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#redirect:[[Syncope]]
__NOTOC__
{{SI}}
{{CMG}}; {{VR}}
 
{{SK}} Fainting
==Overview==
'''Presyncope''' is a state consisting of [[lightheadedness]],<ref name="urlChapter 14: Evaluation of the Dizzy Patient">{{cite web |url=http://www.dartmouth.edu/~dons/part_2/chapter_14.html#chpt_14_presyncope| work=Disorders of the nervous system: a primer | publisher=Dartmouth Medical School|last=Reeves | first= Alexander G | coauthors =Rand S. Swenson |title=Chapter 14: Evaluation of the Dizzy Patient |accessdate=2012-01-06}}</ref> muscular weakness, and feeling faint (as opposed to a [[Syncope (medicine)|syncope]], which is actually fainting). Pre-syncope is most often cardiovascular in [[Etiology_(medicine)|etiology]]. In many patients, lightheadedness is a symptom of [[orthostatic hypotension]]. Orthostatic hypotension occurs when blood pressure drops significantly when the patient stands from a supine or sitting position. If loss of consciousness occurs in this situation, it is termed syncope.
 
Presyncope is frequently reported in patients with forms of [[Dysautonomia]] such as the [[Postural Tachycardia Syndrome]].
 
According to McGraw-Hill Concise Dictionary of Modern Medicine &copy; 2002, presyncope is "An episode of near-fainting which may include lightheadedness, dizziness, severe weakness, blurred vision, which may precede a syncopal episode."
 
==Causes==
===Life-Threatening Causes===
*[[Hemorrhage]]
*[[Hypotension]]
*[[Hypoxia]]
*[[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>
 
===Common Causes===
*[[Arrhythmia]]
*[[Medication]]
*[[Orthostatic hypotension]]
*[[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>
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[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]], [[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]], [[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]], [[alpha blockers]], [[amitriptyline]], [[antiarrhythmics]], [[antidepressants]], [[antiemetics]], [[Antihypertensive|antihypertensive medications]], [[antipsychotic agents]], [[barbiturates]], [[beta blockers]], [[bromocriptine]], [[calcium channel blocker]][[chlorpheniramine]], [[cinnarizine]], [[clonidine]], [[desipramine]], [[digoxin]], [[diphenhydramine]], [[diuretics]], [[dothiepin]], [[Erectile dysfunction medical therapy|erectile dysfunction medications]], [[Ganglionic blocker|ganglionic blocker]], [[hydralazine]], [[hydroxyzine]], [[L-dopa]], [[nitrates]], [[nortriptyline]], [[opiates]], [[phenothiazines]], [[tricyclic antidepressants]], [[vasodilators]]
|-
|-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===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[ACEI|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|Antihypertensive medications]]
*[[Antipsychotic agents]]
*[[Anxiety]]
*[[Aortic aneurysm]]
*[[Aortic dissection]]
*[[Aortic stenosis]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Atrial myxoma]]
*[[Atrioventricular block]]
*[[AVNRT|AV nodal reentrant tachycardia]]
*[[Barbiturates]]
*[[Beta blockers]]
*[[Bifascicular block]]
*[[Bradyarrhythmia]]
*[[Breath-holding spells|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]]
*[[Atrioventricular block|Complete atrioventricular block]]
{{col-break|width=33%}}
*[[Cough]]
*[[Defecation]]
*[[Deglutition]]
*[[Dehydration]]
*[[Desipramine]]
*[[Digoxin]]
*[[Dilated cardiomyopathy]]
*[[Diphenhydramine]]
*[[Diuretics]]
*[[Dothiepin]]
*[[Drop attack]]
*[[Dysautonomia]]
*[[Emotional stress]]
*[[Epsilon wave]]
*[[Erectile dysfunction medical therapy|Erectile dysfunction medications]]
*[[Ethanol]]
*[[Ganglionic blocker|Ganglionic blockers]]
*[[Gastrointestinal bleeding]]
*[[Hair-grooming syncope|Hair combing]]
*[[Heat illness]]
*[[Hemorrhage]]
*[[Hydralazine]]
*[[Hydroxyzine]]
*[[Hypertrophic cardiomyopathy]]
*[[Hyperventilation]]
*[[Hypocapnia]]
*[[Hypoglycemia]]
*[[Hypotension]]
*[[Hypoxia]]
*[[Hysteria|Hysterical faint]]
*[[Implantable cardioverter defibrillator|Implanted cardioverter defibrillator malfunction]]
*[[Jervell and Lange-Nielsen syndrome]]
*[[L-dopa]]
*[[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]]
*[[Mitral stenosis]]
*[[AV block|Mobitz type II heart block]]
*[[Multiple system atrophy]]
*[[Nitrates]]
*[[Nortriptyline]]
{{col-break|width=33%}}
*[[Opiates]]
*[[Orthostatic hypotension]]
*[[Parkinson disease]]
*[[Paroxysmal ventricular tachycardia]]
*[[Atrial flutter|Persistent atrial flutter]]
*[[Phenothiazines]]
*[[Post-exercise]]
*[[Food coma|Postprandial hypotension]]
*[[Preexcitation syndrome]]
*[[Bed rest|Prolonged bed rest]]
*[[QT prolongation|Prolonged corrected QT interval]]
*[[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>
*[[Pulmonic stenosis]]
*[[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]]
*[[Spinal cord injury]]
*[[Subarachnoid hemorrhage]]
*[[Subclavian steal syndrome]]
*[[Supraventricular tachycardia|Supraventricular tachyarrhythmia]]
*[[Takayasu's arteritis]]
*[[Transient ischemic attack]]
*[[Trauma|Trauma with significant blood loss]]
*[[Tricyclic antidepressants]]
*[[Uremia]]
*[[Vagal stimulation]]
*[[Valsalva maneuver]]
*[[Vasodilators]]
*[[Ventricular arrhythmia]]
*[[Ventricular tachycardia]]
*[[Vertebrobasilar insufficiency]]
*[[Vomiting]]
*[[Physical exercise|Weightlifting]]
*[[Wolff-Parkinson-White syndrome]]
{{col-end}}
 
