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{{Syncope}}
{{syncope}}
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{{CMG}}; {{AE}} {{VR}} {{Sara.Zand}}
 
==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==
==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.<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]]
*[[Tamponade]]
*[[Bradyarrhythmia]]
* 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>
*[[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>
{| 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===
*[[Alcohol abuse]]
*[[Arrhythmia]]
*Common fainting spell ([[vasovagal syncope]])
*[[Medication]]
*[[Dehydration]] due to a wide variety of causes including diarrhea and diuretics
*[[Orthostatic hypotension]]
*Drugs including [[opiates]], [[anxiolytics]], [[sedatives]], [[barbiturates]]
*[[Vagal stimulation]]
*[[Hypoglycemia]]
*[[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>
*[[Hypotension]]
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[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]], [[AVNRT|AV nodal reentrant tachycardia]], [[bifascicular block]], [[bradyarrhythmia]], [[brugada syndrome]], [[cardiac tamponade]], [[catecholaminergic polymorphic ventricular tachycardia]], [[channelopathy]], [[AV block|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]], [[Atrial flutter|persistent atrial flutter]], [[preexcitation syndrome]], [[QT prolongation|prolonged corrected QT interval]], [[pulmonic stenosis]], [[retroperitoneal hemorrhage]], [[ruptured abdominal aortic aneurysm]], [[Pulmonary embolism classification|saddle embolus]], [[second degree AV block]], [[Short QT syndrome|short corrected QT interval]], [[short QT syndrome]], [[sick sinus syndrome]], [[Sinoatrial arrest|significant sinus pause]], [[subclavian steal syndrome]], [[Supraventricular tachycardia|supraventricular tachyarrhythmia]], [[third degree heart block]], [[tuberculin]],[[ventricular arrhythmia]], [[ventricular tachycardia]], [[Wolff-Parkinson-White syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical/Poisoning'''
| bgcolor="Beige" |[[Carbon monoxide]], [[cocaine]], [[ethanol]]
|-
|- bgcolor="LightSteelBlue"
|'''Dental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[ACEI|ACE inhibitor]], [[Alfuzosin]], [[alpha blockers]], [[amitriptyline]],  [[Amobarbital sodium]],  [[antiarrhythmics]], [[antidepressants]], [[antiemetics]], [[Antihypertensive|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 medical therapy|erectile dysfunction medications]], [[Ferric Carboxymaltose]],[[Folinic acid]], [[Ganglionic blocker|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]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Gastrointestinal bleeding]]
|-
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Channelopathy]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |[[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]]
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional/Metabolic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |[[Atrial myxoma]], [[carcinoid syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Ophthalmologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Overdose/Toxicity'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Anorexia nervosa]], [[anxiety]], [[emotional stress]], [[Hysteria|hysterical faint]], [[Psychogenic non-epileptic seizures|psychogenic pseudosyncope]]
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Hypoxia]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal/Electrolyte'''
