Evaluation and Management of Syncope

2009 ◽  
Vol 2 (2) ◽  
pp. 65-77 ◽  
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.

scholarly journals Syncope in Children and Adolescents

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.

scholarly journals 17 Evidence for Combined Falls and Syncope Assessment in Older Patients

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv6-iv8
Author(s):  
Rose Anne Kenny
Keyword(s):  
Risk Stratification ◽  
Older Patients ◽  
Older Persons ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Transient Loss ◽  
Esc Guidelines ◽  
Flow Through ◽  
The Brain

Abstract Syncope is a transient loss of consciousness due to cerebral hypoperfusion (reduced blood flow through the brain). Thirty percent of older persons who have syncope are unaware of loss of consciousness and the majority of events are not witnessed. In these cases, the patient presents with non-accidental/unexplained falls (Parry SW et al., 2005). Many of these events are not recognised. Given that most causes of syncope can be treated and further events prevented, the new ESC guidelines for syncope recommends inclusion of falls in syncope risk stratification (Brignole M et al., 2018) in older patients. These new risk stratification recommendations will be reviewed coupled with new prevalence and comorbidity information for falls in community samples and the long term consequences of hypotensive syndromes on cerebral function.

scholarly journals Management of syncope: from evidence to clinical practice

2016 ◽  
Vol 10 ◽  
Author(s):  
Tiziana M. Attardo ◽  
Immacolata Ambrosino ◽  
Elena Magnani ◽  
Nathan Artom ◽  
Nicola Battino ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Rapid Onset ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
High Prevalence ◽  
Transient Loss ◽  
Management Optimization ◽  
Care Costs ◽  
Postural Tone

Syncope is defined as a transient loss of consciousness (T-LOC) due to temporary global cerebral hypoperfusion. It is characterized by rapid onset, short duration, loss of postural tone possibly causing patient fall, and spontaneous full recovery. Syncope has a high prevalence and incidence within the general population with a relevant impact on both quality of life and health care costs. The diagnosis of syncope is often inaccurate and subject to delay, and management is greatly variable. The main objective of this monograph is to discuss a methodological diagnostic approach to signs and symptoms suggestive of syncope, aiming for a management optimization. The present work is based on a systematic review of recent international guidelines.

Transient loss of consciousness

2018 ◽  
Author(s):  
Jonathan Timperley ◽  
Sandeep Hothi
Keyword(s):  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Short Duration ◽  
Complete Recovery ◽  
Complete Loss ◽  
Cerebral Hypoperfusion ◽  
Clinical Approach ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss

Transient loss of consciousness (TLoC) is characterized by a rapid, transient, and complete loss of consciousness of short duration with spontaneous, complete recovery. Syncope is a specific type of TLoC caused by transient, global, cerebral hypoperfusion. TLoC may be traumatic or non-traumatic. Causes of non-traumatic TLoC include syncope, epilepsy, psychogenic causes, and other, rarer causes. Syncope may be reflex (neurally mediated), due to orthostatic hypotension or to cardiovascular disease. This chapter describes the clinical approach to the patient with transient loss of consciousness.

Syncope

2020 ◽  
pp. 5896-5901
Author(s):  
Andrew J. Larner
Keyword(s):  
Cardiac Output ◽  
Heart Disease ◽  
Physical Examination ◽  
Specific Treatment ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Body Parts ◽  
Transient Loss Of Consciousness ◽  
History Of ◽  
Transient Loss

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.

scholarly journals Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the Emergency Department

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Ivo Casagranda ◽  
Michele Brignole ◽  
Simone Cencetti ◽  
Gianfranco Cervellin ◽  
Giorgio Costantino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Initial Evaluation ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Risk Levels ◽  
Risk Patients ◽  
Life Threatening ◽  
Transient Loss ◽  
Multidisciplinary Group ◽  
Diagnostic Investigations

The recommendations enclosed in the present document have been developed by a group of experts appointed by the <em>Gruppo Multidisciplinare per lo Studio della Sincope</em> (Multidisciplinary Group for the Study of Syncope; GIMSI) and Academy of Emergency Medicine and Care (AcEMC). The aim is to define the diagnostic pathway and the management of patients referred to the Emergency Department (ED) for transient loss of consciousness of suspected syncopal cause, which is still unexplained after the initial evaluation. The risk stratification enables the physician to admit, discharge or monitor shortly the patient in the intensive short-stay Syncope Observation Unit (SOU). There are three risk levels of life-threatening events or serious complications (low, moderate, high). Low risk patients can be discharged, while high risk ones should be monitored and treated properly in case of worsening. Moderate risk patients should undergo clinical and instrumental monitoring in SOU, inside the ED. In all these three cases, patients can be subsequently referred to the Syncope Unit for further diagnostic investigations.

Syncope

2019 ◽  
Author(s):  
Annalee M Baker
Keyword(s):  
Heart Block ◽  
Clinical Presentation ◽  
Torsades De Pointes ◽  
Complete Recovery ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Loss Of Consciousness ◽  
Emergency Physicians ◽  
Patients At Risk ◽  
Transient Loss ◽  
Wolff Parkinson White Syndrome

Syncope is a common presenting complaint in the emergency department, accounting for approximately 1 to 3% of presentations and up to 6% of admissions. Syncope is properly defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. Often syncope must be distinguished from other etiologies of transient loss of consciousness, such as seizures and hypoglycemia. Comprehension of the pathogenesis, clinical presentation, and prognosis of the varied causes of syncope is essential if emergency physicians are to succeed in identifying patients at risk for adverse events while also reducing unnecessary syncope admissions. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of syncope. Figures show heart block, prolonged QTc and torsades de pointes, Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, and Brugada syndrome.  This review contains 6 figures, 18 tables, and 58 references. Keywords: Syncope, near-syncope, pre-syncope, arrhythmia, dysrhythmia, sudden cardiac death, vasovagal, passing out, neurocardiogenic  

Risk Stratification of Patients Presenting with Transient Loss of Consciousness

2015 ◽  
Vol 33 (3) ◽  
pp. 387-396 ◽  
Author(s):  
Venkata Krishna Puppala ◽  
Mehmet Akkaya ◽  
Oana Dickinson ◽  
David G. Benditt
Keyword(s):  
Risk Stratification ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss

Risk Stratification of Patients Presenting with Transient Loss of Consciousness

2013 ◽  
Vol 5 (4) ◽  
pp. 433-442
Author(s):  
Venkata Krishna Puppala ◽  
Mehmet Akkaya ◽  
Oana Dickinson ◽  
David G. Benditt
Keyword(s):  
Risk Stratification ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss

Syncope in the older person: a review

2005 ◽  
Vol 15 (3-4) ◽  
pp. 219-235 ◽  
Author(s):  
Samiran Nath ◽  
Rose Anne Kenny
Keyword(s):  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Older Person ◽  
Transient Loss Of Consciousness ◽  
Systemic Hypotension ◽  
Transient Loss

‘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.

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