Syncope causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2] Sara Zand, M.D.[3]

Overview

Peripheral vascular resistance and cardiac output are the two main determinants for the presentation of syncope. autonomic nervous system impairment due to drugs or an autonomic failure, can lead to a decrease in peripheral vascular resistance. Reflex activity impairment may also cause a decrease of peripheral vascular resistance, as the body normal compensation reflexes fail. The decrease in cardiac output may be due to venous pooling, cardioinhibitory reflexes, arrhythmia, pulmonary embolism, and volume depletion leading to diminished venous return, among others.

Causes

Peripheral vascular resistance and cardiac output are the two main determinants for the presentation of syncope. autonomic nervous system impairment due to drugs or an autonomic failure, can lead to a decrease in peripheral vascular resistance. Reflex activity impairment may also cause a decrease of peripheral vascular resistance, as the body normal compensation reflexes fail. Decrease in cardiac output may be due to venous pooling, cardioinhibitory reflexes, arrhythmia, hypertension, pulmonary embolism, and volume depletion leading to diminished venous return, among others.

Life threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.^[1]

Arrhythmia causes of syncope	Cardiovascular non arrhythmia causes of syncope	Non cardiac causes of syncope
Sustained or symptomatic VT Symptomatic conduction system disease or Mobitz II or third-degree heart block Symptomatic bradycardia or sinus pauses not related to neurally mediated syncope Symptomatic SVT Pacemaker/ICD malfunction Inheritable cardiac conditions predisposing to arrhythmias	Ischemic heart disease Severe aortic stenosis Cardiac tamponade Hypertrophic cardiomyopathy Severe prosthetic valve dysfunction Pulmonary embolism Aortic dissection Acute heart failure Moderate-to-severe left ventricle dysfunction	Severe anemia/gastrointestinal bleeding Major traumatic injury due to syncope Persistent vital sign abnormalities

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,Meprobamate, 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, tuberculin,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, Alfuzosin, alpha blockers, amitriptyline, Amobarbital sodium, antiarrhythmics, antidepressants, antiemetics, antihypertensive medications, antipsychotic agents, barbiturates, beta blockers, Bicalutamide, bicisate dihydrochloride,bromocriptine, calcium channel blocker, Chlordiazepoxide, chlorpheniramine, cinnarizine, Clomifene, clonidine, clozapine, desipramine, digoxin, diphenhydramine, disulfiram, diuretics, dothiepin, Dolasetron mesylate, erectile dysfunction medications, Ferric Carboxymaltose,Folinic acid, ganglionic blocker, hydralazine, Hydrocortisone, hydroxyzine, Iloperidone, Interferon-gamma, Ixabepilone, Lacosamide, Levalbuterol, L-dopa, Loxapine, Meropenem, Methocarbamol, Mitomycin, Nabilone, nabumetone, Niacin, Nilutamide, nitrates, nortriptyline, olanzapine opiates, orphenadrine, oxazepam, oxcarbazepine, Pentamidine, Pergolide, prednisolone, Isethionate, Oprelvekin, Oxaprozin, phenothiazines, rifaximin, Ritonavir, ropinirole, Rotigotine, Secobarbital sodium, sertraline, Sodium oxybate, Sodium aurothiomalate, sulindac, Tiagabine, tricyclic antidepressants, Trospium, vasodilators, zolmitriptan, zonisamide, Calcium gluconate, Cefaclor
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

References

↑ 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.
↑ Prandoni, Paolo; Lensing, Anthonie W.A.; Prins, Martin H.; Ciammaichella, Maurizio; Perlati, Marica; Mumoli, Nicola; Bucherini, Eugenio; Visonà, Adriana; Bova, Carlo; Imberti, Davide; Campostrini, Stefano; Barbar, Sofia (2016-10-20). "Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope". New England Journal of Medicine. 375 (16): 1524–1531. doi:10.1056/NEJMoa1602172. ISSN 1533-4406 0028-4793, 1533-4406 Check |issn= value (help). Retrieved 2016-10-21.
↑ 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)
↑ Kapoor, WN. (2000). "Syncope". N Engl J Med. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Unknown parameter |month= ignored (help)
↑ 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.
↑ 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)

[ShenSheldon2017-1] 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] Prandoni, Paolo; Lensing, Anthonie W.A.; Prins, Martin H.; Ciammaichella, Maurizio; Perlati, Marica; Mumoli, Nicola; Bucherini, Eugenio; Visonà, Adriana; Bova, Carlo; Imberti, Davide; Campostrini, Stefano; Barbar, Sofia (2016-10-20). "Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope". New England Journal of Medicine. 375 (16): 1524–1531. doi:10.1056/NEJMoa1602172. ISSN 1533-4406 0028-4793, 1533-4406 Check |issn= value (help). Retrieved 2016-10-21.

[Khoo-2013-3] 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)

[Kapoor-2000-4] Kapoor, WN. (2000). "Syncope". N Engl J Med. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Unknown parameter |month= ignored (help)

[Nishida-2008-5] 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.

[Benbadis-2006-6] 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)

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