An individual that has experienced a cardiogenic syncope may describe the presence of an aura prior to the event, consisting of dizziness, amaurosis, diaphoresis, nausea or blurred vision. The duration of the aura is different in various cases, depending on the mechanism of the disease. If the substrate is arrhythmic, the aura lasts for about 3 seconds, whereas in vasovagal episodes its duration may be as long as 2.5 minutes. This period is followed by a complete, short duration loss of consciousness. Convulsions, myoclonic jerks or tonic spasms caused by brain hypoperfusion [1] may occur during the episode. Urine and fecal matter loss, confusion and oral trauma suggest epilepsy, whereas dysarthria and focal neurologic signs imply cerebrovascular disease. The recovery after a cardiogenic syncope is usually complete and spontaneous.

• Pain

  Triggers include emotional stress or stressful conditions and pain especially among the young. [pccoforegon.com]

  […] admission notes Imaging reports Hospital discharge letters Eye-witness reports A report from a Cardiologist will be required Confirmed diagnosis Clinical status History of syncopal or pre-syncopal episodes Triggers Symptoms Prior to episode - chest pain [casa.gov.au]

  […] swings in body temperature, nausea, abdominal pain, GI problems, muscle aches or pains, fatigue, depression, inappropriate or exaggerated emotional responses, to name a few. [livingwithncs.wordpress.com]

  Those at greatest risk are people who have any of the following conditions: Coronary artery disease (clogged blood vessels to the heart) Chest pain caused by angina (lower blood supply to the heart) Prior heart attack ( myocardial infarction ) Ventricular [hrsonline.org]

• Falling

  Injuries from a fall can be serious, so if you know you’re prone to these episodes, take steps to reduce your risk of falling. [baptisthealth.com]

  Other episodes of psychomotor type occurred in subsequent days, but there were no falls or tonic convulsions. [jnnp.bmj.com]

  Indeed, the heart rate increases slowly as the arterial pressure falls. [courses.washington.edu]

  This relatively benign cause may, however, lead to life-threatening injuries as a result of falls. [amboss.com]

  This is followed by a gradual fall in both arterial pressure and cardiac filling. [ahajournals.org]

• Fatigue

  Prolonged fatigue after a modest amount of physical activity is occasionally seen. This post-exertional fatigue can last 24-72 hours, and interferes with many daily activities. [pacemakerclub.com]

  Unusual difficulty with prolonged fatigue after a modest amount of physical activity which can last 24 to 72 hours and could interferes with many daily activities. Muscle aches which can coincide with the fatigue. [mdjunction.com]

  Usually fatigue is a quite a problematic symptom, as it interferes with daily activities. [medicalfoxx.com]

  Familial aggregation of fainting in a case-control study of neurally mediated hypotension patients who present with unexplained chronic fatigue. Lucas KE et al., Europace. 2006 Oct;8(10):846-51. Epub 2006 Aug 18. [dysautonomiainternational.org]

• Epilepsy

  Lancet 1998;352:1007–11. ▸ The largest population based study of misdiagnosis of epilepsy. [PubMed] [Google Scholar] 6. Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. [ncbi.nlm.nih.gov]

  Clinical commentary Corresponding Author Department of Neurology, Epilepsy Clinic, Fundación Santa Fe de Bogota Hospital, Bogota Correspondence: Luis C Mayor Department of Neurology, Epilepsy Clinic, Fundacion Santa Fe de Bogota, Bogota, Colombia E-mail [onlinelibrary.wiley.com]

• Collapse

  ICD-10-CM Codes › R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified › R50-R69 General symptoms and signs › R55- Syncope and collapse › Syncope and collapse 2016 2017 2018 2019 Billable/Specific Code R55 is [icd10data.com]

  Mandatory diagnostic features for post-race exercise collapse include: postexertional occurrence, nonrecurrent collapse, unremarkable family history, normal cardiac examination and normal electrocardiogram. [aafp.org]

  Retrieve from: https://www.uthsc.edu/cardiology/articles/neurocardiogenic%20syncope.pdf Syncope and collapse; Retrieve from: http://www.icd9data.com/2015/Volume1/780-799/780-789/780/780.2.htm [medicalfoxx.com]