==Clinical test==
The [[tilt table test]] is an evaluative clinical test to help identify presyncope or [[syncope]].<ref name = "natale">Natale, A., Akhtar, M., Jazayeri, M., Dhala, A., Blanck, Z., Deshpande, S., et al. (1995). Provocation of Hypotension During Head-Up Tilt Testing in Subjects With No History of Syncope or Presyncop. American Heart Association, (92), 54-58. doi: 10.1161/01.CIR.92.1.54; url: http://circ.ahajournals.org/content/92/1/54.full</ref> A tilt angle of 60 and 70 degrees is optimal and maintains a high degree of specificity.<ref name = "natale" />  A positive sign with the tilt table test must be taken in context of patient history, with consideration of pertinent clinical findings before coming to a conclusion.
 
== References ==
{{Reflist|2}}
 
[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Neurology]]
[[Category:Nutrition]]
[[Category:Metabolic disorders]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
 
{{WH}}
{{WS}}

Revision as of 17:56, 25 July 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vendhan Ramanujam M.B.B.S [2]

Synonyms and keywords: Fainting

Overview

Presyncope is a state consisting of lightheadedness,[1] muscular weakness, and feeling faint (as opposed to a syncope, which is actually fainting). Pre-syncope is most often cardiovascular in etiology. In many patients, lightheadedness is a symptom of orthostatic hypotension. Orthostatic hypotension occurs when blood pressure drops significantly when the patient stands from a supine or sitting position. If loss of consciousness occurs in this situation, it is termed syncope.

Presyncope is frequently reported in patients with forms of Dysautonomia such as the Postural Tachycardia Syndrome.

According to McGraw-Hill Concise Dictionary of Modern Medicine © 2002, presyncope is "An episode of near-fainting which may include lightheadedness, dizziness, severe weakness, blurred vision, which may precede a syncopal episode."

Causes

Life-Threatening Causes

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, 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, antiarrhythmics, antidepressants, antiemetics, antihypertensive medications, antipsychotic agents, barbiturates, beta blockers, bromocriptine, calcium channel blockerchlorpheniramine, cinnarizine, clonidine, desipramine, digoxin, diphenhydramine, diuretics, dothiepin, erectile dysfunction medications, ganglionic blocker, hydralazine, hydroxyzine, L-dopa, nitrates, nortriptyline, opiates, phenothiazines, tricyclic antidepressants, vasodilators
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

Clinical test

The tilt table test is an evaluative clinical test to help identify presyncope or syncope.[6] A tilt angle of 60 and 70 degrees is optimal and maintains a high degree of specificity.[6] A positive sign with the tilt table test must be taken in context of patient history, with consideration of pertinent clinical findings before coming to a conclusion.

References

  1. ↑ Reeves, Alexander G. "Chapter 14: Evaluation of the Dizzy Patient". Disorders of the nervous system: a primer. Dartmouth Medical School. Retrieved 2012-01-06. Unknown parameter |coauthors= ignored (help)
  2. ↑ 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)
  3. ↑ Kapoor, WN. (2000). "Syncope". N Engl J Med. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Unknown parameter |month= ignored (help)
  4. ↑ 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.
  5. ↑ 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)
  6. ↑ 6.0 6.1 Natale, A., Akhtar, M., Jazayeri, M., Dhala, A., Blanck, Z., Deshpande, S., et al. (1995). Provocation of Hypotension During Head-Up Tilt Testing in Subjects With No History of Syncope or Presyncop. American Heart Association, (92), 54-58. doi: 10.1161/01.CIR.92.1.54; url: http://circ.ahajournals.org/content/92/1/54.full

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