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62yo female fainted on the MRT this morning (Neurally mediated (Carotid…
62yo female fainted on the MRT this morning
Neurogenic
PE: Muscle weakness/paresthesia, CN abnormalities, Vascular bruits, abnormal cognition, speech distrubance, sensory-motor deficits.
Neurally mediated
Carotid sinus hypersensitivity
HX: Older pt
PE: Response to carotid sinus massage (bradycardia and decreased BP > 50mm Hg or)
Situational
HX: Patients who experience syncope with urination, defecation, cough, swallowing, or venipuncture have situational syncope
Vasovagal
HX: Younger pt, common precipitating factor with associated prodromal symptoms
A reflex response causes vasodilation, bradycardia, and systemic hypotension leading to decreased cerebral blood flow.
Cardiac
HX: Older pt
Arrhythmias
HX: usually the cause of sudden death in YA with syncope
PE: Murmur, arrhythmia
PP: Severe bradycardia, 2nd/3rd degree heart block, VT, pacemaker malfunction
Mechanical abnormalities
Structural abnormalities
Hypertrophic cardiomyopathy
HX: Young pt under 40yo, inadequate BP response to excercise
Orthostatic
HX: Older pt
PP: Autonomic dysfunction, medications, Volume depletion
PE: Orthostatis, GT blood loss
Similar presentations: Seizures, metabolic and pscychogenic disorders, acute intoxication
The most common causes of syncope in older pts are orthostatic hypotension (often occurring in the morning after taking medications), carotid sinus hypersensitivity, and cardiac causes.