Syncope

History Of ◽

Syncope is the most common identified cause of transient loss of consciousness, being ten times more frequent than epilepsy. It is a consequence of cerebral hypoperfusion due to reduced cardiac output, often related to reduced venous return due to decreased peripheral vascular resistance with pooling of blood volume in dependent body parts. Diagnosis is clinical, based on history of the circumstances of the event obtained from the patient and reliable eyewitness(es). In most patients, particularly under 45 years of age, the condition is benign and self-limiting, with an excellent prognosis, requiring little investigation beyond physical examination and electrocardiogram to exclude heart disease. Cardiac causes of syncope may require specific treatment.

Definition, epidemiology, classification, and pathophysiology

ESC CardioMed ◽

10.1093/med/9780198784906.003.0468_update_001 ◽

2018 ◽

pp. 2017-2021

Author(s):

J. Gert van Dijk ◽

Roland D. Thijs

Keyword(s):

Cardiac Output ◽

Orthostatic Hypotension ◽

Epileptic Seizures ◽

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Low Cardiac Output ◽

Reflex Syncope ◽

Cardiac Syncope ◽

Syncope can closely resemble other disorders with which it shares an apparent short-lived transient loss of consciousness. Together, these disorders are labelled as ‘transient loss of consciousness (T-LOC)’. Syncope is the form of T-LOC caused by cerebral hypoperfusion; the other main T-LOC forms are several types of epileptic seizures and the psychogenic conditions that resemble either syncope or epileptic seizures. The main forms of syncope are reflex syncope, syncope due to orthostatic hypotension, and cardiac syncope, also comprising cardiopulmonary causes and disorders of the great vessels. All forms of syncope share cerebral hypoperfusion and arterial hypotension as a final common pathway. They differ in the mechanism of hypotension: cardiac syncope is largely due to a low cardiac output, but in orthostatic hypotension and reflex syncope both low peripheral resistance and low cardiac output contribute to syncope. The clinical expression of the main forms is tightly linked to their pathophysiology, which is therefore important for differential diagnosis.

Syncope

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.240504_update_001 ◽

2010 ◽

pp. 4838-4841

Author(s):

A.J. Larner

Keyword(s):

Cardiac Output ◽

Blood Volume ◽

Vascular Resistance ◽

Venous Return ◽

Peripheral Vascular Resistance ◽

Loss Of Consciousness ◽

Body Parts ◽

Peripheral Vascular ◽

Syncope is the commonest identified cause of transient loss of consciousness, being ten times more frequent than epilepsy. It is a consequence of cerebral underperfusion due to reduced cardiac output, often related to reduced venous return due to decreased peripheral vascular resistance, with pooling of blood volume in dependent body parts....

Definition, epidemiology, classification, and pathophysiology

ESC CardioMed ◽

10.1093/med/9780198784906.003.0468 ◽

2018 ◽

pp. 2017-2021

Author(s):

J. Gert van Dijk ◽

Roland D. Thijs

Keyword(s):

Cardiac Output ◽

Orthostatic Hypotension ◽

Epileptic Seizures ◽

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Low Cardiac Output ◽

Reflex Syncope ◽

Cardiac Syncope ◽

Syncope can closely resemble other disorders with which it shares an apparent short-lived transient loss of consciousness. Together, these disorders are labelled as ‘transient loss of consciousness (T-LOC)’. Syncope is the form of T-LOC caused by cerebral hypoperfusion; the other main T-LOC forms are several types of epileptic seizures and the psychogenic conditions that resemble either syncope or epileptic seizures. The main forms of syncope are reflex syncope, syncope due to orthostatic hypotension, and cardiac syncope, also comprising cardiopulmonary causes and disorders of the great vessels. All forms of syncope share cerebral hypoperfusion and arterial hypotension as a final common pathway. They differ in the mechanism of hypotension: cardiac syncope is largely due to a low cardiac output, but both low peripheral resistance and low cardiac output contribute to syncope due to orthostatic hypotension and reflex syncope. The clinical expression of the main forms is tightly linked to their pathophysiology, which is therefore important for differential diagnosis.

