Syncope

Wednesday. Cant feel leg, Numb: on right leg, left arm

Hx of mi, stents, graft
Parotid tumor surgery

Should ask:
Meds: htn
Carotid sinus syndrome: turn head then collapse

Funny turn distinguish presyncopal/syncopal, vertigo, disequilibrium

Syncope: transient LOC, global reduction of arterial flow to brain. Activating
reticular activating system.

- arrythmia, fall bp, vasovagal syncope, meds change: bp acei, arbs, bb,
vasodilator,
hx of arrythmias: brady/tachy if has ICD. Heart block.
Hx of heart disease. HOCM, prolonged QT
Diabetes: autonomic neuropathy, risk factor, painless MI.
Situation: cough, micturition, panic, prolonged standing, pain

Ddx
Hypoglycemia
Seizure
Baroreceptor sensitivity
Hypovolemia
Pulmonary embolus: massive saddle embolism. Hypoxemia, right ventricles
dilation.
Big MI

Numbness
: spinal stenosis
reye syndrome

General inspection: pale, sweating, medication: parkinsons plus-hypomimia,

festinating gait, pill rolling.increase tone esp in wrist.

Neck: previous carotid surgery, goitre

Heart: BP,HR, arrythmias, volume, apex beat (displaced), murmur, hypertrophy.

HOCM: Aortic regurg, pacemaker

Bedside
ECG: WPW, MI, prolonged PR, QT, urinalysis, vitals, skin prick
Macrolides, quinolone, antidepressant cause tachycardia
Bloods: troponin, d-dimer, glucose
CXR (aortic dissection)
ECHO
Holter monitor (implantable loop recorder)
Carotid sinus massage induce asystole, bp response.
Tilt table