| bgcolor="Beige" |[[Uremia]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" |[[Anaphylaxis]], [[Takayasu's arteritis]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |[[Breath-holding spells|Breath holding spells]], [[choking game]], [[cough]], [[defecation]], [[deglutition]], [[drop attack]], [[Hair-grooming syncope|hair combing]], [[heat illness]], [[hyperventilation]], [[hypocapnia]], [[hypoglycemia]], [[Implantable cardioverter defibrillator|implanted cardioverter defibrillator malfunction]], [[Laughter-induced syncope|laughing]], [[micturition]], [[post-exercise]], [[Food coma|postprandial hypotension]], [[Bed rest|prolonged bed rest]], [[sneeze]], [[Hypovolemia|significant blood loss]], [[valsalva maneuver]], [[vomiting]], [[Physical exercise|weightlifting]]
|-
|}


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
*[[Addison's Disease]]
{{col-begin|width=80%}}
*[[Adriamycin]]
{{col-break|width=33%}}
*[[Alpha-blockers]]
*[[ACEI|ACE inhibitor]]
*[[Alcohol]]
*[[Acute coronary syndrome]]
*[[Anemia]]
*[[Acute myocardial infarction]]
*[[Antiarrythmics]]
*[[Acute myocarditis]]
*[[Antihypertensives]]
*[[Adams-Stokes syndrome]]
*[[Alpha blockers]]
*[[Amitriptyline]]
*[[Anaphylaxis]]
*[[Anomalous origins of coronary arteries]]
*[[Anorexia nervosa]]
*[[Antiarrhythmics]]
*[[Antidepressants]]
*[[Antiemetics]]
*[[Antihypertensive|Antihypertensive medications]]
*[[Antipsychotic agents]]
*[[Anxiety]]
*[[Anxiety]]
*[[Aortic Stenosis]]
*[[Aortic aneurysm]]
*[[Aortic Dissection]]
*[[Aortic dissection]]
*[[Arteriosclerosis]] of the carotid arteries
*[[Aortic stenosis]]
*[[Arteriosclerosis]] of cerebral vessels
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Arrhythmia]]
*[[Atrial myxoma]]
*[[Autonomic insufficiency]]
*[[Atrioventricular block]]
*[[AVNRT|AV nodal reentrant tachycardia]]
*[[Barbiturates]]
*[[Barbiturates]]
*[[Beta blockers]]
*[[Beta blockers]]
*[[Bicisate dihydrochloride]],
*[[Bifascicular block]]
*[[Bradyarrhythmia]]
*[[Bradyarrhythmia]]
*[[Cardiac Tamponade]]
*[[Breath-holding spells|Breath holding spells]]
*[[Cardiomyopathy]]
*[[Bromocriptine]]
*[[Carotid Sinus Hypersensitivity]]
*[[Brugada syndrome]]
*[[Cerebrovascular Disease]]
*[[Calcium channel blocker]]
*[[Carbon monoxide]]
*[[Carcinoid syndrome]]
*[[Cardiac tamponade]]
*[[Carotid sinus hypersensitivity]]
*[[Catecholaminergic polymorphic ventricular tachycardia]]
*[[Channelopathy]]
*[[Chlorpheniramine]]
*[[Choking game]]
*[[Cinnarizine]]
*[[Clonidine]]
*[[Cocaine]]
*[[Atrioventricular block|Complete atrioventricular block]]
{{col-break|width=33%}}
*[[Cough]]
*[[Cough]]
*[[Cerebrovascular accident]] or [[stroke]]
*[[Defecation]]
*[[Defecation]]
*[[Deglutition]]
*[[Dehydration]]
*[[Dehydration]]
*[[Diarrhea]]
*[[Desipramine]]
*[[Digitalis]]
*[[Digoxin]]
*[[Dilated cardiomyopathy]]
*[[Diphenhydramine]]
*[[Diuretics]]
*[[Diuretics]]
*[[Heart failure]]
*[[Dothiepin]]
*[[Drop attack]]
*[[Dysautonomia]]
*[[Emotional stress]]
*[[Epsilon wave]]
*[[Erectile dysfunction medical therapy|Erectile dysfunction medications]]
*[[Ethanol]]
*[[Ferric Carboxymaltose]]
*[[Ganglionic blocker|Ganglionic blockers]]
*[[Gastrointestinal bleeding]]
*[[Hair-grooming syncope|Hair combing]]
*[[Heat illness]]
*[[Hemorrhage]]
*[[Hydralazine]]
*[[Hydralazine]]
*[[Hydroxyzine]]
*[[Hypertrophic cardiomyopathy]]
*[[Hyperventilation]]
*[[Hypocapnia]]
*[[Hypoglycemia]]
*[[Hypoglycemia]]
*[[Hypotension]]
*[[Hypoxia]]
*[[Hypoxia]]
*[[Hypovolemia]]
*[[Hysteria|Hysterical faint]]
*[[Hyperbradykininemia]]
