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 risk factors of cardiac syncope include
Risk Factors
- 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
- Short term risk factors associated with the outcomes of syncope in the emergency department untill 30 days after event include:
- Male sex
- Older age (>60 y)
- No prodrome
- Palpitations preceding loss of consciousness
- Exertional syncope
- Structural heart disease
- Heart failure
- Cerebrovascular disease
- Family history of SCD
- Trauma
- Physical Examination or Laboratory Investigation
- Evidence of bleeding
- Persistent abnormal vital signs
- Abnormal ECG
- Positive troponin
- Long term risk factors associated with the outcomes of syncope > 30 days until one year after event include:
- Male sex
- Older age
- Absence of nausea/vomiting preceding syncopal event
- Ventricular arrhythmia
- Cancer
- Structural heart disease
- Heart failure
- Cerebrovascular disease
- Diabetes mellitus
- Physical Examination or Laboratory Investigation
- Abnormal ECG
- Lower GFR
- High CHADS score ( congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack)
- The following factors has been associated with increased risk of orthostatic syncope:[2]
- 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)
References
- ↑ . doi:10.1161/CIR.0000000000000499Circulation. Missing or empty
|title=(help) - ↑ Anil, OmMurti (2016). "Syncope: Approach to diagnosis". Journal of Clinical and Preventive Cardiology. 5 (3): 84. doi:10.4103/2250-3528.191099. ISSN 2250-3528.