Syncope and palpitations

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.160202_update_001 ◽

2010 ◽

pp. 2636-2642

Author(s):

K. Rajappan ◽

A.C. Rankin ◽

A.D. McGavigan ◽

S.M. Cobbe

Keyword(s):

Heart Disease ◽

Chest Pain ◽

Cardiac Death ◽

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Past Medical History ◽

Cardiac Syncope ◽

Appropriate Treatment ◽

Cardiac Condition ◽

History Of

Syncope is a transient episode of loss of consciousness (T-LOC) due to cerebral hypoperfusion. Its causes can be subdivided on the basis of pathophysiology, including (1) neurally mediated—or reflex—syncope; (2) orthostatic hypotension; (3) cardiac causes; and (4) cerebrovascular or psychogenic causes. Neurocardiogenic syncope, or simple faint, is the commonest cause and is benign, but it is always important to exclude or establish the diagnosis of cardiac syncope, because this has an adverse prognosis that may be improved with appropriate treatment. Cardiac arrhythmia should be considered in all patients who have syncope associated with any of the following: (1) exertion, chest pain, or palpitations; (2) a past medical history of heart disease; (3) abnormal cardiovascular findings on examination; (4) an abnormal ECG; and (5) a family history of sudden cardiac death in people younger than 40 years old or with an inherited cardiac condition....

Migraine Angiitis Precipitated by Sex Headache and Leading to Watershed Infarction

Cephalalgia ◽

10.1046/j.1468-2982.1993.1306427.x ◽

1993 ◽

Vol 13 (6) ◽

pp. 427-430 ◽

Cited By ~ 37

Author(s):

Matthew Jackson ◽

Graham Lennox ◽

Timothy Jaspan ◽

David Jefferson

Keyword(s):

Family History ◽

Subarachnoid Haemorrhage ◽

Cerebrovascular Disease ◽

Past History ◽

Loss Of Consciousness ◽

Border Zones ◽

History Of ◽

Transient Loss ◽

Watershed Infarction

Vasospasm is a rare cause of cerebrovascular disease except following subarachnoid haemorrhage. We describe a woman who developed an explosive-type sex headache, followed by a series of severe migrainous headaches associated with fully reversible segmental cerebral arterial narrowing and dilatation, resulting in widespread infarction in cerebral arterial border zones. This led to transient loss of consciousness and multiple focal cortical deficits including blindness. She had a past history of migraine and a family history of both migraine and sex headaches. Similar cases have been reported in the literature under a variety of rubrics. We suggest that this newly recognized clinico-radiological syndrome is a migraine variant.

High Diagnostic Yield and Accuracy of History, Physical Examination, and ECG in Patients with Transient Loss of Consciousness in FAST: The Fainting Assessment Study

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2007.00984.x ◽

2007 ◽

Vol 0 (0) ◽

pp. 071003084053005-???

Author(s):

NYNKE VAN DIJK ◽

KIMBERLY R. BOER ◽

NANCY COLMAN ◽

ANNEMIEKE BAKKER ◽

JAN STAM ◽

...

Keyword(s):

Physical Examination ◽

Diagnostic Yield ◽

Loss Of Consciousness ◽

High Diagnostic Yield ◽

Assessment Study ◽

Evaluation and Management of Syncope

Clinical Scholars Review ◽

10.1891/1939-2095.2.2.65 ◽

2009 ◽

Vol 2 (2) ◽

pp. 65-77 ◽

Cited By ~ 4

Author(s):

Joanne L. Thanavaro

Keyword(s):

