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==Overview==
==Overview==
[[Peripheral vascular resistance]] and [[cardiac output]] are the two main determinants for the presentation of syncope. [[autonomic nervous system]] impairment due to drugs or an autonomic failure, can lead to a decrease in [[peripheral vascular resistance]]. Reflex activity impairment may also cause a decrease of [[peripheral vascular resistance]], as the body normal compensation reflexes fail. Decrease in [[cardiac output]] may be due to venous pooling, cardioinhibitory reflexes, [[arrhythmia]], [[hypertension]], [[pulmonary embolism]], and volume depletion leading to diminished venous return, among others.
Peripheral vascular resistance and [[cardiac output]] are the two main determinants for the presentation of syncope. [[autonomic nervous system]] impairment due to [[drugs]] or an autonomic failure, can lead to a decrease in [[peripheral vascular resistance]]. Reflex activity impairment may also cause a decrease of [[peripheral vascular resistance]], as the body normal compensation reflexes fail. The decrease in [[cardiac output]] may be due to venous pooling, cardioinhibitory reflexes, [[arrhythmia]], [[pulmonary embolism]], and volume depletion leading to diminished venous return, among others.


==Causes==
==Causes==
[[Peripheral vascular resistance]] and [[cardiac output]] are the two main determinants for the presentation of syncope. [[autonomic nervous system]] impairment due to drugs or an autonomic failure, can lead to a decrease in [[peripheral vascular resistance]]. Reflex activity impairment may also cause a decrease of [[peripheral vascular resistance]], as the body normal compensation reflexes fail. Decrease in [[cardiac output]] may be due to venous pooling, cardioinhibitory reflexes, [[arrhythmia]], [[hypertension]], [[pulmonary embolism]], and volume depletion leading to diminished venous return, among others.
[[Peripheral vascular resistance]] and [[cardiac output]] are the two main determinants for the presentation of syncope. [[autonomic nervous system]] impairment due to drugs or an autonomic failure, can lead to a decrease in [[peripheral vascular resistance]]. Reflex activity impairment may also cause a decrease of [[peripheral vascular resistance]], as the body normal compensation reflexes fail. Decrease in [[cardiac output]] may be due to venous pooling, cardioinhibitory reflexes, [[arrhythmia]], [[hypertension]], [[pulmonary embolism]], and volume depletion leading to diminished venous return, among others.
===Life threatening Causes===
===Life threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<ref name="ShenSheldon2017">{{cite journal|last1=Shen|first1=Win-Kuang|last2=Sheldon|first2=Robert S.|last3=Benditt|first3=David G.|last4=Cohen|first4=Mitchell I.|last5=Forman|first5=Daniel E.|last6=Goldberger|first6=Zachary D.|last7=Grubb|first7=Blair P.|last8=Hamdan|first8=Mohamed H.|last9=Krahn|first9=Andrew D.|last10=Link|first10=Mark S.|last11=Olshansky|first11=Brian|last12=Raj|first12=Satish R.|last13=Sandhu|first13=Roopinder Kaur|last14=Sorajja|first14=Dan|last15=Sun|first15=Benjamin C.|last16=Yancy|first16=Clyde W.|title=2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society|journal=Circulation|volume=136|issue=5|year=2017|issn=0009-7322|doi=10.1161/CIR.0000000000000499}}</ref>
 
