In most cases, the patient should be gently placed in a reclined position, and if possible, the feet should be elevated. Patients and caregivers must be educated on what to do during a syncopal attack and how to minimize the chance of injury during a syncopal episode. The prognosis for syncope patients depends on which type of syncope they have. Medications may include beta-blockers, fludrocortisone, SSRIs, midodrine, disopyramide and yohimbine Mild aerobic conditioning, especially in the water Medications and treatment include: 1,2,3,5,6 Tilt table test to measure blood pressure with changes in posture The diagnosis of syncope often focuses on ruling out potentially serious causes of syncope, particularly heart-related problems. Heart Arrythmias such as ventricular tachycardia (fast heart rate), bradyarrhythmias (very slow heart rate) and related arrhythmic events. Primary Pulmonary Hypertension: a rare disease characterized by elevated pulmonary artery pressure with no apparent cause. Left Ventricular Outflow Obstruction: encompass a series of stenotic lesions starting in the anatomic left ventricular outflow tract and stretching to the descending portion of the aortic arch. As a result, the ability of the heart to pump blood is usually weakened.Ĭardiomyopathies: diseases of the heart muscle. The right ventricle is dilated and contracts poorly. Long QT syndrome: an electrical heart abnormality that can produce dangerous arrhythmias.Īrrhythmogenic right ventricular dysplasia (ARVD): a rare form of cardiomyopathy in which the heart muscle of the right ventricle (RV) is replaced by fat and/or fibrous tissue. The first step in evaluating syncope is to evaluate the patient for possible cardiac syncope 12 10,11 Cardiac syncope is often quite serious. 10,11 Occasionally, heart-rhythm problems cause syncope in otherwise healthy people, but individuals with underlying heart disease (such as a previous heart attack or heart valve disease) are at greater risk. 6,10,11Ĭardiac Syncope/Heart-Rhythm Disorders may cause syncope if the heart rate is too slow or too fast, but variable. Situational Syncope: occurs during or immediately after urination, defecation, coughing, laughing, or as a result of gastrointestinal stimulation. Vasovagal Syncope: trigger events can include: emotional stress, trauma, the sight of blood or needles, prolonged standing, and sudden fear.Ĭarotid Sinus Syncope: occurs because of constriction of the carotid artery in the neck and can occur after turning the head, while shaving, or when wearing a tight collar. Thus, the overall lifetime incidence of fainting can approach 50%. 1,2,6,8 Approximately 25% of elderly people faint, which may relate to use of medications or to physiological changes. It can occur for a variety of reasons, usually termed "trigger events." Estimates of isolated fainting episodes range from 15-25% in young people. Reflex Syncope is sometimes known as "the common faint" because it is fairly common. There is general agreement amongst medical experts that these symptoms are due to changes in heart rate and blood pressure. 1,2,6 The low blood pressure leads to syncope if it is severe enough, or to lightheadedness (pre-syncope) if less severe or if the patient is lying down. Neurally Mediated Syncope (NMS): previously called Neurocardiogenic Syncope (NCS) and Neurally Mediated Hypotension (NMH), 9 is a chronic condition characterized by peripheral vasodilation (blood pooling in the extremities), a decrease in blood pressure, and a slow or lowered heart rate upon standing. 1 It is important to distinguish syncope from "dizziness" or "pre-syncope," which generally refers to an alteration in balance, vision, or perception of the environment, without the loss of consciousness. Syncope accounts for approximately 3% of ER visits and 6% of hospital admissions. Syncope can occur in otherwise healthy people and affects all age groups, but occurs more often in the elderly. After a syncopal episode, an individual may be temporarily unconscious, but will revive and slowly return to normal. Some forms of syncope are fairly benign, while other forms can indicate serious health problems. 11 Syncope can be caused by numerous things. Syncope is the formal medical term for fainting, describing a temporary loss of consciousness due to a sudden decline in blood flow to the brain.
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