Materiały źródłowe

• #1 Diagnosis and treatment of syncope

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861366/

  In the evaluation of patients with syncope, the critical first step is a detailed medical history. A diagnostic strategy based on initial evaluation is warranted. The importance of the initial evaluation goes well beyond its capability to make a diagnosis as it determines the most appropriate subsequent diagnostic pathways and risk evaluation. […] According to the Guidelines on Syncope of the European Society of Cardiology (ESC) the initial evaluation of a patient presenting with syncope consists of taking a careful history, and a physical examination, including orthostatic blood pressure measurements and standard electrocardiogram (ECG). […] Is loss of consciousness attributable to syncope or not? Differentiating true syncope from nonsyncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy.

• #1 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p303.html

  Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. […] A standardized approach to syncope evaluation reduces hospital admissions and medical costs, and increases diagnostic accuracy. The initial assessment for all patients presenting with syncope includes a detailed history, physical examination, and electrocardiography. The initial evaluation may diagnose up to 50% of patients and allows immediate short-term risk stratification. […] High-risk patients with cardiovascular or structural heart disease, history concerning for arrhythmia, abnormal electrocardiographic findings, or severe comorbidities should be admitted to the hospital for further evaluation.

• #1 Fainting: Causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/182524

  Fainting, or syncope, is a sudden and temporary loss of consciousness. It usually happens when there is a slight decrease in the amount of oxygen reaching the brain. […] Fainting is not usually serious, but sometimes, it can indicate an underlying medical issue. People should treat every case of fainting as a medical emergency until they have uncovered the cause and treated the symptoms. […] If a person faints and may have one of these conditions, they should seek medical attention. A doctor will likely recommend monitoring and possibly treatment for the condition. […] A fainting episode may be the symptom of a more severe underlying condition, such as heart disease. […] The doctor will ask about the person’s medical history and any medications they take regularly. […] If the tests do not show a treatable condition, the doctor will schedule a follow-up.

• #1 Syncope: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17536-syncope

  Syncope is also known as fainting. This is a temporary loss of consciousness with a quick recovery. […] However, you need treatment for certain causes, such as heart issues. […] Syncope can be a sign of a more serious condition. Its important to get treatment right away after you have an episode of syncope. Most people can prevent problems with syncope once they get an accurate diagnosis and proper treatment. […] If you have syncope, you should see a provider who can refer you to a syncope specialist for a complete evaluation. […] A syncope specialist will do a physical exam and a careful review of your medical history. […] You may then have one or more tests to help determine the cause of your syncope. […] Treatment options will depend on whats causing your syncope and the results of your evaluation and testing. The goal of treatment is to keep you from having episodes of syncope.

• #1 Syncope | Doctor

  https://patient.info/doctor/syncope

  Syncope is defined as transient loss of consciousness (TLoC) due to cerebral hypoperfusion, characterised by a rapid onset, short duration, and spontaneous complete recovery. […] Patients presenting with a history of blackouts, faints or collapse need careful evaluation to assess the precise nature of the problem. This is essential so as to assess both the risk of a serious underlying disorder and also the risk of recurrence and subsequent injury. […] A definite diagnosis for the cause of syncope in the elderly can be made in the majority of patients. […] An accurate history, including from an eye-witness if available, is essential and often alone will lead to a correct diagnosis. […] Recovery from syncope is usually associated with almost immediate restoration of appropriate behaviour and orientation but there may be marked fatigue.

• #1 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p303.html

  In cases of unexplained syncope, provocative testing and prolonged electrocardiographic monitoring strategies can be diagnostic. […] The treatment of neurally mediated and orthostatic hypotension syncope is largely supportive, although severe cases may require pharmacotherapy. Cardiac syncope may require cardiac device placement or ablation. […] A detailed history will suggest a diagnosis in up to 50% of patients and is the most important diagnostic tool in the evaluation of syncope. […] The examination should focus on initial vital signs; orthostatic blood pressure measurements; and vascular (pulses and carotid bruits), cardiac, pulmonary (evidence of congestive heart failure), abdominal, rectal, and skin/nail (anemia) signs. […] Continuous cardiac monitoring is the diagnostic standard to establish a correlation between symptoms and ECG findings. […] The treatment of syncope is directed at the underlying cause. Morbidity and mortality are generally low except in cardiac syncope; therefore, patient reassurance is an important part of treatment.

• #1 Vasovagal syncope – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/diagnosis-treatment/drc-20350531

  Diagnosing vasovagal syncope often begins with a physical exam. During the physical exam, your healthcare professional listens to your heart and takes your blood pressure. Your healthcare professional may massage the main arteries in your neck to see if that causes you to feel faint. […] Your healthcare professional also may recommend several tests to rule out other possible causes of your fainting particularly heart-related conditions. These tests may include: […] Electrocardiogram. This test records the electrical signals your heart produces. It can detect irregular heart rhythms and other cardiac conditions. You may need to wear a portable monitor for at least a day or as long as a month. […] Echocardiogram. This test uses ultrasound imaging to view the heart and look for conditions such as valve problems that can cause fainting.

• #1 Syncope Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/811669-workup

  Echocardiography is the test of choice for evaluating suspected mechanical cardiac causes of syncope. […] If a clinical suspicion of structural heart disease exists, transthoracic echocardiography can be useful in selected patients with syncope. […] Obtain a standard 12-lead electrocardiogram (ECG) in patients with syncope. […] This is a level A recommendation in the 2007 American College of Emergency Physicians (ACEP) consensus guidelines for syncope and a class I recommendation in the 2017 American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) syncope guidelines. […] Stress testing/electrophysiologic studies (EPS) have a higher diagnostic yield than the Holter monitor and should be obtained for any patient with a suspected arrhythmia as a cause of syncope. […] A cardiac stress test is appropriate for patients in whom cardiac syncope is suspected and who have risk factors for coronary atherosclerosis.

• #1 Diagnosis and treatment of syncope

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861366/

  Classical vasovagal syncope is diagnosed if precipitating events such as fear, severe pain, emotional distress, instrumentation or prolonged standing are associated with typical prodromal symptoms. […] Situational syncope is diagnosed if syncope occurs during or immediately after urination, defaecation, cough or swallowing. […] Orthostatic syncope is diagnosed when there is documentation of orthostatic hypotension (defined as a decrease in systolic blood pressure 20mmHg or a decrease of systolic blood pressure to 90mmHg) associated with syncope or presyncope. […] Cardiac ischaemia-related syncope is diagnosed when symptoms are present with ECG evidence of acute ischaemia with or without myocardial infarction. […] Arrhythmia-related syncope is diagnosed by ECG when there is sinus bradycardia 40 beats/min or repetitive sinoatrial blocks or sinus pauses 3s in the absence of medications known to have negative chronotropic effect.

• #1 Vasovagal syncope – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/diagnosis-treatment/drc-20350531

  Exercise stress test. This test studies heart rhythms during exercise. It’s usually conducted while you walk or jog on a treadmill. […] Blood tests. Your healthcare professional may look for conditions such as anemia that can cause or contribute to fainting spells. […] Tilt table test. If no heart conditions appear to cause your fainting, your healthcare professional may suggest that you undergo a tilt table test. During the test, you lie flat on your back on a table that changes positions, tilting you upward at various angles. A technician monitors your heart rhythms and blood pressure during the test to see if changing your posture affects them.

