Syncope risk factors: Difference between revisions
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{{Syncope}} | {{Syncope}} | ||
{{CMG}}; {{AE}} {{Sahar}} | {{CMG}}; {{AE}} {{Sahar}} {{Sara.Zand}} | ||
==Overview== | ==Overview== | ||
Syncope is a [[Sign (medical)|sign]] of insufficient [[cerebral blood flow]] and it should be evaluated for the underlying [[Causes|cause]]. Possible underlying [[ | [[Syncope]] is a [[Sign (medical)|sign]] of insufficient [[cerebral blood flow]] and it should be evaluated for the underlying [[Causes|cause]]. Possible underlying [[risk factors]] of [[cardiac]] [[syncope]] include older age (>60 y), [[male]] sex, presence of known [[ischemic heart disease]], [[structural heart disease]], previous [[arrhythmias]], or reduced [[ventricular function]], brief prodromes such as [[palpitations]] or sudden [[loss of consciousness ]] without a prodrome, [[syncope]] during exertion, [[syncope]] in the supine position, low number of [[syncope]] episodes (1 or 2), abnormal [[cardiac]] examination, [[family history]] of inheritable conditions or [[premature sudden cardiac death]] ([[SCD]]) (<50 y of age), or presence of known [[congenital heart disease]]. Common [[risk factors]] associated with noncardiac [[causes]] of [[syncope]] include younger age, no known [[cardiac disease]], [[syncope]] only in the standing position, positional change from supine or sitting to standing, presence of prodrome: [[nausea]], [[vomiting]], feeling warm, presence of specific triggers ||||( [[dehydration]], [[pain]], stressful stimulus, [[medical environment]]), situational triggers( [[cough]], [[laugh]], [[micturition]], [[defecation]], [[deglutition]]), history of [[syncope]] with similar characteristics and frequent recurrence | ||
==Risk Factors== | ==Risk Factors== | ||
[[ | *Common [[risk factors]] associated with [[cardiac]] [[causes]] of [[syncope]] include:<ref>{{cite journal|doi=10.1161/CIR.0000000000000499Circulation}}</ref> | ||
* Older age (>60 y) | :* Older age (>60 y) | ||
* [[Male]] sex | :* [[Male]] sex | ||
* Presence of known [[ischemic heart disease]], [[structural heart disease]], previous [[arrhythmias]], or reduced [[ventricular function]] | :* Presence of known [[ischemic heart disease]], [[structural heart disease]], previous [[arrhythmias]], or reduced [[ventricular function]] | ||
* Brief prodromes, such as palpitations, or sudden loss of consciousness without a prodrome | :* Brief prodromes, such as palpitations, or sudden loss of consciousness without a prodrome | ||
* [[Syncope] during exertion | :* [[Syncope]] during exertion | ||
* [[Syncope]] in the supine position | :* [[Syncope]] in the supine position | ||
* Low number of [[syncope]] episodes (1 or 2) | :* Low number of [[syncope]] episodes (1 or 2) | ||
* Abnormal [[cardiac]] examination | :* Abnormal [[cardiac]] examination | ||
* [[Family history]] of inheritable conditions or [[premature sudden cardiac death ([[SCD]]) (<50 y of age) | :* [[Family history]] of inheritable [[conditions]] or [[premature sudden cardiac death]] ([[SCD]]) (<50 y of age) | ||
* Presence of known [[congenital heart disease]] | :* Presence of known [[congenital heart disease]] | ||
Common risk factors associated with noncardiac causes of [[syncope]] include: | *Common risk factors associated with noncardiac causes of [[syncope]] include: | ||
*Younger age | :* Younger age | ||
*No known cardiac disease | :* No known cardiac disease | ||
* [[Syncope]] only in the standing position | :* [[Syncope]] only in the standing position | ||
* Positional change from supine or sitting to standing | :* Positional change from supine or sitting to standing | ||
* Presence of prodrome: [[nausea]], [[vomiting]], feeling warmth | :* Presence of prodrome: [[nausea]], [[vomiting]], feeling warmth | ||
* Presence of specific triggers: [[dehydration]], [[pain]], stressful stimulus, [[medical environment]] | :* Presence of specific triggers: [[dehydration]], [[pain]], stressful stimulus, [[medical environment]] | ||
* Situational triggers: [[cough]], [[laugh]], [[micturition]], [[defecation]], [[deglutition]] | :* Situational triggers: [[cough]], [[laugh]], [[micturition]], [[defecation]], [[deglutition]] | ||
* History of [[syncope]] with similar characteristics and frequent recurrence | :* History of [[syncope]] with similar characteristics and frequent recurrence | ||
:* The following factors | *Short term [[risk factors]] associated with the outcomes of [[syncope]] in the emergency department until 30 days after event include: | ||
:*Male sex | |||
:*Older age (>60 y) | |||
:*No prodrome | |||
:*[[Palpitation]] preceding loss of consciousness | |||
:*Exertional [[syncope]] | |||
:*[[Structural heart disease]] | |||
:*[[Heart failure]] | |||
:*[[Cerebrovascular disease]] | |||
:*Family history of [[SCD]] | |||
:*[[Trauma]] | |||
:*Physical Examination or Laboratory Investigation | |||
:*Evidence of [[bleeding]] | |||
:*Persistent abnormal [[vital signs]] | |||
:*Abnormal [[ECG]] | |||
:*Positive [[troponin]] | |||
*Long term risk factors associated with the outcomes of [[syncope]] > 30 days until one year after event include: | |||
:*Male sex | |||
:*Older age | |||
:*Absence of nausea/vomiting preceding syncopal event | |||
:*[[Ventricular arrhythmia]] | |||
:*[[Cancer]] | |||
:*[[Structural heart disease]] | |||
:*[[Heart failure]] | |||
:*[[Cerebrovascular disease]] | |||