  This effect combined with the following collapse can make a strong and dramatic impression on bystanders. The weakness of the legs causes most sufferers to sit or lie down if there is time to do so. [en.wikipedia.org]

  A minimum of two straps are used to restrain the patient in the event they lose consciousness and collapse. Patients are in a supine position while they are connected to a monitoring system(s) and blood pressure is checked. [eplabdigest.com]

• Yawning

  • Pale skin • Dizziness or lightheadedness • Tunnel vision-which means a person’s field of vision is so constricted that he or she can only see what is in front of them • Slow, weak pulse • Jerky and/or abnormal movements • Nausea • Blurry vision • Yawning [eatingdisorders.com]

  Lightheadediness, yawning, sleepiness dizziness pallor on standing and specially resting provoks sleepiness. I have never passed out in the common sense of the term. No palpitation or chest pain until this year. [healthunlocked.com]

  Other symptoms that may occur before fainting include feeling either warm or cold, tremors, yawning and having a bluish/purple or red coloring to the skin, or looking very pale or grey. During fainting, “seizure-like” activity may occur. [pccoforegon.com]

  Symptoms Before you faint due to vasovagal syncope, you may experience some of the following: Pale skin Lightheadedness Tunnel vision — your field of vision narrows so that you see only what's in front of you Nausea Feeling warm A cold, clammy sweat Yawning [mayoclinic.org]

• Nausea

  Clinical findings Abrupt loss of vascular tone; nausea; diaphoresis; pallor. [medical-dictionary.thefreedictionary.com]

  They may complain of symptoms including nausea, abdominal pain, clamminess, tremors, lightheadedness, headache, malaise, exhaustion and confusion. [pccoforegon.com]

  Lightheadedness Warm feeling Sweating yawning nausea Blurred vision Sudden blackout During neurocardiogenic syncope, may the following symptoms are prominent: Shuddering movement Pulse rate become lowered down pupil become dilated. [medicalfoxx.com]

  An individual that has experienced a cardiogenic syncope may describe the presence of an aura prior to the event, consisting of dizziness, amaurosis, diaphoresis, nausea or blurred vision. [symptoma.com]

• Tachycardia

  More commonly, cardiac syncope is due to disorders of automaticity (sick sinus syndrome), conduction disorders (atrioventricular block), or tachyarrhythmias (especially ventricular tachycardia and supraventricular tachycardia with rapid ventricular rate [diseasesatoz.com]

  Tachycardia is suggestive for an acute cardiovascular event, such as a myocardial infarction, pulmonary embolism or signifies an ongoing tachyarrhythmia. [symptoma.com]

  Epileptic seizures often cause disturbances in cardiac rhythm, generally consisting of mild changes in heart rate such as sinus tachycardia. [jnnp.bmj.com]

  VT, ventricular tachycardia. [revespcardiol.org]

  → ↓ ejection fraction Sick sinus syndrome Ventricular tachycardia Atrioventricular block Supraventricular arrhythmias Adams-Stokes syndrome Torsades de pointes Cardiovascular syncope Structural outflow obstruction Massive MI Aortic stenosis Mitral valve [amboss.com]

• Sweating

  Lightheadedness Warm feeling Sweating yawning nausea Blurred vision Sudden blackout During neurocardiogenic syncope, may the following symptoms are prominent: Shuddering movement Pulse rate become lowered down pupil become dilated. [medicalfoxx.com]

  Often, the affected person feels fine after he or she regains consciousness, but weakness, shakiness or sweating may persist for a short period. [baptisthealth.com]

  Important associated symptoms immediately before or after the event include whether there was a sense of impending LOC, nausea, sweating, blurred or tunnel vision, tingling of lips or fingertips, chest pain, or palpitations. [msdmanuals.com]

  In the second to minutes leading up to the fainting, the patient may feel weakness, nausea, pallor, and sweating. [courses.washington.edu]

  During nausea and epigastric discomfort (minute 11.30) the sinus rhythm, superimposed by sweating and movement artifacts, progressively slows down. [jnnp.bmj.com]

• Suggestibility

  A sudden occurrence of syncope, or "drop attack", is most suggestive of an arrhythmic cause for syncope. [ncbi.nlm.nih.gov]

  Tachycardia is suggestive for an acute cardiovascular event, such as a myocardial infarction, pulmonary embolism or signifies an ongoing tachyarrhythmia. [symptoma.com]