• #1 Syncope Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/811669-workup

  The American College of Radiology (ACR) considers no imaging studies as being appropriate in the setting of a low probability of cardiac or neurologic pathology, but chest radiography may be appropriate in select clinical scenarios. […] In the setting of a suspected cardiovascular origin of syncope or presyncope (on the basis of history, physical examination, and ECG findings), an appropriate initial imaging evaluation is resting transthoracic echocardiography (TTE). […] The American College of Cardiology (ACC), American Heart Association (AHA), and the Heart Rhythm Society (HRS) indicate no benefit to obtaining routine cardiac imaging in evaluating patients with syncope unless there is suspicion of a cardiac origin from findings on an initial assessment, including the patient’s history, physical examination, or electrocardiogram (class III).

• #1 Head-up tilt test – a rationale for using in diagnosis of syncope

  http://www.hvt-journal.com/articles/art225

  The most developed diagnostic options are in the case of arrhythmic syncope. Electrocardiographic monitoring is recommended if there are clinical or ECG data suggesting arrhythmias as a cause of syncope. […] HUTT (head-up tilt test) is a test aimed at triggering the neurocardiogenic reflex in predisposed persons. […] HUTT is indicated in patients with suspected reflex syncope when initial assessment does not allow to find a diagnosis. […] HUTT should not be performed in patients with syncope of unclear etiology whose epilepsy, neurological disorders or other cardiovascular diseases have not been ruled out, as well as to assess the effectiveness of treatment or patients with fainting without loss of consciousness. […] Head-up tilt test can be useful non-invasive examination for the diagnosis of syncope of unclear etiology when vasovagal mechanism is suspected.

• #1 Syncope Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/811669-workup

  The American College of Cardiology (ACC), American Heart Association (AHA), and the Heart Rhythm Society (HRS) recommend investigation and management in a hospital in the presence of a serious medical condition identified during the initial assessment of individuals presenting with syncope that may be relevant to its cause. […] They note that although targeted blood tests are reasonable for assessing selected patients with syncope identified from clinical evaluation, history and physical examination, and electrocardiographic (ECG) findings (class IIa), there’s no clarity regarding the utility of brain natriuretic peptide and high-sensitivity troponin levels in patients suspected of having a cardiac etiology of syncope (class IIb). Furthermore, there is no benefit to obtaining routine and comprehensive laboratory tests for evaluating patients with syncope (class III).

• #1 Syncope (Fainting) | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

  Syncope is also called fainting or passing out. […] It can be harmless or a symptom of an underlying medical condition. […] It’s important to determine the cause of syncope and any underlying conditions. […] However, several serious heart conditions, such as bradycardia, tachycardia or blood flow obstruction, can also cause syncope. […] Neurally mediated syncope (NMS) is the most common form of fainting and a frequent reason for emergency department visits. […] It’s harmless and rarely requires medical treatment. […] NMS usually happens after standing for a long time. […] Situational syncope, which is a type of NMS, is related to certain physical functions, such as violent coughing (especially in men), laughing, swallowing or urination. […] Cardiac (cardiovascular) syncope is caused by various heart conditions, such as bradycardia, tachycardia or certain types of low blood pressure.

• #1 Syncope or Fainting – Cardiac causes, symptoms, diagnosis & treatment

  http://www.krishnacardiac.com/dis_conditions/s_syn.htm

  Vasovagal syncope accounts for about 50 percent of all episodes of fainting. […] Your doctor may prescribe medication to prevent the recurrence of vasovagal syncope. […] Orthostatic hypotension or „postural syncope” is a potentially serious condition which occurs when your blood pressure significantly drops after you stand or sit up. […] Your doctor can treat orthostatic hypotension by treating the underlying illness or cause. […] Although certain irregular heart rates (arrhythmias) may cause syncope, fainting isn’t inevitable if you have an arrhythmia. […] Some of the arrhythmias which may cause fainting are: atrioventricular block, sinus node disorder, ventricular tachycardia, paroxysmal atrial tachycardia, atrial fibrillation, or bradycardia. […] Syncope may be caused by the following cardiac conditions: […] Carotid sinus sensitivity.

• #1 Syncope (Fainting) | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

  It can indicate an increased risk of sudden cardiac death. […] Conditions that may warrant hospital evaluation and treatment include various abnormal heart rhythms, coronary artery disease, severe aortic stenosis and pulmonary embolism. […] If evaluation suggests cardiac vascular abnormalities, or if you have experienced multiple instances of fainting due to heart problems, an ambulatory external or implantable cardiac monitor may be required. […] Anyone with syncope should receive an initial evaluation, including a detailed physical exam, medical history and blood pressure and heart rate check by a health care professional. […] A resting 12-lead ECG (electrocardiogram) also is recommended as part of an initial evaluation to provide information about the cause of syncope. […] Other tests, such as an exercise stress test, a Holter monitor and an echocardiogram, may be needed to assess for other cardiac causes.

• #1 Diagnosis and treatment of syncope

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861366/

  The presence of suspected or certain heart disease is associated with a higher risk of arrhythmias and mortality at one year. […] If cardiac evaluation does not show evidence of arrhythmia as a cause of syncope, evaluation for neurally-mediated syndromes is recommended only in those with recurrent or severe syncope. […] Neurologic disease may cause transient loss of consciousness (for example, certain seizures), but is almost never the cause of syncope. […] The cause of syncope may remain unexplained after the initial evaluation. […] For patients with unexplained syncope the most likely diagnosis is neurally-mediated for which the appropriate tests are described above. […] Establishing the basis for syncope (that is, determining the diagnosis) is a prerequisite for advising patients with regard to prognosis, and to developing an effective treatment strategy. […] Most patients with syncope require only reassurance and education regarding the nature of the disease and the avoidance of triggering events.

• #1 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/1100/syncope.html

  Syncope is an abrupt, transient, and complete loss of consciousness associated with an inability to maintain postural tone; recovery is rapid and spontaneous. The immediate cause of syncope is cerebral hypoperfusion, which may occur due to systemic vasodilation, decreased cardiac output, or both. The primary classifications of syncope are cardiac, reflex (neurogenic), and orthostatic. Evaluation focuses on history, physical examination (including orthostatic blood pressure measurements), and electrocardiographic results. If the findings are inconclusive and indicate possible adverse outcomes, additional testing may be considered. However, testing has limited utility, except in patients with cardiac syncope. Prolonged electrocardiographic monitoring, stress testing, and echocardiography may be beneficial in patients at higher risk of adverse outcomes from cardiac syncope. Neuroimaging should be ordered only when findings suggest a neurologic event or a head injury is suspected. Laboratory tests may be ordered based on history and physical examination findings (e.g., hemoglobin measurement if gastrointestinal bleeding is suspected). Patients are designated as having lower or higher risk of adverse outcomes according to history, physical examination, and electrocardiographic results, which can inform decisions regarding hospital admission. Risk stratification tools, such as the Canadian Syncope Risk Score, may be beneficial in this decision; some tools include cardiac biomarkers as a component. The prognosis of patients with reflex and orthostatic syncope is good; cardiac syncope is more likely to be associated with adverse outcomes. […] The diagnostic yield of implantable loop recorders in unexplained syncope: a systematic review and meta-analysis. […] Diagnostic value of neurological studies in diagnosing syncope: a systematic review. […] Evaluation of syncope.

• #1 Patient education: Syncope (fainting) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/syncope-fainting-beyond-the-basics/print

  Anyone who has had an episode of syncope should have an ECG. An ECG can be performed in a clinician’s office and takes only a few minutes. […] Heart rhythm monitoring may be recommended to diagnose rhythm problems that come and go and have not been detected with a routine ECG. […] An echocardiogram is useful for identifying underlying structural heart disease such as hypertrophic cardiomyopathy or significant aortic stenosis. […] Treatment of syncope is based upon the underlying cause. The goal of treatment is to prevent recurrences or more serious problems. […] Vasovagal syncope can usually be treated by learning to take precautions to avoid potential triggers and minimize the potential risk of harm. […] A pacemaker is a small device that is implanted under your skin. Wires from the device are threaded to the heart where they emit impulses that help regulate the heartbeat. Pacemakers are often recommended if you have syncope caused by sinus bradycardia, carotid sinus hypersensitivity, or heart block. […] In some people with serious, life-threatening ventricular arrhythmias (such as ventricular tachycardia) that cause syncope, a device called an implantable cardioverter-defibrillator (ICD) is used.