* Massive [[Hemorrhage]]
*[[Hemorrhage]]
*[[Tamponade]]
*[[Hypotension]]
*[[Bradyarrhythmia]]
*[[Hypoxia]]
* Massive [[Pulmonary embolism]]<ref>{{Cite journal| doi = 10.1056/NEJMoa1602172| issn = 0028-4793, 1533-4406| volume = 375| issue = 16| pages = 1524–1531| last1 = Prandoni| first1 = Paolo| last2 = Lensing| first2 = Anthonie W.A.| last3 = Prins| first3 = Martin H.| last4 = Ciammaichella| first4 = Maurizio| last5 = Perlati| first5 = Marica| last6 = Mumoli| first6 = Nicola| last7 = Bucherini| first7 = Eugenio| last8 = Visonà| first8 = Adriana| last9 = Bova| first9 = Carlo| last10 = Imberti| first10 = Davide| last11 = Campostrini| first11 = Stefano| last12 = Barbar| first12 = Sofia| title = Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope| journal = New England Journal of Medicine| accessdate = 2016-10-21| date = 2016-10-20| url = http://www.nejm.org/doi/10.1056/NEJMoa1602172}}</ref>  
*[[Pulmonary embolism]] was found in 17% of patients admitted to the hospital for syncope may have pulmonary embolism according to a study of Italian hospitals.<ref>{{Cite journal| doi = 10.1056/NEJMoa1602172| issn = 0028-4793, 1533-4406| volume = 375| issue = 16| pages = 1524–1531| last1 = Prandoni| first1 = Paolo| last2 = Lensing| first2 = Anthonie W.A.| last3 = Prins| first3 = Martin H.| last4 = Ciammaichella| first4 = Maurizio| last5 = Perlati| first5 = Marica| last6 = Mumoli| first6 = Nicola| last7 = Bucherini| first7 = Eugenio| last8 = Visonà| first8 = Adriana| last9 = Bova| first9 = Carlo| last10 = Imberti| first10 = Davide| last11 = Campostrini| first11 = Stefano| last12 = Barbar| first12 = Sofia| title = Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope| journal = New England Journal of Medicine| accessdate = 2016-10-21| date = 2016-10-20| url = http://www.nejm.org/doi/10.1056/NEJMoa1602172}}</ref> This suggests these patients should be routinely assessed with the [[Pulmonary embolism assessment of clinical probability and risk scores|Wells score]] and [[d-dimer]] test with imaging if the Wells score was more than 4 or the d-dimer test was abnormal.
*[[Ruptured abdominal aortic aneurysm]]
*[[Ruptured abdominal aortic aneurysm]]
*[[Ventricular arrhythmia]]<ref name="Khoo-2013">{{Cite journal  | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 | doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}</ref>
*[[Ventricular arrhythmia]]<ref name="Khoo-2013">{{Cite journal  | last1 = Khoo | first1 = C. | last2 = Chakrabarti | first2 = S. | last3 = Arbour | first3 = L. | last4 = Krahn | first4 = AD. | title = Recognizing life-threatening causes of syncope. | journal = Cardiol Clin | volume = 31 | issue = 1 | pages = 51-66 | month = Feb | year = 2013 | doi = 10.1016/j.ccl.2012.10.005 | PMID = 23217687 }}</ref>
 
{| style="border: 2px solid #4479BA; align="left"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Arrhythmia causes of [[syncope]]}}
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF| Cardiovascular non arrhythmia causes of [[syncope]]}}
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|Non cardiac causes of [[syncope]]}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
*Sustained or symptomatic [[ventricular tachycardia|VT]]
*Symptomatic conduction system disease or Mobitz II or third-degree heart block
*Symptomatic bradycardia or sinus pauses not related to [[neurally mediated syncope]]
*Symptomatic [[Supraventricular tachycardia|SVT]]
*Pacemaker/ICD malfunction
*Inheritable cardiac conditions predisposing to [[arrhythmias]]
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
* [[Ischemic heart disease]]
* Severe [[aortic stenosis]]
* Cardiac [[tamponade]]
* [[Hypertrophic cardiomyopathy]]
*Severe prosthetic valve dysfunction
*[[Pulmonary embolism]]
*[[Aortic dissection]]
*Acute [[heart failure]]
*Moderate-to-severe [[left ventricle]] dysfunction
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
*Severe [[anemia]]/[[gastrointestinal bleeding]]
*Major [[traumatic injury]] due to [[syncope]]
*Persistent [[vital sign]] abnormalities
|-
|}
===Common Causes===
===Common Causes===
*[[Arrhythmia]]
*[[Arrhythmia]]
*[[Medication]]
*[[Medication]]
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*[[Vagal stimulation]]
*[[Vagal stimulation]]
*[[Vertebrobasilar insufficiency]]<ref name="Kapoor-2000">{{Cite journal  | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}</ref>
*[[Vertebrobasilar insufficiency]]<ref name="Kapoor-2000">{{Cite journal  | last1 = Kapoor | first1 = WN. | title = Syncope. | journal = N Engl J Med | volume = 343 | issue = 25 | pages = 1856-62 | month = Dec | year = 2000 | doi = 10.1056/NEJM200012213432507 | PMID = 11117979 }}</ref>
===Causes by Organ System===
===Causes by Organ System===
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 16:19, 20 January 2021