  Dangerous causesare suggested by red flag findings. Syncope with exertion suggests cardiac outflow obstruction or exercise-induced arrhythmia. Such patients sometimes also have chest pain, palpitations, or both. [msdmanuals.com]

  Dangerous causes are suggested by red flag findings. Syncope with exertion suggests cardiac outflow obstruction or exercise-induced arrhythmia. Such patients sometimes also have chest pain, palpitations, or both. [merckmanuals.com]

• Dizziness

  Vertigo, dizziness, and imbalance rank amongst the most common presenting symptoms in neurology, ENT, geriatric medicine, and general practice. [books.google.com]

  dizziness,? which generally refers to an alteration in balance, vision, or perception of the environment, without the loss of consciousness. [dysautonomiainternational.org]

  The patient that had been presenting asystole and syncope in the first tilt-test presented only dizziness in the follow-up tilt-test. [academic.oup.com]

  He began experiencing medical difficulties including sleeping problems, dizziness and headaches due to blood vessel dilation. [benglasslaw.com]

• Seizure

  However, simultaneous ECG-EEG recording of a tonic seizure could not be obtained. [jnnp.bmj.com]

  Relations between syncope, seizure, and arrhythmia. There are clinically important relations between syncope and seizure disorders. [ncbi.nlm.nih.gov]

• Convulsions

  Consider the possibility of convulsive syncope, when antiepileptic drug treatment is inefficient in presumed epilepsy Consider the possibility of convulsive syncope of cardiovascular cause when there are atypical premonitory symptoms (nausea, lightheadedness [ncbi.nlm.nih.gov]

• Agitation

  Venlafaxine 75 mg XR form PO QD or BID Nausea, anorexia, hypertension Paroxetine* 10 mg PO QD Nausea, tremor, diarrhea, agitation Erythropoietin 8000 IU SC once per week Requires injections, burning at site, increased hematocrit, CVA Metoprolol* 25–50 [ahajournals.org]

  Venlafaxine 75 mg XR form PO QD or BID Nausea, anorexia, hypertension Paroxetine * 10 mg PO QD Nausea, tremor, diarrhea, agitation Erythropoietin 8000 IU SC once per week Requires injections, burning at site, increased hematocrit, CVA Metoprolol * 25 [circ.ahajournals.org]

• Giddiness

  See also separate Dizziness, Giddiness and Feeling Faint article. [patient.info]

A careful history inquiry is a key tool in evaluating a syncope patient [2]. It should always be combined with clinical examination and a 12 lead electrocardiogram (class A recommendations [3]). The victim should be asked about the position of the body before symptoms set in [4] [5], the activity he or she was involved in and other precipitating factors. Anamnesis should determine if the person has a history of myocardial infarction, structural heart disease, arrhythmia, channelopathy or cardiomyopathy. Prior medication (diuretics, beta blockers, vasodilators, nitrates, antiarrhythmic, tricyclic antidepressants) is always important to know.

The physical evaluation must highlight the vital signs and heart auscultation. Tachycardia is suggestive for an acute cardiovascular event, such as a myocardial infarction, pulmonary embolism or signifies an ongoing tachyarrhythmia. An acute coronary syndrome may also be accompanied by bradycardia, especially if a cardiac conduction defect is present. Murmurs also point to a cardiac cause of the syncope but do not warrant it. Cardiovascular evaluation should be completed by assessment of the jugular veins, auscultation of lung rales, palpation of the liver and possible abdominal masses signifying abdominal aneurysms and evaluation of peripheral edema.

A Schellong test is a useful maneuver, indicating orthostatic hypotension if positive. A carotid sinus massage should only be performed by an experienced physician since it can induce prolonged cardiac pauses or severe bradycardia. The maneuver is to be avoided if carotid bruits are present.

Multiple recurrences during a short period of time require immediate cause diagnosis and therapeutic intervention.