• #1 Diagnosing and Treating Vasovagal Syncope | Banner Health

  https://www.bannerhealth.com/services/heart/vasovagal-syncope

  Your provider may use these measures to diagnose vasovagal syncope: Medical history, asking about your symptoms, triggers and family history, Physical exam to help check your overall health and identify any factors that could be causing you to faint, Tilt table test, a specialized test that monitors how your body responds to changes in position, Echocardiogram, which uses ultrasound to look for heart conditions that may cause fainting, Electrocardiogram (EKG), which records your heart’s electrical activity and can spot irregularities, Exercise stress test, to monitor your heart rhythm while you walk or jog on a treadmill, Holter monitor, a portable device you wear to record your heart’s rhythm for 24 to 48 hours. […] Lifestyle changes to help treat syncope include: Stay hydrated, Talk to your provider about adding more salt to your diet, Take breaks from standing, Learn relaxation techniques to help cope with stress, Tense your leg muscles periodically or wear compression stockings to help keep blood from pooling in the legs, Get regular physical activity.

• #1 Blackouts/Fainting – Causes, Symptoms & Treatment – LCC

  https://www.londoncardiovascularclinic.co.uk/cardiology-info/symptoms-diagnosis/blackout

  Fainting is uncommon after early childhood but can still occur in some individuals, especially in stressful or hot conditions. […] Understanding the causes of fainting symptoms and blackouts is important for proper diagnosis and treatment. […] Diagnosing the cause of blackouts and fainting is essential for effective treatment. […] If aortic stenosis is suspected, the following investigations may be required: […] To diagnose vasovagal syncope, your doctor will first review your clinical history, which might strongly suggest this condition. […] A diagnosis of POTS can often be suspected based on clinical history and examination. […] Treating blackouts and fainting depends on the underlying cause. […] There is no medical therapy (medication) available to treat aortic stenosis, so valve replacement is the primary option. […] Typically, the following simple vasovagal syncope management strategies help prevent or minimise the episodes: […] At London Cardiovascular Clinic, POTS specialists will tailor a POTS treatment programme specifically for each patient.

• #1 Syncope – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/syncope/

  Syncope is a sudden, transient loss of consciousness, which is thought to be secondary to cerebral hypoperfusion. The diagnostic approach is focused on determining if loss of consciousness was due to syncope (ruling out differential diagnoses), ruling out immediately life-threatening causes of syncope, and determining the risk of serious adverse events from syncope, which further guide management and disposition. This involves obtaining a detailed history and performing a physical examination, including orthostatic vital sign measurements and an initial ECG. Further diagnostics should be guided by clinical suspicion of the underlying disease. […] The treatment strategy depends on the cause. […] Adding an ECG and orthostatic vital signs to a thorough clinical evaluation can help identify the etiology of syncope in up to 50% of patients. […] Rule out life-threatening causes of syncope such as pulmonary embolism, hemorrhage, and serious cardiac conditions.

• #1 Types of Syncope: What Are They, Symptoms, and Causes 

  https://www.healthline.com/health/types-of-syncope

  Syncope is a temporary loss of consciousness that happens due to a decrease in blood flow to your brain. Its more commonly known as fainting. […] Fainting accounts for between 3 and 5 percent of emergency room visits in the United States. An estimated 42 percent of the population will experience a fainting episode during their lifetime. […] Sometimes, though, the cause of fainting cant be determined. Its estimated that 10 to 40 percent of fainting cases have an unknown cause. […] Cardiac syncope is fainting caused by a problem with your heart. When your heart isnt working quite as it should, your brain receives less blood. Its estimated that cardiac syncope causes about 15 percent of fainting episodes. […] To diagnose the cause of your fainting, your doctor will first take your medical history. Theyll ask you about your symptoms, what you were doing when you fainted, and if youre taking medications or have underlying conditions. […] A variety of tests can be used to diagnose the cause of fainting. These tests may include: Electrocardiogram (ECG): An ECG measures the rhythm and electrical activity of your heart using small electrodes.

• #2 Syncope in adults: Clinical manifestations and initial diagnostic evaluation – UpToDate

  https://www.uptodate.com/contents/syncope-in-adults-clinical-manifestations-and-initial-diagnostic-evaluation

  Syncope is a clinical syndrome in which transient loss of consciousness (TLOC) is caused by a period of inadequate cerebral blood flow and oxygenation, most often the result of an abrupt drop of systemic blood pressure. Typically, the inadequate cerebral nutrient flow is of relatively brief duration, and, by definition, syncope is self-limited. […] Unfortunately, the term „syncope” is often misapplied to encompass other forms of abrupt collapse, such as seizures or concussions, which may or may not be accompanied by TLOC. Such broader, less-specific usage of the term „syncope” should be avoided, as imprecise usage impairs accurate diagnosis and undermines comparison of clinical study outcomes. […] Issues relating to the clinical presentation and diagnosis of syncope in adults will be reviewed here.

• #2 Diagnosis and treatment of syncope | Heart

  https://heart.bmj.com/content/93/1/130

  In the evaluation of patients with syncope, the critical first step is a detailed medical history. A diagnostic strategy based on initial evaluation is warranted. The importance of the initial evaluation goes well beyond its capability to make a diagnosis as it determines the most appropriate subsequent diagnostic pathways and risk evaluation. […] According to the Guidelines on Syncope of the European Society of Cardiology (ESC) the initial evaluation of a patient presenting with syncope consists of taking a careful history, and a physical examination, including orthostatic blood pressure measurements and standard electrocardiogram (ECG). […] Three key questions should be addressed during the initial evaluation: Is loss of consciousness attributable to syncope or not? Differentiating true syncope from non-syncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy.

• #2 Diagnosis and treatment of syncope

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861366/

  In the evaluation of patients with syncope, the critical first step is a detailed medical history. A diagnostic strategy based on initial evaluation is warranted. The importance of the initial evaluation goes well beyond its capability to make a diagnosis as it determines the most appropriate subsequent diagnostic pathways and risk evaluation. […] According to the Guidelines on Syncope of the European Society of Cardiology (ESC) the initial evaluation of a patient presenting with syncope consists of taking a careful history, and a physical examination, including orthostatic blood pressure measurements and standard electrocardiogram (ECG). […] Is loss of consciousness attributable to syncope or not? Differentiating true syncope from nonsyncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy.

• #2 Vasovagal syncope – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/diagnosis-treatment/drc-20350531

  Diagnosing vasovagal syncope often begins with a physical exam. During the physical exam, your healthcare professional listens to your heart and takes your blood pressure. Your healthcare professional may massage the main arteries in your neck to see if that causes you to feel faint. […] Your healthcare professional also may recommend several tests to rule out other possible causes of your fainting particularly heart-related conditions. These tests may include: […] Electrocardiogram. This test records the electrical signals your heart produces. It can detect irregular heart rhythms and other cardiac conditions. You may need to wear a portable monitor for at least a day or as long as a month. […] Echocardiogram. This test uses ultrasound imaging to view the heart and look for conditions such as valve problems that can cause fainting.