Syncope Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2] Sara Zand, M.D.[3]

Overview

Peripheral vascular resistance and cardiac output are the two main determinants for the presentation of syncope. autonomic nervous system impairment due to drugs or an autonomic failure, can lead to a decrease in peripheral vascular resistance. Reflex activity impairment may also cause a decrease of peripheral vascular resistance, as the body normal compensation reflexes fail. The decrease in cardiac output may be due to venous pooling, cardioinhibitory reflexes, arrhythmia, pulmonary embolism, and volume depletion leading to diminished venous return, among others.

Causes

Peripheral vascular resistance and cardiac output are the two main determinants for the presentation of syncope. autonomic nervous system impairment due to drugs or an autonomic failure, can lead to a decrease in peripheral vascular resistance. Reflex activity impairment may also cause a decrease of peripheral vascular resistance, as the body normal compensation reflexes fail. Decrease in cardiac output may be due to venous pooling, cardioinhibitory reflexes, arrhythmia, hypertension, pulmonary embolism, and volume depletion leading to diminished venous return, among others.

Life threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[1]

Arrhythmia causes of syncope Cardiovascular non arrhythmia causes of syncope Non cardiac causes of syncope
  • Sustained or symptomatic VT
  • Symptomatic conduction system disease or Mobitz II or third-degree heart block
  • Symptomatic bradycardia or sinus pauses not related to neurally mediated syncope
  • Symptomatic SVT
  • Pacemaker/ICD malfunction
  • Inheritable cardiac conditions predisposing to arrhythmias

Common Causes

Causes by Organ System

Cardiovascular Acute coronary syndrome, acute myocardial infarction, acute myocarditis, Adams-Stokes syndrome, anomalous origins of coronary arteries, aortic aneurysm, aortic dissection, aortic stenosis, arrhythmogenic right ventricular dysplasia, atrial myxoma, atrioventricular block, AV nodal reentrant tachycardia, bifascicular block, bradyarrhythmia, brugada syndrome, cardiac tamponade, catecholaminergic polymorphic ventricular tachycardia, channelopathy, complete atrioventricular block, dehydration, dilated cardiomyopathy, epsilon wave, hemorrhage, hypertrophic cardiomyopathy, hypotension, Jervell and Lange-Nielsen syndrome, long QT syndrome, mitral stenosis,Meprobamate, orthostatic hypotension, paroxysmal ventricular tachycardia, persistent atrial flutter, preexcitation syndrome, prolonged corrected QT interval, pulmonic stenosis, retroperitoneal hemorrhage, ruptured abdominal aortic aneurysm, saddle embolus, second degree AV block, short corrected QT interval, short QT syndrome, sick sinus syndrome, significant sinus pause, subclavian steal syndrome, supraventricular tachyarrhythmia, third degree heart block, tuberculin,ventricular arrhythmia, ventricular tachycardia, Wolff-Parkinson-White syndrome
Chemical/Poisoning Carbon monoxide, cocaine, ethanol
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect ACE inhibitor, Alfuzosin, alpha blockers, amitriptyline, Amobarbital sodium, antiarrhythmics, antidepressants, antiemetics, antihypertensive medications, antipsychotic agents, barbiturates, beta blockers, Bicalutamide, bicisate dihydrochloride,bromocriptine, calcium channel blocker, Chlordiazepoxide, chlorpheniramine, cinnarizine, Clomifene, clonidine, clozapine, desipramine, digoxin, diphenhydramine, disulfiram, diuretics, dothiepin, Dolasetron mesylate, erectile dysfunction medications, Ferric Carboxymaltose,Folinic acid, ganglionic blocker, hydralazine, Hydrocortisone, hydroxyzine, Iloperidone, Interferon-gamma, Ixabepilone, Lacosamide, Levalbuterol, L-dopa, Loxapine, Meropenem, Methocarbamol, Mitomycin, Nabilone, nabumetone, Niacin, Nilutamide, nitrates, nortriptyline, olanzapine opiates, orphenadrine, oxazepam, oxcarbazepine, Pentamidine, Pergolide, prednisolone, Isethionate, Oprelvekin, Oxaprozin, phenothiazines, rifaximin, Ritonavir, ropinirole, Rotigotine, Secobarbital sodium, sertraline, Sodium oxybate, Sodium aurothiomalate, sulindac, Tiagabine, tricyclic antidepressants, Trospium, vasodilators, zolmitriptan, zonisamide, Calcium gluconate, Cefaclor
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Gastrointestinal bleeding
Genetic Channelopathy
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic Carotid sinus hypersensitivity, dysautonomia, Lewy body dementia, multiple system atrophy, parkinson disease, seizure, spinal cord injury, subarachnoid hemorrhage, transient ischemic attack, vagal stimulation, vertebrobasilar insufficiency
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Atrial myxoma, carcinoid syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anorexia nervosa, anxiety, emotional stress, hysterical faint, psychogenic pseudosyncope
Pulmonary Hypoxia
Renal/Electrolyte Uremia
Rheumatology/Immunology/Allergy Anaphylaxis, Takayasu's arteritis
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Breath holding spells, choking game, cough, defecation, deglutition, drop attack, hair combing, heat illness, hyperventilation, hypocapnia, hypoglycemia, implanted cardioverter defibrillator malfunction, laughing, micturition, post-exercise, postprandial hypotension, prolonged bed rest, sneeze, significant blood loss, valsalva maneuver, vomiting, weightlifting

