Syncope risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Syncope is a sign of insufficient cerebral blood flow and it should be evaluated for the underlying cause. Possible underlying causes of syncope include structural heart disease, vasovagal syncope and arrhythmia. Risk factors associated with the development of either of these disorders may contribute to the development of syncope.

Risk Factors

Syncope is a sign of insufficient cerebral blood flow and it should be evaluated for the underlying cause. Possible underlying causes of syncope include structural heart disease, vasovagal syncope

• Common risk factors associated with cardiac causes of 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)
• 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

• The following factors has been associated with increased risk of orthostatic syncope:

• • 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)