• #2 Patient education: Syncope (fainting) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/syncope-fainting-beyond-the-basics/print

  Syncope must first be differentiated from other nonsyncope conditions that cause temporary loss of consciousness and/or collapse, such as seizures or head injury causing concussion. There are three main ways to identify the causes of syncope: the medical history, the physical examination, and cardiac testing. A medical history and physical examination are recommended for anyone who has had syncope. Some people will also require cardiac testing. […] Gathering as much information as possible about events that occurred before, during, and after a syncopal episode can be helpful in determining the possible cause of syncope. […] If the cause of the syncope is not readily apparent, the clinician may perform special maneuvers to test your response. […] A number of medical tests are available to help determine the cause of the syncope.

• #2 How to approach a patient with syncope

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n29-Title-How-to-approach-a-patient-with-syncope

  The absence of signs of suspected or overt heart disease virtually excludes a cardiac cause of syncope with the exception of syncope accompanied by palpitations which could be due to paroxysmal tachycardia (especially paroxysmal supraventricular tachycardia). Conversely, the presence of heart disease at the initial evaluation is a strong predictor of a cardiac cause of syncope, but its specificity is low – about half of patients with heart disease have a non-cardiac cause of syncope. […] It is the global cerebral hypoperfusion that differentiates syncope from the non-syncopal causes of transient loss of consciousness in which the disorder of consciousness is not associated with decreased cerebral blood. […] Initial evaluation may lead to a certain diagnosis (no further evaluation may be needed and treatment can be planned), in the following situations: Vasovagal syncope: if precipitating events such as fear, severe pain, emotional distress, instrumentation or prolonged standing are associated with typical prodromal symptoms.

• #2 Diagnosis of Syncope – Syncope

  https://syncope.co.uk/syncope-fainting-blacking-out-passing-out/diagnosis/

  In some cases of fainting, youll need to seek medical help after the fainting episode to decide whether theres an underlying health condition. Your doctor will determine whether further investigation and treatment is needed. […] Most cases of fainting arent a cause for concern and dont require treatment, but you should see your doctor if youre at all concerned. […] During an assessment your doctor will ask about your fainting episodes and your recent medical history. They may request some tests for you see below, or decide to send you to a specialist for more detailed investigation. […] If your doctor thinks your loss of consciousness may have been caused by a heart problem, they may suggest that you have an electrocardiogram (ECG). […] If your doctor thinks your fainting episode was caused by Carotid Sinus Syndrome, they may massage the carotid sinus in your neck to see whether it makes you feel faint or lightheaded. […] Your doctor may measure your blood pressure while youre lying down and again after you stand up. If your blood pressure falls when you stand up you may have orthostatic hypotension. […] If you have orthostatic hypotension, you may be asked further questions to help determine the cause.

• #2 Syncope (Fainting) | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

  It can indicate an increased risk of sudden cardiac death. […] Conditions that may warrant hospital evaluation and treatment include various abnormal heart rhythms, coronary artery disease, severe aortic stenosis and pulmonary embolism. […] If evaluation suggests cardiac vascular abnormalities, or if you have experienced multiple instances of fainting due to heart problems, an ambulatory external or implantable cardiac monitor may be required. […] Anyone with syncope should receive an initial evaluation, including a detailed physical exam, medical history and blood pressure and heart rate check by a health care professional. […] A resting 12-lead ECG (electrocardiogram) also is recommended as part of an initial evaluation to provide information about the cause of syncope. […] Other tests, such as an exercise stress test, a Holter monitor and an echocardiogram, may be needed to assess for other cardiac causes.

• #2 How to approach a patient with syncope

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n29-Title-How-to-approach-a-patient-with-syncope

  Situational syncope: if syncope occurs during or immediately after urination, defaecation, cough or swallowing. […] Orthostatic syncope: when there is documentation of orthostatic hypotension associated with syncope or pre-syncope. […] Cardiac ischaemia-related syncope: when symptoms are present with ECG evidence of acute ischaemia with or without myocardial infarction, independently of its mechanism. […] Arrhythmia-related syncope in presence of the following ECG abnormalities: – Sinus bradycardia 40 beats/min or repetitive sinoatrial blocks or sinus pauses 3 s in the absence of negatively chronotropic medications – Mobitz II 2nd or 3rd degree atrioventricular block – Alternating left and right bundle branch block – Rapid paroxysmal supraventricular tachycardia or ventricular tachycardia – Pacemaker malfunction with cardiac pauses.

• #2 Syncope Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/811669-workup

  The frequency and nature of syncope events should determine the selection of specific cardiac monitoring (class I). […] In the inpatient setting, telemetry is useful for individuals admitted for evaluation of suspected cardiac cause for syncope (class I). […] In selected patients with syncope that has a suspected arrhythmic cause, electrophysiology studies (EPS) can be useful (class IIa). […] However, EPS has no benefit and is not recommended in the evaluation of syncope in the setting of a normal ECG and normal cardiac structure and function unless there is a suspected arrhythmic cause (class III). […] In selected patients with syncope who have known or suspected neurodegenerative disease, a referral for autonomic evaluation can help improve diagnostic and prognostic accuracy (class IIa).

• #2 Vasovagal syncope – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/diagnosis-treatment/drc-20350531

  Exercise stress test. This test studies heart rhythms during exercise. It’s usually conducted while you walk or jog on a treadmill. […] Blood tests. Your healthcare professional may look for conditions such as anemia that can cause or contribute to fainting spells. […] Tilt table test. If no heart conditions appear to cause your fainting, your healthcare professional may suggest that you undergo a tilt table test. During the test, you lie flat on your back on a table that changes positions, tilting you upward at various angles. A technician monitors your heart rhythms and blood pressure during the test to see if changing your posture affects them.

• #2 Syncope (Fainting) | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

  If the initial evaluation is unclear, it may be useful for patients to undergo a tilt test. […] Patients with VVS and without a serious medical condition usually can be managed in an outpatient setting. […] For people who are dehydrated, it may be beneficial to increase their salt and fluid intake to prevent syncope. […] Patients of any age may need medication to help control or improve syncope. […] A cardiovascular assessment by a health care professional is recommended for athletes before resuming competitive sports. […] Standardized national registries and large databases are needed to gather more data to better understand the incidence and prevalence of syncope, patient risks and outcomes, set lifestyle policies and improve health care delivery.

• #2

  https://journals.lww.com/jcpc/fulltext/2016/05030/syncope__approach_to_diagnosis.3.aspx

  A confident diagnosis of vasovagal syncope or orthostatic hypotension (OH) can be made without further investigation if the history is suggestive and cardiac examination and ECG are normal. […] The presence of structural heart disease is the most important predictor of a cardiac cause of syncope. […] The most commonly used protocols are the low-dose intravenous isoproterenol test and the protocol using sublingual nitroglycerine. […] A positive response to carotid sinus massage (CSM) in patients with syncope is highly predictive of the occurrence of spontaneous asystolic episodes. […] The evaluation and treatment of syncope are very challenging.

• #2 Fainting: Causes, Treatment, & Diagnosis- K Health

  https://khealth.com/learn/symptom/fainting/

  Ambulatory monitor to record your heart rate and rhythm over a period of time […] EEG to look at brain wave activity to check for seizures […] Brain imaging using CT or MRI to look for neurological causes. […] While the occasional fainting episode won’t require treatment, see your doctor for an evaluation if you frequently faint. […] You should also seek medical attention if you sustain a falling injury from fainting, remain unconscious longer than a few minutes, or experience frequent fainting spells.

