![]() The following recommendations are consistent with the 2017 American Heart Association (AHA) syncope guidelines. Vasovagal syncope and situational syncope can occur more easily in patients with preexisting orthostatic hypotension. Reflex-mediated and orthostatic causes of syncope occur more frequently and tend to be more benign than cardiac and vascular causes. Postural (orthostatic) tachycardia syndrome ( POTS).Neurogenic (a type of dysautonomia): e.g., diabetic neuropathy, Parkinson disease.Medication-induced: e.g., beta blockers, calcium channel blockers, alpha blockers.Hypovolemia: e.g., GI fluid loss, diuretic use, adrenal insufficiency. ![]() Situational syncope: e.g., micturitional syncope.Vasovagal syncope ( neurocardiogenic syncope).See “ Noncardiac syncope” for further details. These typically benign etiologies can coexist in the same patient, i.e., they are not mutually exclusive. Intracranial: e.g., subarachnoid hemorrhage, pontine strokeĬardiac and vascular causes of syncope have a higher chance of being life-threatening and should be ruled out first! Noncardiac causes.Pulmonary: e.g, pulmonary embolism, pulmonary hypertension, tension pneumothorax.Circulatory shock: e.g., cardiogenic shock, hemorrhagic shock, other types of hypovolemic shock, septic shock.Valvular heart disease: e.g., severe aortic stenosis.Ventricular outflow tract obstruction: e.g., hypertrophic obstructive cardiomyopathy.Myocardial infarction or acute coronary syndrome.Malfunction or failure of pacemaker/ AICD.Arrhythmias associated with sudden cardiac arrest: e.g., LQTS, Brugada syndrome.Ventricular tachyarrhythmias, e.g., sustained VT, ARVC-associated VT.Bradyarrhythmias, e.g., Mobitz II or 3 rd-degree AV block.See “ Cardiac syncope” for further details. This category includes life-threatening causes of syncope that require specialized management. For a list of syncope mimics, i.e., other causes of transient loss of consciousness, see “ Differential diagnosis of syncope.” Cardiac and vascular causes The following are lists of underlying causes of syncope. POTS: Poorly understood Often occurs following other medical conditions (e.g., pregnancy, trauma, surgery, viral illness).Neurogenic orthostatic hypotension: Diabetic neuropathy, Parkinson disease.Age-related loss of baroreceptor sensitivity.Medications that cause vasodilation or limit tachycardia (e.g., beta blockers, alpha blockers, calcium channel blockers).Hypovolemia (e.g., dehydration, hemorrhage, use of diuretics).Postural tachycardia syndrome ( POTS): orthostasis with tachycardia and no hypotension.Most types of orthostatic syncope: orthostatic hypotension.Pressure on the carotid sinuses (e.g., during a massage, when shaving, tightening a necktie).Micturition (commonly seen in male individuals with prostatic hyperplasia).Emotional stress, e.g., fear, sight of blood, medical procedures.Vasovagal syncope ( Neurocardiogenic syncope) DefinitionsĮxamples of triggers and/or underlying causes The treatment strategy depends on the cause. In many cases, syncope is multifactorial and it is not possible to determine a specific etiology. Further diagnostics should be guided by clinical suspicion of the underlying disease. ![]() This involves obtaining a detailed history and performing a physical examination, including orthostatic vital sign measurements and an initial ECG. 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. It can be divided into cardiac syncope, e.g., due to arrhythmias or structural heart disease (potentially life-threatening), and noncardiac syncope, which includes frequently benign causes such as reflex syncope (due to vasovagal responses or carotid sinus syndrome) and orthostatic syncope. Syncope is a sudden, transient loss of consciousness, which is thought to be secondary to cerebral hypoperfusion.
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