Risk Stratification ◽

Specific Treatment ◽

Complete Recovery ◽

Medical Problem ◽

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Life Threatening ◽

Transient Loss ◽

Life Threatening Event ◽

Postural Tone

Syncope is a transient loss of consciousness precipitated by cerebral hypoperfusion, which is associated with a brief absence of postural tone and usually followed by a complete recovery. This clinical condition is a common medical problem and may be attributed to a multitude of disease processes. Risk stratification identifies the safest setting for the initial evaluation as well as which patients are most likely to have a life-threatening event. Establishing the diagnosis of syncope is important so that specific treatment can be instituted to prevent future recurrences and eliminate the underlying predisposing disease. This article reviews the etiology, risk stratification, diagnosis, and therapeutic management of syncope.

Syncope in the older person: a review

Reviews in Clinical Gerontology ◽

10.1017/s0959259806001808 ◽

2005 ◽

Vol 15 (3-4) ◽

pp. 219-235 ◽

Cited By ~ 1

Author(s):

Samiran Nath ◽

Rose Anne Kenny

Keyword(s):

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Older Person ◽

Systemic Hypotension ◽

‘Syncope’ is derived from the Greek words ‘syn’ (meaning ‘together’) and ‘koptein’ (meaning ‘cut’). It is a syndrome characterized by transient loss of consciousness resulting from temporary and self-limited cerebral hypoperfusion, most often the result of systemic hypotension.

Approach to Loss of Consciousness: Distinguishing Epileptic Seizures, Psychogenic Nonepileptic Seizures, and Syncope

Seminars in Neurology ◽

10.1055/s-0041-1726359 ◽

2021 ◽

Vol 41 (06) ◽

pp. 667-672

Author(s):

Ima Ebong ◽

Zahra Haghighat ◽

Meriem Bensalem-Owen

Keyword(s):

Physical Examination ◽

Diagnostic Tests ◽

Epileptic Seizures ◽

Loss Of Consciousness ◽

Psychogenic Nonepileptic Seizures ◽

Transient Loss ◽

Nonepileptic Seizures

AbstractTransient loss of consciousness (TLOC) is a common emergent neurological issue, which can be attributed to syncope, epileptic seizures, and psychogenic nonepileptic seizures. The purpose of this article is to outline an approach to diagnosing the most common etiologies of TLOC by focusing on the importance of the history and physical examination, as well as targeted diagnostic tests.

Syncope in Children and Adolescents

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2017-0017 ◽

2017 ◽

Vol 34 (3) ◽

pp. 193-198

Author(s):

Ljiljana Pejčić ◽

Marija Ratković Janković ◽

Radmila Mileusnić-Milenović ◽

Karin Vasić ◽

Ivana Nikolić

Keyword(s):

Sudden Death ◽

Cerebral Hypoperfusion ◽

Small Subset ◽

Loss Of Consciousness ◽

Pediatric Age Group ◽

Life Threatening ◽

History Of ◽

Transient Loss ◽

Great Fear ◽

Life Threatening Event

Summary In the pediatric age group, most cases of syncope represent benign, neutrally-mediated alterations in vasomotor tone. Due to the global cerebral hypoperfusion, syncope is defined as a transient loss of consciousness followed by spontaneous recovery and/or a state of presyncope, including dizziness, lightheadedness, pallor, diaphoresis and palpitations which may precede the loss of consciousness. These symptoms could be a sign of a life-threatening event in a small subset of patients, even though most causes of syncope in childhood are benign, and life-threatening causes of syncope generally have cardiac etiology. In all these cases, routine evaluation includes history, physical examination and a 12-lead standard electrocardiogram which should be performed. Further investigation is indicated by worrying features which include syncope that occurs without warning, syncope during exercise, history of familial sudden death, and abnormalities on clinical exam or electrocardiography. The fact is that syncope generates great fear of injury or sudden death among parents and doctors, and the main aim of the present paper is to help the physician involved in the care of children to differentiate the life-threatening causes of syncope from the common, more benign neutrally-mediated syncope.