• #2 How to approach a patient with syncope

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n29-Title-How-to-approach-a-patient-with-syncope

  Syncope is a transient, self-limited loss of consciousness usually leading to falling; the onset of syncope is relatively rapid, and the subsequent recovery is spontaneous, complete, and usually prompt. The underlying mechanism is a transient period of global cerebral hypoperfusion. The starting point for evaluation of syncope is the „Initial evaluation that consists of history, physical examination including orthostatic blood pressure measurements and standard electrocardiogram. Differentiating true syncope from other non-syncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy. […] Differentiating true syncope from non-syncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy.

• #2 Syncope or fainting

  https://www.finapres.com/blog/syncope-or-fainting

  Syncope, also known as fainting or passing out, is a transient loss of consciousness (TLOC) due to a temporary drop in blood flow to the brain. Syncope is characterized by a rapid onset, short duration and spontaneous complete recovery. […] About 30-40% of all people will faint at least once in their life, and syncope is the reason for 1-3% of all visits to emergency departments and hospital admissions. […] The three main groups of syncope are: Reflex syncope, Cardiac syncope, and Orthostatic hypotension (OH): an abnormal large drop in blood pressure upon standing. […] Dizziness, visual disturbances (eg seeing black spots), unsteadiness, having a pale skin, abdominal discomfort (nausea), and sudden sweat are common symptoms and warning signs of syncope. […] The initial syncope evaluation consists of careful history taking, physical examination, including supine and standing BP measurements, and electrocardiogram (ECG). […] Autonomic function assessment helps to identify autonomic failure as the underlying cause of syncope. […] Therefore, continuous non-invasive blood pressure monitoring can be an effective method to support the diagnosis of syncope!

• #2 Fainting (Syncope) | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/f/fainting

  Fainting (syncope) is common during childhood in healthy adolescents and young adults. Around 20% of young adults report having fainted at least once. […] Despite being common, fainting can cause a great deal of worry for patients and their caregivers. This is often due to the fear that those who faint are at risk for sudden death. […] Fainting (syncope) is caused by a sudden decrease in blood pressure. For a moment, the brain does not have the needed amount of oxygen. […] Fainting caused by heart issues during childhood is rare. Though rare, this causes the most concern because a cardiac cause can be life-threatening. […] The most common cause of syncope during childhood is vasovagal syncope or neurocardiogenic syncope. These account for more than 90% of fainting in childhood. […] Most healthy children and adolescents who have fainted are checked out by their primary care doctor.

• #2 Vasovagal Syncope: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23325-vasovagal-syncope

  Vasovagal syncope happens when your nervous system overreacts and your blood pressure and heart rate drop suddenly, causing you to faint or pass out. You’re usually unconscious for less than one minute. […] This is the most common type of reflex syncope, which happens automatically for reasons you can’t control. […] One out of 3 people will experience vasovagal syncope at least once in their life. […] Most of the time, a vasovagal syncopal episode happens when you’re standing or sitting. It’s rare for it to occur if you’re lying down. […] A healthcare provider will ask questions about what might have caused you to faint. […] A provider may also run the following tests, depending on the circumstances of your symptoms: Blood tests. These can detect several conditions that can cause fainting, like low iron in your blood (anemia).

• #2 Syncope (Fainting) | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

  Syncope is also called fainting or passing out. […] It can be harmless or a symptom of an underlying medical condition. […] It’s important to determine the cause of syncope and any underlying conditions. […] However, several serious heart conditions, such as bradycardia, tachycardia or blood flow obstruction, can also cause syncope. […] Neurally mediated syncope (NMS) is the most common form of fainting and a frequent reason for emergency department visits. […] It’s harmless and rarely requires medical treatment. […] NMS usually happens after standing for a long time. […] Situational syncope, which is a type of NMS, is related to certain physical functions, such as violent coughing (especially in men), laughing, swallowing or urination. […] Cardiac (cardiovascular) syncope is caused by various heart conditions, such as bradycardia, tachycardia or certain types of low blood pressure.

• #2 Syncope in children | Causes, symptoms & diagnosis | Children’s Wisconsin

  https://childrenswi.org/medical-care/herma-heart/conditions/syncope

  Syncope is a temporary loss of consciousness and muscle tone caused by inadequate blood supply to the brain. Syncope is better known as fainting. […] More than 100,000 adults and children visit a physician each year with complaints of fainting spells. […] The common reason behind a child’s syncopal or fainting episode is a temporary lack of oxygen-rich (red) blood getting to the brain. […] Types of syncope include: […] The most common type of syncope is called vasovagal syncope. […] Another cause of syncope is orthostatic hypotension. […] Some children have abnormalities of the structures of the heart that can cause syncopal episodes. […] Irregular or rapid heart rhythms can also trigger syncopal episodes. […] Yet another cause of syncope can be an inflammation of the heart muscle known as myocarditis.

• #2 Syncope (Fainting) | UpBeat.org – powered by the Heart Rhythm Society

  https://upbeat.org/early-warning-signs/syncope

  Fainting (syncope) is a sudden transient loss of consciousness. It most often happens when the blood pressure is too low (hypotension) and the heart does not pump enough oxygen to the brain. […] Fainting is common and a single spell usually is not serious. […] However, some are life threatening, especially fainting during exertion. The most serious causes of syncope are related to heart damage or abnormal electrical system disorders that affect the heart’s ability to pump blood efficiently. […] In some cases, fainting is the only warning sign of an abnormal heart rhythm (arrhythmia) that could lead to sudden cardiac arrest and death. […] Cardiovascular syncope is usually sudden. There may be no warning signs that an individual is about to faint. […] Fainting is the primary symptom – and may be the only warning sign – of Long QT Syndrome (LQTS), an inherited electrical disorder of the heart.

• #2 How to approach a patient with syncope

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n29-Title-How-to-approach-a-patient-with-syncope

  The presence of suspected or certain heart disease is associated with a higher risk of arrhythmias and mortality at one year. […] If cardiac evaluation does not show evidence of arrhythmia as a cause of syncope, evaluation for neurally-mediated syndromes is recommended only in those with recurrent or severe syncope. […] If the diagnosis is confirmed, treatment may be initiated; if not, a reappraisal process may be useful. […] For patients with unexplained syncope the most likely diagnosis is neurally-mediated for which the appropriate tests are described above. […] Once the evaluation is completed and the cause of syncope is undetermined, re-appraisal of the work-up is needed since subtle findings or new historical information may change the strategy. […] Psychiatric assessment is recommended in patients with frequent recurrent syncope who have multiple other somatic complaints and when initial evaluation raises concerns about stress, anxiety and possible other psychiatric disorders.

• #2 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/1100/syncope.html

  Syncope is an abrupt, transient, and complete loss of consciousness associated with an inability to maintain postural tone; recovery is rapid and spontaneous. The immediate cause of syncope is cerebral hypoperfusion, which may occur due to systemic vasodilation, decreased cardiac output, or both. The primary classifications of syncope are cardiac, reflex (neurogenic), and orthostatic. Evaluation focuses on history, physical examination (including orthostatic blood pressure measurements), and electrocardiographic results. If the findings are inconclusive and indicate possible adverse outcomes, additional testing may be considered. However, testing has limited utility, except in patients with cardiac syncope. Prolonged electrocardiographic monitoring, stress testing, and echocardiography may be beneficial in patients at higher risk of adverse outcomes from cardiac syncope. Neuroimaging should be ordered only when findings suggest a neurologic event or a head injury is suspected. Laboratory tests may be ordered based on history and physical examination findings (e.g., hemoglobin measurement if gastrointestinal bleeding is suspected). Patients are designated as having lower or higher risk of adverse outcomes according to history, physical examination, and electrocardiographic results, which can inform decisions regarding hospital admission. Risk stratification tools, such as the Canadian Syncope Risk Score, may be beneficial in this decision; some tools include cardiac biomarkers as a component. The prognosis of patients with reflex and orthostatic syncope is good; cardiac syncope is more likely to be associated with adverse outcomes. […] The diagnostic yield of implantable loop recorders in unexplained syncope: a systematic review and meta-analysis. […] Diagnostic value of neurological studies in diagnosing syncope: a systematic review. […] Evaluation of syncope.

