Following collapse, cerebral perfusion is restored and recovery is rapid. Situational syncope describes the scenario when vasovagal episodes are triggered by specific actions, such as coughing, urinating or having blood taken.
Dizziness
Catherine Bracewell, Rosaire Gray, Rosaire Gray in Essential Facts in Geriatric Medicine, 2011
Dizziness is a common symptom in older people occurring in up to 30% of patients over 65. Symptoms can range from mild and brief to severe and disabling. It is important to enquire as to exactly what the patient means by dizziness to help determine the underlying cause. Th ere are three main types of dizziness: Vertigo. ➤ Presyncope. ➤ Disequilibrium. ➤ Occasionally, patients report blurred vision, feelings of unreality, or blackouts and these symptoms need to be investigated appropriately.
Syncope
Anh Vu Nguyen, Dung Nguyen in Learning from Medical Errors, 2005
Syncope is a not uncommon complaint and represents approximately 3% of ED evaluations annually.1 By definition, it ‘is a sudden, transient loss of consciousness associated with inability to maintain postural tone.’1 An important feature of syncope that distinguishes it from many other causes of loss of consciousness is the spontaneous recovery. Near syncope (sometimes called presyncope) can be caused by the same disease processes and is usually worked up in a similar fashion. The difference is that there is no loss of consciousness in near syncope.
Presyncope – not always an orthostatic problem
Published in Journal of Community Hospital Internal Medicine Perspectives, 2015
A 41-year-old female was brought to the ER after a presyncope and absence episode while riding a bike. She recalled no prodromi. Her physical and neurological examinations were unremarkable; past medical, family, substance, and travel history bland. She reported a constant tiredness, sporadic slight cephalgia, responsive to acetaminophen, and a recent syncope while jogging, resulting in a fall, circumstances of which she could not recall. Non-compaction cardiomyopathy is a type of cardiomyopathy that was first described 25 years ago. Its molecular genetic basis is not yet fully clear, and the same is true of its diagnosis, treatment, and prognosis. Further study of these matters is needed.
Swallow presyncope in an athletic patient caused by third-degree atrioventricular block
Published in Acta Clinica Belgica, 2018
Axel Van Damme, Tine De Backer, Philippe Vanderheeren
IntroductionSwallow syncope is a neurally mediated syncope. Multiple causes have been described in literature. A rare cause is arrhythmias. Only a limited amount of cases present the association of swallow syncope and third degree AV-block. Case presentationA 39-year-old man presented with episodes of presyncope while eating. Further medical history, physical examination, resting 12-lead ECG, cyclo-ergometry, transthoracic echocardiography and MRI of the heart were normal. 24 h Holter monitoring demonstrated high-grade third-degree atrioventricular (AV) block. The patient was scheduled for pacemaker implantation. DiscussionArrhythmia is a rare cause of swallow syncope. Reported arrhythmic causes are sinus bradycardia, sinoatrial block, atrioventricular block and complete atrial and ventricular asystole. Essential to the diagnosis is that (pre)syncope is preceded by swallowing and documentation of AV block on 24 h Holter monitoring. Treatment is guided by ESC guidelines which state that reflex syncope has a grade IIa recommendation for pacing, while current evidence suggests that asymptomatic vagally mediated AV block should not be treated until symptomatic.
Exertional Syncope and Presyncope
Published in The Physician and Sportsmedicine, 2005
Kevin J. McAward, James M. Moriarity, Kimberly G. Harmon, Aaron Rubin
Physicians often see patients who have syncope or presyncope, but episodes associated with exercise are uncommon. Transient syncopal episodes usually require minimal evaluation and intervention. Most cases of exercise-associated syncope have neurocardiogenic origins and are benign, but fainting may signal a potentially fatal underlying problem. More serious causes of exertional syncope include structural cardiovascular abnormalities and cardiac arrhythmias. All physicians who care for active patients should be aware of the potential seriousness of this early warning sign and evaluate patients accordingly. Familiarity with the Bethesda guidelines will help clinicians decide when it is safe for an athlete to return to play following a syncopal episode.