:*[[Diabetes mellitus]] | |||
:*Physical Examination or Laboratory Investigation | |||
:*Abnormal [[ECG]] | |||
:*Lower [[GFR]] | |||
:*High CHADS score ( [[congestive heart failure]], [[hypertension]], age ≥75 years, [[diabetes mellitus]], [[stroke]] or [[transient ischemic attack]]) | |||
*The following factors have been associated with increased risk of orthostatic syncope:<ref name="Anil2016">{{cite journal|last1=Anil|first1=OmMurti|title=Syncope: Approach to diagnosis|journal=Journal of Clinical and Preventive Cardiology|volume=5|issue=3|year=2016|pages=84|issn=2250-3528|doi=10.4103/2250-3528.191099}}</ref> | |||
** Sudden postural change of the head (especially upon waking in the morning) | ** Sudden postural change of the head (especially upon waking in the morning) | ||
** Standing still for a long period | ** Standing still for a long period | ||
| Line 45: | Line 76: | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
Latest revision as of 20:33, 21 January 2021
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Syncope risk factors On the Web |
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American Roentgen Ray Society Images of Syncope risk factors |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Sara Zand, M.D.[3]
Overview
Syncope is a sign of insufficient cerebral blood flow and it should be evaluated for the underlying cause. Possible underlying risk factors of cardiac syncope include older age (>60 y), male sex, presence of known ischemic heart disease, structural heart disease, previous arrhythmias, or reduced ventricular function, brief prodromes such as palpitations or sudden loss of consciousness without a prodrome, syncope during exertion, syncope in the supine position, low number of syncope episodes (1 or 2), abnormal cardiac examination, family history of inheritable conditions or premature sudden cardiac death (SCD) (<50 y of age), or presence of known congenital heart disease. Common risk factors associated with noncardiac causes of syncope include younger age, no known cardiac disease, syncope only in the standing position, positional change from supine or sitting to standing, presence of prodrome: nausea, vomiting, feeling warm, presence of specific triggers ||||( dehydration, pain, stressful stimulus, medical environment), situational triggers( cough, laugh, micturition, defecation, deglutition), history of syncope with similar characteristics and frequent recurrence
Risk Factors
- Common risk factors associated with cardiac causes of syncope include:[1]
- Older age (>60 y)
- Male sex
- Presence of known ischemic heart disease, structural heart disease, previous arrhythmias, or reduced ventricular function
- Brief prodromes, such as palpitations, or sudden loss of consciousness without a prodrome
- Syncope during exertion
- Syncope in the supine position
- Low number of syncope episodes (1 or 2)
- Abnormal cardiac examination
- Family history of inheritable conditions or premature sudden cardiac death (SCD) (<50 y of age)
- Presence of known congenital heart disease
- Common risk factors associated with noncardiac causes of syncope include:
- Younger age
- No known cardiac disease
- Syncope only in the standing position
- Positional change from supine or sitting to standing
- Presence of prodrome: nausea, vomiting, feeling warmth
- Presence of specific triggers: dehydration, pain, stressful stimulus, medical environment
- Situational triggers: cough, laugh, micturition, defecation, deglutition
- History of syncope with similar characteristics and frequent recurrence
- Short term risk factors associated with the outcomes of syncope in the emergency department until 30 days after event include:
- Male sex
- Older age (>60 y)
- No prodrome
- Palpitation preceding loss of consciousness
- Exertional syncope
- Structural heart disease
- Heart failure
- Cerebrovascular disease
- Family history of SCD
- Trauma
- Physical Examination or Laboratory Investigation
- Evidence of bleeding
- Persistent abnormal vital signs
- Abnormal ECG
- Positive troponin
- Long term risk factors associated with the outcomes of syncope > 30 days until one year after event include:
- Male sex
- Older age
- Absence of nausea/vomiting preceding syncopal event
- Ventricular arrhythmia
- Cancer
- Structural heart disease
- Heart failure
- Cerebrovascular disease
- Diabetes mellitus
- Physical Examination or Laboratory Investigation
- Abnormal ECG
- Lower GFR
- High CHADS score ( congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack)
- The following factors have been associated with increased risk of orthostatic syncope:[2]
- Sudden postural change of the head (especially upon waking in the morning)
- Standing still for a long period
- Certain antihypertensive drugs (e.g., diuretics, vasodilators)
- Severe exertion with dehydration
- Reduced “thirst drive” in elderly individuals
- Avoidance of fluid intake in older men (to minimize prostate symptoms)
- Excess alcohol or caffeine use
- Straining during micturition or defecation
- High environmental temperature (including hot baths, showers, and saunas)
- Large meals (especially with refined carbohydrates)
References
- ↑ . doi:10.1161/CIR.0000000000000499Circulation. Missing or empty
|title=(help) - ↑ Anil, OmMurti (2016). "Syncope: Approach to diagnosis". Journal of Clinical and Preventive Cardiology. 5 (3): 84. doi:10.4103/2250-3528.191099. ISSN 2250-3528.