Neurocardiogenic syncope natural history
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Vasovagal syncope usually has an easily identified triggering event such as emotional stress, trauma, pain, the sight of blood, or prolonged standing. Sycope recurs in few, while others just experience a single episode. Mortality associated with syncope is largely associated with the underlying etiology if any.
Natuaral History
The natural history is extremely variable; some patients experience single episode while others have recurrent episodes. [1]
In a european study, 465 patients were evaluated for the early (1 month) and late (2 years) death rate and syncopal relapses of patients referred for syncope to 11 general hospitals emergency departments. The following results were found:[2]
- The death rate was higher (17% of all deaths) in the first month of observation
- Reoccurrence of the syncopal episode was low overall in both the short and the long term (0.3% and 0.8% in the first month and in the second year, respectively).
- Mortality was higher in patients having previous cardiovascular disease or in those displaying ECG abnormalities. Both of these two factors represent the main predictors of short- or long-term mortality on multivariate analysis
Prognosis
Vasovagal syncope appears to have a benign prognosis.[3] People recover completely within minutes to hours. Patients with clinical neurocardiogenic syncope have excellent prognosis as far as survival is concerned.[4] If syncope is symptomatic of an underlying condition, then the prognosis will reflect the course of the disorder.
Complication
The main danger of fainting fits or vasovagal syncope is the risk of injury by falling while unconscious. If the etiology of syncope remains unclear, the patient should be stratified with respect to the risk of a cardiovascular event and/or sudden cardiac death and further evaluation is required. [5]
The mortality depends on to the underlying cause:[6]
- Cardiac causes (arrhythmias or cardiovascular disease) have a 20-30% mortality.
- Non-cardiac causes have 5-10% mortality.
Reference
- ↑ Alboni P, Brignole M, Degli Uberti EC (2007). "Is vasovagal syncope a disease?". Europace. 9 (2): 83–7. doi:10.1093/europace/eul179. PMID 17272328.
- ↑ Ungar A, Del Rosso A, Giada F, Bartoletti A, Furlan R, Quartieri F; et al. (2010). "Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study". Eur Heart J. 31 (16): 2021–6. doi:10.1093/eurheartj/ehq017. PMID 20167743.
- ↑ Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ; et al. (2002). "Incidence and prognosis of syncope". N Engl J Med. 347 (12): 878–85. doi:10.1056/NEJMoa012407. PMID 12239256.
- ↑ Ruiz GA, Peralta A, Gonzalez-Zuelgaray J, Duce E (1995). "Evolution of patients with clinical neurocardiogenic (vasovagal) syncope not subjected to specific treatment". Am Heart J. 130 (2): 345–50. PMID 7631619.
- ↑ Veltmann C, Borggrefe M, Wolpert C, Schimpf R (2010). "Evaluation and management of syncope". Minerva Cardioangiol. 58 (6): 701–15. PMID 21135810.
- ↑ White CM, Tsikouris JP (2000). "A review of pathophysiology and therapy of patients with vasovagal syncope". Pharmacotherapy. 20 (2): 158–65. PMID 10678294.