Causes in Alphabetical Order

References

  1. ↑ Shen, Win-Kuang; Sheldon, Robert S.; Benditt, David G.; Cohen, Mitchell I.; Forman, Daniel E.; Goldberger, Zachary D.; Grubb, Blair P.; Hamdan, Mohamed H.; Krahn, Andrew D.; Link, Mark S.; Olshansky, Brian; Raj, Satish R.; Sandhu, Roopinder Kaur; Sorajja, Dan; Sun, Benjamin C.; Yancy, Clyde W. (2017). "2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 136 (5). doi:10.1161/CIR.0000000000000499. ISSN 0009-7322.
  2. ↑ Prandoni, Paolo; Lensing, Anthonie W.A.; Prins, Martin H.; Ciammaichella, Maurizio; Perlati, Marica; Mumoli, Nicola; Bucherini, Eugenio; Visonà, Adriana; Bova, Carlo; Imberti, Davide; Campostrini, Stefano; Barbar, Sofia (2016-10-20). "Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope". New England Journal of Medicine. 375 (16): 1524–1531. doi:10.1056/NEJMoa1602172. ISSN 1533-4406 0028-4793, 1533-4406 Check |issn= value (help). Retrieved 2016-10-21.
  3. ↑ Khoo, C.; Chakrabarti, S.; Arbour, L.; Krahn, AD. (2013). "Recognizing life-threatening causes of syncope". Cardiol Clin. 31 (1): 51–66. doi:10.1016/j.ccl.2012.10.005. PMID 23217687. Unknown parameter |month= ignored (help)
  4. ↑ Kapoor, WN. (2000). "Syncope". N Engl J Med. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Unknown parameter |month= ignored (help)
  5. ↑ Nishida, K.; Hirota, SK.; Tokeshi, J. (2008). "Laugh syncope as a rare sub-type of the situational syncopes: a case report". J Med Case Rep. 2: 197. doi:10.1186/1752-1947-2-197. PMID 18538031.
  6. ↑ Benbadis, SR.; Chichkova, R. (2006). "Psychogenic pseudosyncope: an underestimated and provable diagnosis". Epilepsy Behav. 9 (1): 106–10. doi:10.1016/j.yebeh.2006.02.011. PMID 16697264. Unknown parameter |month= ignored (help)
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