IBHRE Syncope and Autonomic Disorders 2

Question 1

In the VASIS (Vasovagal Syncope International Study) classification, Type 2B vasovagal syncope is characterized by:

Accepted Answer

Cardioinhibitory response with asystole ≥3 seconds

Answer

VASIS Type 2B is defined as a cardioinhibitory response with asystole of ≥3 seconds, which may favor pacemaker implantation in selected patients.

Question 2

The standard tilt table test is typically performed at what upright angle?

Accepted Answer

70 degrees

Answer

The Westminster protocol and most international guidelines recommend a tilt angle of 70 degrees as the standard for evaluating neurally mediated syncope.

Question 3

Fludrocortisone reduces syncope primarily by:

Accepted Answer

Increasing blood volume via renal sodium and water retention

Answer

Fludrocortisone is a synthetic mineralocorticoid that promotes renal sodium retention and fluid expansion, increasing central blood volume and reducing orthostatic hypotension.

Question 4

Syncope occurring during exercise in a young patient should raise concern for which underlying condition?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Exercise-induced syncope in young patients is a red flag for obstructive or arrhythmic cardiac causes, with hypertrophic cardiomyopathy being a leading concern.

Question 5

The autonomic response in vasovagal syncope involves activation of which reflex?

Accepted Answer

Bezold-Jarisch reflex

Answer

The Bezold-Jarisch reflex, triggered by activation of cardiac C-fibers (mechanoreceptors) in the inferior left ventricular wall, causes reflex bradycardia and vasodilation.

IBHRE - International Board of Heart Rhythm Examiners Practice Test

IBHRE - International Board of Heart Rhythm Examiners Practice Test

IBHRE Syncope and Autonomic Disorders 2