Syncope causes

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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]

Overview

More serious causes of syncope include cardiac (heart-related) causes such as an abnormal heart rhythm (an arrhythmia), where the heart beats too slowly, too rapidly or too irregularly to pump enough blood to the brain. Other important cardio-vascular conditions that can be manifested by syncope include subclavian steal syndrome and aortic stenosis. Vasovagal (situational) syncope, one of the most common types, may occur in scary or embarrassing situations or during blood drawing, coughing, or urinating

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.

• Hemorrhage
• Hypotension
• Hypoxia
• Ruptured abdominal aortic aneurysm
• Ventricular arrhythmia

Common Causes

• Arrhythmia
• Medication
• Orthostatic hypotension
• Vagal stimulation
• Vertebrobasilar insufficiency

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, 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, 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, alpha blockers, amitriptyline, Amobarbital sodium, antiarrhythmics, antidepressants, antiemetics, antihypertensive medications, antipsychotic agents, barbiturates, beta blockers, Bicalutamide, bromocriptine, calcium channel blocker, Chlordiazepoxide, chlorpheniramine, cinnarizine, Clomifene, clonidine, clozapine, desipramine, digoxin, diphenhydramine, disulfiram, diuretics, dothiepin, erectile dysfunction medications, ganglionic blocker, hydralazine, hydroxyzine, Interferon-gamma, Levalbuterol, L-dopa, Meropenem, Methocarbamol, Nabilone, nabumetone, nitrates, nortriptyline, olanzapine opiates, orphenadrine, oxazepam, oxcarbazepine, Pentamidine, prednisolone, Isethionate, phenothiazines, rifaximin, Ritonavir, ropinirole, Secobarbital sodium, sertraline, sulindac, tricyclic antidepressants, vasodilators, zolmitriptan, zonisamide, Calcium gluconate
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

• ACE inhibitor
• Acute coronary syndrome
• Acute myocardial infarction
• Acute myocarditis
• Adams-Stokes syndrome
• Alpha blockers
• Amitriptyline
• Anaphylaxis
• Anomalous origins of coronary arteries
• Anorexia nervosa
• Antiarrhythmics
• Antidepressants
• Antiemetics
• Antihypertensive medications
• Antipsychotic agents
• Anxiety
• Aortic aneurysm
• Aortic dissection
• Aortic stenosis
• Arrhythmogenic right ventricular dysplasia
• Atrial myxoma
• Atrioventricular block
• AV nodal reentrant tachycardia
• Barbiturates
• Beta blockers
• Bifascicular block
• Bradyarrhythmia
• Breath holding spells
• Bromocriptine
• Brugada syndrome
• Calcium channel blocker
• Carbon monoxide
• Carcinoid syndrome
• Cardiac tamponade
• Carotid sinus hypersensitivity
• Catecholaminergic polymorphic ventricular tachycardia
• Channelopathy
• Chlorpheniramine
• Choking game
• Cinnarizine
• Clonidine
• Cocaine
• Complete atrioventricular block

• Cough
• Defecation
• Deglutition
• Dehydration
• Desipramine
• Digoxin
• Dilated cardiomyopathy
• Diphenhydramine
• Diuretics
• Dothiepin
• Drop attack
• Dysautonomia
• Emotional stress
• Epsilon wave
• Erectile dysfunction medications
• Ethanol
• Ganglionic blockers
• Gastrointestinal bleeding
• Hair combing
• Heat illness
• Hemorrhage
• Hydralazine
• Hydroxyzine
• Hypertrophic cardiomyopathy
• Hyperventilation
• Hypocapnia
• Hypoglycemia
• Hypotension
• Hypoxia
• Hysterical faint
• Implanted cardioverter defibrillator malfunction
• Interferon-gamma
• Jervell and Lange-Nielsen syndrome
• L-dopa
• Laughing
• Lewy body dementia
• Long QT syndrome
• Micturition
• Mitral stenosis
• Mobitz type II heart block
• Multiple system atrophy
• Nabilone
• Nitrates
• Nortriptyline

• Opiates
• Orthostatic hypotension
• Parkinson disease
• Paroxysmal ventricular tachycardia
• Persistent atrial flutter
• Phenothiazines
• Post-exercise
• Postprandial hypotension
• Preexcitation syndrome
• Prolonged bed rest
• Prolonged corrected QT interval
• Psychogenic pseudosyncope
• Pulmonic stenosis
• Retroperitoneal hemorrhage
• Ruptured abdominal aortic aneurysm
• Saddle embolus
• Second degree AV block
• Seizure
• Short corrected QT interval
• Short QT syndrome
• Sick sinus syndrome
• Significant blood loss
• Significant sinus pause
• Sneeze
• Spinal cord injury
• Subarachnoid hemorrhage
• Subclavian steal syndrome
• Supraventricular tachyarrhythmia
• Takayasu's arteritis
• Transient ischemic attack
• Trauma with significant blood loss
• Tricyclic antidepressants
• Uremia
• Vagal stimulation
• Valsalva maneuver
• Vasodilators
• Ventricular arrhythmia
• Ventricular tachycardia
• Vertebrobasilar insufficiency
• Vomiting
• Weightlifting
• Wolff-Parkinson-White syndrome

References

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