• #2 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p303.html

  In cases of unexplained syncope, provocative testing and prolonged electrocardiographic monitoring strategies can be diagnostic. […] The treatment of neurally mediated and orthostatic hypotension syncope is largely supportive, although severe cases may require pharmacotherapy. Cardiac syncope may require cardiac device placement or ablation. […] A detailed history will suggest a diagnosis in up to 50% of patients and is the most important diagnostic tool in the evaluation of syncope. […] The examination should focus on initial vital signs; orthostatic blood pressure measurements; and vascular (pulses and carotid bruits), cardiac, pulmonary (evidence of congestive heart failure), abdominal, rectal, and skin/nail (anemia) signs. […] Continuous cardiac monitoring is the diagnostic standard to establish a correlation between symptoms and ECG findings. […] The treatment of syncope is directed at the underlying cause. Morbidity and mortality are generally low except in cardiac syncope; therefore, patient reassurance is an important part of treatment.

• #2 Vasovagal Syncope: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23325-vasovagal-syncope

  Most people who have vasovagal syncope will recover on their own. […] If you pass out, you should receive emergency medical care right away. […] You should talk to a healthcare provider if: You’ve never had a vasovagal syncopal episode before and passed out. […] You may be able to prevent vasovagal syncope episodes by drinking more fluids, eating more salt and standing up slowly. […] Many people who have vasovagal syncope can limit its impact on their lives. They can learn to recognize the symptoms of a vasovagal syncopal episode and avoid known triggers. […] If you can recognize an episode before it happens, you may be able to stop it.

• #2 Understanding Fainting — Diagnosis and Treatment

  https://www.webmd.com/brain/understanding-fainting-treatment?page=2

  Fainting may also happen when the part of the nervous system that regulates blood pressure and heart rate malfunctions in response to a trigger, such as emotional stress or pain. […] If you suffer from episodes of fainting, the type of treatment your doctor offers will depend on the cause of your fainting spells and how often you experience them. […] Infrequent non-heart related fainting may not need to be treated. […] You may be given certain medications to manage the underlying problem, or if you have an irregular heartbeat you may require a pacemaker. […] In certain instances, you may be asked to wear support hose that help keep your blood pressure in balance or to increase your salt intake, which increases blood volume.

• #2 Syncope (Fainting) | UpBeat.org – powered by the Heart Rhythm Society

  https://upbeat.org/early-warning-signs/syncope

  People with underlying heart disease are at higher risk for cardiovascular syncope, although this may be the initial symptom suggesting such a problem. […] Syncope is a symptom that can be caused by many different factors. When it comes to treatment, there is no „one size fits all” approach, making an accurate diagnosis very important. […] Treatment should address the underlying cause of syncope. […] Depending on the diagnosis, cardiovascular syncope may be stopped or controlled with one or more of the following therapies: […] Insertion of a pacemaker is the standard treatment for syncope caused by a slow heartbeat (bradycardia). […] An implantable cardioverter defibrillator (ICD) is a pacemaker-like device that continually monitors the heart, and delivers a life-saving shock if a dangerous heart rhythm is detected.

• #2 Syncope in children | Causes, symptoms & diagnosis | Children’s Wisconsin

  https://childrenswi.org/medical-care/herma-heart/conditions/syncope

  Other situations or illnesses that can cause syncope in kids include, but are not limited to, the following: […] The following are the most common symptoms of syncope. […] Some children will experience presyncope, which is the feeling that they are about to faint. […] In other instances, the child will have no presyncopal sensations, but will simply faint. […] Some types of syncope are caused by a serious problem, so it is recommended that your child be seen by a physician to determine the reason for all fainting spells. […] Your child’s physician will obtain a medical history and perform a physical examination. […] Other diagnostic tests for syncope may include: […] Specific treatment for syncope will be determined by your child’s physician based on: […] For vasovagal syncope, avoiding the situations that trigger the episodes is recommended. […] For illnesses causing syncope, such as irregular heart rhythms or epilepsy, medications may be prescribed by your child’s physician to help control the disease. […] With outflow obstructions, surgical repair of the heart problem may be indicated.

• #2 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  No specific laboratory testing has sufficient power to be absolutely indicated for evaluation of syncope. Tests may not be necessary and can be tailored to any signs or symptoms that raise concern for a specific underlying illness. […] A standard 12-lead ECG is a level A recommendation in the 2007 ACEP consensus guidelines for syncope. […] Other diagnostic tests and procedures include the following: Head-up tilt-table test: Useful for confirming autonomic dysfunction and can generally be safely arranged on an outpatient basis. […] The treatment choice for syncope depends on the cause or precipitant of the syncope. […] Syncope is a prevalent disorder, accounting for 1-3% of emergency department (ED) visits and as many as 6% of hospital admissions each year in the United States. […] Although most causes of syncope are benign, this symptom presages a life-threatening event in a small subset of patients. […] Cardiac syncope has a poorer prognosis than other forms of syncope; the 1-year endpoint mortality has been shown to be as high as 45%. […] Patients with cardiac syncope appear to do worse than patients with noncardiac syncope.

• #2 Diagnosis and treatment of syncope

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1861366/

  The presence of suspected or certain heart disease is associated with a higher risk of arrhythmias and mortality at one year. […] If cardiac evaluation does not show evidence of arrhythmia as a cause of syncope, evaluation for neurally-mediated syndromes is recommended only in those with recurrent or severe syncope. […] Neurologic disease may cause transient loss of consciousness (for example, certain seizures), but is almost never the cause of syncope. […] The cause of syncope may remain unexplained after the initial evaluation. […] For patients with unexplained syncope the most likely diagnosis is neurally-mediated for which the appropriate tests are described above. […] Establishing the basis for syncope (that is, determining the diagnosis) is a prerequisite for advising patients with regard to prognosis, and to developing an effective treatment strategy. […] Most patients with syncope require only reassurance and education regarding the nature of the disease and the avoidance of triggering events.

• #2 Syncope (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Syncope_(medicine)

  Syncope affects about three to six out of every thousand people each year. […] It is the reason for one to three percent of visits to emergency departments and admissions to hospital. […] Of those presenting with syncope to an emergency department, about 4% died in the next 30 days. […] The risk of a poor outcome, however, depends very much on the underlying cause. […] Management of syncope focuses on treating the underlying cause. […] This can be challenging as the underlying cause is unclear in half of all cases. […] Recommended acute treatment of vasovagal and orthostatic (hypotension) syncope involves returning blood to the brain by positioning the person on the ground, with legs slightly elevated or sitting leaning forward and the head between the knees for at least 10-15 minutes, preferably in a cool and quiet place.

