Lets kick it with Dr. Bill Kormos and try not to pass out with excitement as we talk syncope
4 questions to ask: 1) Did this person have a LOC 2) Was it from syncope or non-syncope (rule out mimics such as metabolic, seizure, pseudo-syncope etc.) 3) Is the etiology of syncope clear (consider meds) 4) What is the underlying risk of cardiac syncope
4 main etiologies of syncope: 👍👉 1) Reflex (60%); vasovagal, situational 2) Orthostatic (15%); hypovolemia, ANS-failure drug induced 3) Cardiac arrhythmia (10%) (SSS, AB block, tachycardia, Long-QT, brugada) 4) Cardiac structural (5%)
What are some high risk features that point to a cardiac cause? ♥️
-Hx of heart disease
-Dyspnea
-CP
-Exertional
-Positional (supine)
-Abnormal ECG
Consider using EGSY score; A score >3 makes cardiac syncope likely and increased 2 yr mortality 😲
PE in syncope may not be as common as suggested by the PESIT trial (17%)
In fact it may be closer to 1-2%
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1/ 34 y/o F with new AML dx on chemo (7+3) ANC 200. Counts are expected to continue to drop & not get better for at least another ~10d. Has been febrile 🌡️🔥 & on cefepime 2g q8 for the past 5 days💊💉. What do you do next?
1/36 y/o F hx of anxiety p/w a 2nd episode of transient chest pain w emotional stress & her admission EKG shows 4 mm ST elevations in leads V1-V3. Her 1st troponins check was high. She is currently chest-pain free & vitals are normal.
3/ You look up and notice the STEMI pathway chart conveniently plastered above your workstation‼️
You recognize the patient's presentation is consistent with ACS and her ST elevations meet criteria for STEMI---> you appropriately escalate and decide to call "code STEMI" 🚨📞
3/ What are your ULT options? Check out the awesome slide below.
Takeaways:
💊Start with allopurinol! It will give you the biggest bang for your buck
💊Your target UA level is 6⃣- titrate q2-4 weeks
💊Start prophylactic therapy at the same time (NSAID, colchicine, pred)
2/ First, the spleen is a complex, beautiful & underrated organ. There, we said it. 🤷
It’s so great that 15% of people have an extra accessory spleen
The spleen has 3 general components: A marginal zone & 2 pulps.
3/ ↔️Marginal Zone: Free-flowing transit space for immune cells, where antigens are captured by dendritic cells and B cells (i.e. as APCs) prior to migration to white pulp.
⚪️White Pulp: Physically exclusive lymphoid tissue where T and B cells mature 👶👧👩👵