*[[Implantable cardioverter defibrillator|Implanted cardioverter defibrillator malfunction]]
*[[Hypertensive encephalopathy]]
*[[Interferon-gamma]]
*[[Hypertrophic obstructive cardiomyopathy]]
*[[Ixabepilone]]
*[[Hyperventilation]]
*[[Jervell and Lange-Nielsen syndrome]]
*[[Hysteria]]
*[[L-dopa]]
*[[Methamphetamine]]
*[[Laughter-induced syncope|Laughing]]<ref name="Nishida-2008">{{Cite journal  | last1 = Nishida | first1 = K. | last2 = Hirota | first2 = SK. | last3 = Tokeshi | first3 = J. | title = Laugh syncope as a rare sub-type of the situational syncopes: a case report. | journal = J Med Case Rep | volume = 2 | issue =  | pages = 197 | month =  | year = 2008 | doi = 10.1186/1752-1947-2-197 | PMID = 18538031 }}</ref>
*[[Lewy body dementia]]
*[[Long QT syndrome]]
*[[Micturition]]
*[[Micturition]]
*[[Migrane]]
*[[Mitral stenosis]]
*[[Myocarditis]]
*[[AV block|Mobitz type II heart block]]
*[[Myocardial infarction]]
*[[Multiple system atrophy]]
*[[Nabilone]]
*[[Niacin]]
*[[Nilutamide]]
*[[Nitrates]]
*[[Nitrates]]
*[[Nortriptyline]]
{{col-break|width=33%}}
*[[Opiates]]
*[[Opiates]]
*[[Oprelvekin]]
*[[Orthostatic hypotension]]
*[[Orthostatic hypotension]]
*[[Pacemaker malfunction]]
*[[Oxaprozin]]
*[[Parkinson disease]]
*[[Paroxysmal ventricular tachycardia]]
*[[Pergolide]]
*[[Atrial flutter|Persistent atrial flutter]]
*[[Phenothiazines]]
*[[Phenothiazines]]
*[[Pulmonary embolism]]
*[[Post-exercise]]
*Reduced [[pulmonary artery]] flow
*[[Food coma|Postprandial hypotension]]
*[[Sedatives]]
*[[Preexcitation syndrome]]
*[[Seizures]]
*[[Bed rest|Prolonged bed rest]]
*[[Sick sinus disease]]
*[[QT prolongation|Prolonged corrected QT interval]]
*[[Situational syncope]]
*[[Psychogenic non-epileptic seizures|Psychogenic pseudosyncope]]<ref name="Benbadis-2006">{{Cite journal  | last1 = Benbadis | first1 = SR. | last2 = Chichkova | first2 = R. | title = Psychogenic pseudosyncope: an underestimated and provable diagnosis. | journal = Epilepsy Behav | volume = 9 | issue = 1 | pages = 106-10 | month = Aug | year = 2006 | doi = 10.1016/j.yebeh.2006.02.011 | PMID = 16697264 }}</ref>
*[[Somatization disorder]]
*[[Pulmonic stenosis]]
*[[Stokes-Adams attack]]
*[[Retroperitoneal hemorrhage]]
*[[Ruptured abdominal aortic aneurysm]]
*[[Pulmonary embolism classification|Saddle embolus]]
*[[AV block|Second degree AV block]]
*[[Seizure]]
*[[Short QT syndrome|Short corrected QT interval]]
*[[Short QT syndrome]]
*[[Sick sinus syndrome]]
*[[Hypovolemia|Significant blood loss]]
*[[Sinoatrial arrest|Significant sinus pause]]
*[[Sneeze]]
*[[Sodium oxybate]]
*[[Spinal cord injury]]
*[[Subarachnoid hemorrhage]]
*[[Subclavian steal syndrome]]
*[[Subclavian steal syndrome]]
*[[Sympathectomy]]
*[[Supraventricular tachycardia|Supraventricular tachyarrhythmia]]
*[[Tacharrhythmia]]
*[[Takayasu's arteritis]]
*[[Takayasu's arteritis]]
*[[Tiagabine]]
*[[Transient ischemic attack]]
*[[Transient ischemic attack]]
*[[Trauma]]
*[[Trauma|Trauma with significant blood loss]]
*[[Tricyclic antidepressants]]
*[[Tricyclic antidepressants]]
*[[Vasovagal syncope]]
*[[Uremia]]
*[[Vagal stimulation]]
*[[Valsalva maneuver]]
*[[Valsalva maneuver]]
*Valve [[thrombus]]
*[[Vasodilators]]
*[[Valvular disease]]
*[[Ventricular arrhythmia]]
*[[Ventricular tachycardia]]
*[[Ventricular tachycardia]]
*[[Vertebrobasilar insufficiency]]
*[[Vomiting]]
*[[Physical exercise|Weightlifting]]
*[[Wolff-Parkinson-White syndrome]]
{{col-end}}


==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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