• #3 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/1100/syncope.html

  Syncope is an abrupt, transient, and complete loss of consciousness associated with an inability to maintain postural tone; recovery is rapid and spontaneous. The immediate cause of syncope is cerebral hypoperfusion, which may occur due to systemic vasodilation, decreased cardiac output, or both. The primary classifications of syncope are cardiac, reflex (neurogenic), and orthostatic. Evaluation focuses on history, physical examination (including orthostatic blood pressure measurements), and electrocardiographic results. If the findings are inconclusive and indicate possible adverse outcomes, additional testing may be considered. However, testing has limited utility, except in patients with cardiac syncope. Prolonged electrocardiographic monitoring, stress testing, and echocardiography may be beneficial in patients at higher risk of adverse outcomes from cardiac syncope. Neuroimaging should be ordered only when findings suggest a neurologic event or a head injury is suspected. Laboratory tests may be ordered based on history and physical examination findings (e.g., hemoglobin measurement if gastrointestinal bleeding is suspected). Patients are designated as having lower or higher risk of adverse outcomes according to history, physical examination, and electrocardiographic results, which can inform decisions regarding hospital admission. Risk stratification tools, such as the Canadian Syncope Risk Score, may be beneficial in this decision; some tools include cardiac biomarkers as a component. The prognosis of patients with reflex and orthostatic syncope is good; cardiac syncope is more likely to be associated with adverse outcomes. […] The diagnostic yield of implantable loop recorders in unexplained syncope: a systematic review and meta-analysis. […] Diagnostic value of neurological studies in diagnosing syncope: a systematic review. […] Evaluation of syncope.

• #3 How to approach a patient with syncope

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n29-Title-How-to-approach-a-patient-with-syncope

  Syncope is a transient, self-limited loss of consciousness usually leading to falling; the onset of syncope is relatively rapid, and the subsequent recovery is spontaneous, complete, and usually prompt. The underlying mechanism is a transient period of global cerebral hypoperfusion. The starting point for evaluation of syncope is the „Initial evaluation that consists of history, physical examination including orthostatic blood pressure measurements and standard electrocardiogram. Differentiating true syncope from other non-syncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy. […] Differentiating true syncope from non-syncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy.

• #3 Diagnosis and treatment of syncope | Heart

  https://heart.bmj.com/content/93/1/130

  In the evaluation of patients with syncope, the critical first step is a detailed medical history. A diagnostic strategy based on initial evaluation is warranted. The importance of the initial evaluation goes well beyond its capability to make a diagnosis as it determines the most appropriate subsequent diagnostic pathways and risk evaluation. […] According to the Guidelines on Syncope of the European Society of Cardiology (ESC) the initial evaluation of a patient presenting with syncope consists of taking a careful history, and a physical examination, including orthostatic blood pressure measurements and standard electrocardiogram (ECG). […] Three key questions should be addressed during the initial evaluation: Is loss of consciousness attributable to syncope or not? Differentiating true syncope from non-syncopal conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy.

• #3 Patient education: Syncope (fainting) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/syncope-fainting-beyond-the-basics/print

  Syncope must first be differentiated from other nonsyncope conditions that cause temporary loss of consciousness and/or collapse, such as seizures or head injury causing concussion. There are three main ways to identify the causes of syncope: the medical history, the physical examination, and cardiac testing. A medical history and physical examination are recommended for anyone who has had syncope. Some people will also require cardiac testing. […] Gathering as much information as possible about events that occurred before, during, and after a syncopal episode can be helpful in determining the possible cause of syncope. […] If the cause of the syncope is not readily apparent, the clinician may perform special maneuvers to test your response. […] A number of medical tests are available to help determine the cause of the syncope.

• #3 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  No specific laboratory testing has sufficient power to be absolutely indicated for evaluation of syncope. Tests may not be necessary and can be tailored to any signs or symptoms that raise concern for a specific underlying illness. […] A standard 12-lead ECG is a level A recommendation in the 2007 ACEP consensus guidelines for syncope. […] Other diagnostic tests and procedures include the following: Head-up tilt-table test: Useful for confirming autonomic dysfunction and can generally be safely arranged on an outpatient basis. […] The treatment choice for syncope depends on the cause or precipitant of the syncope. […] Syncope is a prevalent disorder, accounting for 1-3% of emergency department (ED) visits and as many as 6% of hospital admissions each year in the United States. […] Although most causes of syncope are benign, this symptom presages a life-threatening event in a small subset of patients. […] Cardiac syncope has a poorer prognosis than other forms of syncope; the 1-year endpoint mortality has been shown to be as high as 45%. […] Patients with cardiac syncope appear to do worse than patients with noncardiac syncope.

• #3 Syncope (Fainting) | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

  It can indicate an increased risk of sudden cardiac death. […] Conditions that may warrant hospital evaluation and treatment include various abnormal heart rhythms, coronary artery disease, severe aortic stenosis and pulmonary embolism. […] If evaluation suggests cardiac vascular abnormalities, or if you have experienced multiple instances of fainting due to heart problems, an ambulatory external or implantable cardiac monitor may be required. […] Anyone with syncope should receive an initial evaluation, including a detailed physical exam, medical history and blood pressure and heart rate check by a health care professional. […] A resting 12-lead ECG (electrocardiogram) also is recommended as part of an initial evaluation to provide information about the cause of syncope. […] Other tests, such as an exercise stress test, a Holter monitor and an echocardiogram, may be needed to assess for other cardiac causes.

• #3 Vasovagal Syncope | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html

  Sometimes the healthcare provider needs to check for other possible causes for fainting. […] If these tests are normal, you might need something called a tilt table test. […] If you have had episodes of vasovagal syncope, your healthcare provider might make some suggestions on how to help prevent fainting. […] Occasionally, you may need medicine to help control vasovagal syncope. […] Vasovagal syncope itself is generally not dangerous. […] See a healthcare provider right away if you have recurrent episodes of passing out or other related problems. […] Vasovagal syncope is the most common cause of fainting. It happens when the blood vessels open too wide or the heartbeat slows, causing a temporary lack of blood flow to the brain. […] It’s generally not a dangerous condition. […] Most people with occasional vasovagal syncope need to make only lifestyle changes, such as drinking more fluids and eating more salt.

• #3 Vasovagal Syncope: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23325-vasovagal-syncope

  Vasovagal syncope happens when your nervous system overreacts and your blood pressure and heart rate drop suddenly, causing you to faint or pass out. You’re usually unconscious for less than one minute. […] This is the most common type of reflex syncope, which happens automatically for reasons you can’t control. […] One out of 3 people will experience vasovagal syncope at least once in their life. […] Most of the time, a vasovagal syncopal episode happens when you’re standing or sitting. It’s rare for it to occur if you’re lying down. […] A healthcare provider will ask questions about what might have caused you to faint. […] A provider may also run the following tests, depending on the circumstances of your symptoms: Blood tests. These can detect several conditions that can cause fainting, like low iron in your blood (anemia).

• #3 Syncope (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Syncope_(medicine)

  „Passing out”, „Syncopy”, and „Fainting” redirect here. […] Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. […] It is caused by a decrease in blood flow to the brain, typically from low blood pressure. […] A medical history, physical examination, and electrocardiogram (ECG) are the most effective ways to determine the underlying cause. […] The ECG is useful to detect an abnormal heart rhythm, poor blood flow to the heart muscle and other electrical issues, such as long QT syndrome and Brugada syndrome. […] Treatment depends on the underlying cause. […] Those who are considered at high risk following investigation may be admitted to hospital for further monitoring of the heart.

• #3

  https://journals.lww.com/jcpc/fulltext/2016/05030/syncope__approach_to_diagnosis.3.aspx

  The goal in every case should be to determine the cause with sufficient confidence to provide a reliable assessment of prognosis and treatment options. […] The differentiation between syncope and nonsyncopal conditions with real or apparent LOC can be achieved in most cases with a detailed clinical history. […] If the answers to these questions are positive, the episode has a high likelihood of being syncope. […] The causes of syncope are highly age dependent. […] In the general population, the most common cause of syncope is neurocardiogenic, followed by primary arrhythmias. […] Neurally mediated syncope describes LOC associated with reflex vasodilation and bradycardia occurring as a response to certain triggers. […] Cardiac syncope is the second most common cause of syncope. […] Orthostatic syncope occurs within seconds or minutes of becoming upright, typically on rising and after meals.

