Syncope natural history, complications and prognosis

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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

Patients with syncope are at risk of the development of complications, such as trauma from frequent falls and Sudden cardiac death. The prognosis of syncope depends on underlying causes. Syncope caused by cardiovascular diseases may be life-threatening and is an important cause of sudden cardiac death. Prognosis of vasovagal syncope is favorable.

Natural history, Complications and Prognosis

Natural History

If underlying cause of syncope left untreated and syncope occurs frequently, patients with syncope may suffer from trauma of the head and neck and sudden cardiac death due to fatal cardiac arrhythmia.

  • Clinical characteristic of uncommon causes of syncope include the following:[1][2][3]


Uncommon conditions associated with syncope Clinical aspect Cause of syncope
Cardiac tamponade Hypotension, tachycardia, cardiogenic shock Tachycardia, hypotension, abrupt bradycardia
Constrictive pericarditis Heart failure symptoms, exertional dyspnea, orthopnea, edema Cough syncope
Left ventricular non compaction Trabeculation or recess in left ventricle Tachyarrhythmia
Takotsubo cardiomyopathy Apical ballooning , basal hyperkinesia , following stressful event, chest pain and ECG change mimicking ischemia Uncommon cause of syncope, multifactorial
Pulmonary embolus Cardiac arrest and pulseless electrical activity following hypoxia, tachycardia, hypotension and shock Bradycardia, hypotension
Pulmonary arterial hypertension Exertional syncope, specially in younger patients Peripheral vasodilation following exercise, low cardiac output state
Amyloidosis Amyloid deposition in heat, kidney, peripheral and autonomic nervous system AV block, arrhythmia, low cardiac output due to restrictive cardiomyopathy
Hemochromatosis Dilated cardiomyopathy due to Iron deposition Myocardial involvement, sick sinuse syndrome, AV block
Myocarditis Chest pain, arrhythmia, left ventricular systolic dysfunction, hemodynamic collapse Ventricular tachycardia, AV block, transient hemodynamic collapse
Lyme disease Myocarditis accompanied by erythma migrant, neurologic involvement AV block, vasovagal syncope
disease Cardiomyopathy caused by trypanosomiasis Ventricular tachycardia, AV block
Friedreich ataxia Hypertrophic Cardiomyopathy (HCM), gait ataxia, bladder dysfunction Tachycardia, bradycardia, SCD is common
Cardiac tumors Triad of valve obstruction , emboli, systemic signs and symptoms Obstruction to blood flow
Prosthetic valve thrombosis Asymptomatic or symptomatic heart failure Embolic event, valve obstruction
Anomalous coronary artery Common cause of exertional syncope and SCD specially in young athletes Bezold jarisch reflex,hypotension, VT, AV block
Subclavian steal syndrome Significant stenosis in subclavian artery leading flow reversal in vertebral artery and vertebrobasilar ischemia and syncope Syncope following upper extremities activity
Aortic dissection Neurologic symptoms, heart failure symptoms, myocardial infarction Increased risk of inhospital death, tamponade, neurologic deficit in patients with syncope
Coarctation of the aorta (COA) Heart failure symptoms, dissection of aorta Associated with bicuspid aortic valve stenosis
Rheumatoid arthritis Systemic inflammatory disorder Complete heart block
Carcinoid syndrome, Pheochromocytoma, Mastocytosis,  Vasoactive intestinal peptide tumor Vasodilation, flushing, pruritus, gastrointestinal symptoms Transient hypotension
Beta thalassemia major Dilated cardiomyopathy , severe anemia, multiple organ failure Arrhythmia
Migraine Association between headache and syncope Vasovagal syncope, orthostase intolerance
Seizure-induced bradycardia, hypotension Temporal lobe epilepsy Postictal bradyarrhythmia due to temporal lobe or limbic system

Complications

Patients with syncope are at risk of the development of the following complications:[4]

  • Frequent falls resulting in injuries to head and neck
  • Development of cardiovascular disorders
  • Sudden cardiac death
  • Death

Prognosis

The prognosis of syncope depends on underlying causes.[5][6]

References

  1. Shen, Win-Kuang; Sheldon, Robert S.; Benditt, David G.; Cohen, Mitchell I.; Forman, Daniel E.; Goldberger, Zachary D.; Grubb, Blair P.; Hamdan, Mohamed H.; Krahn, Andrew D.; Link, Mark S.; Olshansky, Brian; Raj, Satish R.; Sandhu, Roopinder Kaur; Sorajja, Dan; Sun, Benjamin C.; Yancy, Clyde W. (2017). "2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 136 (5). doi:10.1161/CIR.0000000000000499. ISSN 0009-7322.
  2. . doi:10.2169/internalmedicine.52.8818. Check |doi= value (help). Missing or empty |title= (help)
  3. Vasquez, Andres F.; Seger, John J. (2009). "An Uncommon Case of Heart Failure". Southern Medical Journal. 102 (11): 1183–1185. doi:10.1097/SMJ.0b013e3181b63b1c. ISSN 0038-4348.
  4. Auer, J. (2008). "Syncope and trauma. Are syncope-related traumatic injuries the key to find the specific cause of the symptom?". European Heart Journal. 29 (5): 576–578. doi:10.1093/eurheartj/ehm637. ISSN 0195-668X.
  5. Soteriades, Elpidoforos S.; Evans, Jane C.; Larson, Martin G.; Chen, Ming Hui; Chen, Leway; Benjamin, Emelia J.; Levy, Daniel (2002). "Incidence and Prognosis of Syncope". New England Journal of Medicine. 347 (12): 878–885. doi:10.1056/NEJMoa012407. ISSN 0028-4793.
  6. Saklani, Pradyot; Krahn, Andrew; Klein, George (2013). "Syncope". Circulation. 127 (12): 1330–1339. doi:10.1161/CIRCULATIONAHA.112.138396. ISSN 0009-7322.