• #3 Vasovagal Syncope | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html

  Vasovagal syncope is a condition that leads to fainting in some people. It’s also called neurocardiogenic syncope or reflex syncope. It’s the most common cause of fainting. It’s usually not harmful and not a sign of a more serious problem. […] Vasovagal syncope is quite common. It most often affects children and young adults, but it can happen at any age. It happens to men and women in about equal numbers. Unlike some other causes of fainting, vasovagal syncope does not signal an underlying problem with the heart or brain. […] Fainting is the defining symptom of vasovagal syncope. […] Your healthcare provider will review your medical history and do a physical exam. This will probably include measuring the blood pressure while lying down, seated, and then standing. Your healthcare provider will likely do an electrocardiogram (ECG) as well, to evaluate the hearts rhythm.

• #3 How to approach a patient with syncope

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-3/vol3n29-Title-How-to-approach-a-patient-with-syncope

  Situational syncope: if syncope occurs during or immediately after urination, defaecation, cough or swallowing. […] Orthostatic syncope: when there is documentation of orthostatic hypotension associated with syncope or pre-syncope. […] Cardiac ischaemia-related syncope: when symptoms are present with ECG evidence of acute ischaemia with or without myocardial infarction, independently of its mechanism. […] Arrhythmia-related syncope in presence of the following ECG abnormalities: – Sinus bradycardia 40 beats/min or repetitive sinoatrial blocks or sinus pauses 3 s in the absence of negatively chronotropic medications – Mobitz II 2nd or 3rd degree atrioventricular block – Alternating left and right bundle branch block – Rapid paroxysmal supraventricular tachycardia or ventricular tachycardia – Pacemaker malfunction with cardiac pauses.

• #3 Syncope Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/811669-workup

  The American College of Cardiology (ACC), American Heart Association (AHA), and the Heart Rhythm Society (HRS) recommend investigation and management in a hospital in the presence of a serious medical condition identified during the initial assessment of individuals presenting with syncope that may be relevant to its cause. […] They note that although targeted blood tests are reasonable for assessing selected patients with syncope identified from clinical evaluation, history and physical examination, and electrocardiographic (ECG) findings (class IIa), there’s no clarity regarding the utility of brain natriuretic peptide and high-sensitivity troponin levels in patients suspected of having a cardiac etiology of syncope (class IIb). Furthermore, there is no benefit to obtaining routine and comprehensive laboratory tests for evaluating patients with syncope (class III).

• #3 Syncope (Fainting) | UpBeat.org – powered by the Heart Rhythm Society

  https://upbeat.org/early-warning-signs/syncope

  People with underlying heart disease are at higher risk for cardiovascular syncope, although this may be the initial symptom suggesting such a problem. […] Syncope is a symptom that can be caused by many different factors. When it comes to treatment, there is no „one size fits all” approach, making an accurate diagnosis very important. […] Treatment should address the underlying cause of syncope. […] Depending on the diagnosis, cardiovascular syncope may be stopped or controlled with one or more of the following therapies: […] Insertion of a pacemaker is the standard treatment for syncope caused by a slow heartbeat (bradycardia). […] An implantable cardioverter defibrillator (ICD) is a pacemaker-like device that continually monitors the heart, and delivers a life-saving shock if a dangerous heart rhythm is detected.

• #3 Syncope Signs, Symptoms & Diagnosis | Fainting Treatment NJ

  https://www.valleyhealth.com/services/syncope

  If your syncope is caused by an arrhythmia, your electrophysiologist may recommend one or more antiarrhythmic drugs to manage your irregular heart rhythm. […] When medications do not control the arrhythmia causing your syncope, your electrophysiologist may recommend catheter ablation. […] Your electrophysiologist may recommend cardiac device therapy if your irregular heart rhythm requires ongoing monitoring and control to prevent syncope. […] Our electrophysiologists work collaboratively with other specialists at Valley to understand the cause of your fainting. We aim to give you an accurate diagnosis and the right treatment to help you feel better faster.

• #3 Syncope (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Syncope_(medicine)

  Syncope affects about three to six out of every thousand people each year. […] It is the reason for one to three percent of visits to emergency departments and admissions to hospital. […] Of those presenting with syncope to an emergency department, about 4% died in the next 30 days. […] The risk of a poor outcome, however, depends very much on the underlying cause. […] Management of syncope focuses on treating the underlying cause. […] This can be challenging as the underlying cause is unclear in half of all cases. […] Recommended acute treatment of vasovagal and orthostatic (hypotension) syncope involves returning blood to the brain by positioning the person on the ground, with legs slightly elevated or sitting leaning forward and the head between the knees for at least 10-15 minutes, preferably in a cool and quiet place.

• #3

  https://journals.lww.com/jcpc/fulltext/2016/05030/syncope__approach_to_diagnosis.3.aspx

  A confident diagnosis of vasovagal syncope or orthostatic hypotension (OH) can be made without further investigation if the history is suggestive and cardiac examination and ECG are normal. […] The presence of structural heart disease is the most important predictor of a cardiac cause of syncope. […] The most commonly used protocols are the low-dose intravenous isoproterenol test and the protocol using sublingual nitroglycerine. […] A positive response to carotid sinus massage (CSM) in patients with syncope is highly predictive of the occurrence of spontaneous asystolic episodes. […] The evaluation and treatment of syncope are very challenging.

• #4 Patient education: Syncope (fainting) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/syncope-fainting-beyond-the-basics/print

  Anyone who has had an episode of syncope should have an ECG. An ECG can be performed in a clinician’s office and takes only a few minutes. […] Heart rhythm monitoring may be recommended to diagnose rhythm problems that come and go and have not been detected with a routine ECG. […] An echocardiogram is useful for identifying underlying structural heart disease such as hypertrophic cardiomyopathy or significant aortic stenosis. […] Treatment of syncope is based upon the underlying cause. The goal of treatment is to prevent recurrences or more serious problems. […] Vasovagal syncope can usually be treated by learning to take precautions to avoid potential triggers and minimize the potential risk of harm. […] A pacemaker is a small device that is implanted under your skin. Wires from the device are threaded to the heart where they emit impulses that help regulate the heartbeat. Pacemakers are often recommended if you have syncope caused by sinus bradycardia, carotid sinus hypersensitivity, or heart block. […] In some people with serious, life-threatening ventricular arrhythmias (such as ventricular tachycardia) that cause syncope, a device called an implantable cardioverter-defibrillator (ICD) is used.

• #4 Fainting – treatments, symptoms, causes and prevention | healthdirect

  https://www.healthdirect.gov.au/fainting

  If you dont know whether someone is fainting or is having a serious incident like a cardiac arrest, follow DRSABCD. […] Fainting is when you suddenly lose consciousness and become unresponsive for a few seconds. […] A faint can be caused by tiredness, dehydration, severe pain, anxiety, low blood pressure, low blood sugar levels, heart attack or stroke. […] You should see a doctor if you: have fainted and do not know the cause; have recently fainted more than once. […] Fainting can be the sign of something simple, or of a more serious a medical condition, like a heart or brain disorder. […] You should call an ambulance if you or someone near you has fainted and they: have severe bleeding or injury; had irregular heartbeat, chest pains, shortness of breath or palpitations before fainting; have a severe headache, ongoing blurred vision, slurred speech or feel disoriented; fainted whilst sitting or lying down, fainted more than once, or took longer than a few minutes to regain consciousness; have a diagnosed heart condition; did not feel warning signs beforehand; are over 60 years old.

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