Blood workup is nonspecific in this disease, but certain tests may show predisposing factors for a cardiogenic syncope: abnormal electrolytes levels, heart enzymes or B-type natriuretic peptide [6]. An echocardiography is indicated when mechanical cardiac causes are suspected, whereas an electrocardiogram is useful in all cardiogenic syncope patients. A normal aspect implies good prognosis, but clinical judgment may still dictate the need for Holter monitoring or loop event recording [7]. The standard electrocardiogram may show atrioventricular blocks of various degrees [8], Brugada syndrome, Wolff-Parkinson-White syndrome or acute ischemia. Sinus pauses, sustained and nonsustained ventricular tachycardia episodes may also be substrates for a cardiogenic syncope. A positive tilt table test indicates a vasodepressor mechanism.

• Focal Spikes

  A standard EEG showed focal spike and wave with delta slowing on the right centrotemporal region (C4-T4). [jnnp.bmj.com]

• Sinus Arrest

  Finally, it is likely that falling and tonic convulsions after sinus arrest were anoxic rather than epileptic in origin, as they did not show when sinus arrest was shorter than nine seconds, nor after pacemaker implantation. [jnnp.bmj.com]

  So even though sinus pause and sinus arrest is used many times interchangeably, it should be avoided. What are the electrophysiological mechanisms of sinus pause ? Simple sinus bradycardia. The commonest mechanism is the increased vagal tone. [drsvenkatesan.com]

  In intrinsic sick sinus syndrome, syncope typically occurs secondary to long pauses caused by sinus arrest or sinoatrial block.1 In the setting of tachyarrhythmia, syncope or near-syncope occurs at the onset of paroxysmal tachycardia, before vascular [clevelandclinicmeded.com]

• Abnormal ECG

  Among the EGSYS risk factors, highest odds ratios belonged to ECG abnormality (11.27), palpitation (7.48), and blurred vision (5.12) which were lower than these values in the Del Rosso et al. study, except for ECG abnormality. [hindawi.com]

  Patients who have a significant cardiac history and those who seem to have a cardiac syncope (because of associated chest pain, dyspnea, cardiac murmur, signs of CHF, or ECG abnormalities) should be considered to be at increased risk. [emedicine.medscape.com]

  And among the patients who died, 82% were older and had cardiac risk factors such as abnormal ECG and/or heart disease. [frontiersin.org]

However, more research is needed to determine the diagnostic value of these methods.6 Treatment of neurocardiogenic syncope Treatment consists of education, manoeuvres to avert syncope, drug treatment, and pacemakers. [ncbi.nlm.nih.gov]

Despite the significant advances in the treatment of cardiovascular diseases over the past decades, cardiogenic syncope continues to be associated with a significantly worse prognosis when compared with non-cardiogenic syncope. [ncbi.nlm.nih.gov]

Keywords Syncope Prognosis Cardiogenic syncope Emergency department This is a preview of subscription content, log in to check access. Notes Conflict of interest None. References 1. [link.springer.com]

A normal aspect implies good prognosis, but clinical judgment may still dictate the need for Holter monitoring or loop event recording. [symptoma.com]

[…] also known as vasovagal syncope), which is the most common cause of syncope in both children and adults, accounting for 50-66% of unexplained syncope.1 2 The distinction between neurocardiogenic syncope and other causes of fainting is essential, as the prognosis [bmj.com]

Syncope Summary Etiology Clinical features Diagnostics Differential diagnoses Treatment Complications [amboss.com]

[…] consciousness, either with momentary premonitory symptoms or without warning, due to cerebral anemia caused by ventricular asystole, extreme bradycardia, or ventricular fibrillation. neurocardiogenic syncope a particularly serious type of vasovagal attack ; the etiology [medical-dictionary.thefreedictionary.com]

Objectives List the cardiac etiologies of syncope. Differentiate between the various cardiac etiologies of syncope. Discuss the treatment of syncope of cardiac etiology. [emsworld.com]

The reality is that the majority of syncopal episodes have a cardiovascular etiology. The most prominent cause is due to structural or ischemic heart disease leading to bradyarrhythmias and tachyarrhythmias. [eplabdigest.com]

Directly after the event, important clues to the etiology, such as seizure activity, incontinence and immediate vital signs (including body temperature), should be sought. [aafp.org]

Embryology (33) Neurosurgery (30) Infectology (27) Otorhinolaryngology (26) Emergency Medicine (20) Rheumatology (20) Obstetrics, Gynaecology (19) Endocrinology, Metabolism (18) Occupational Medicine and Toxicology (18) Microbiology (16) Haematology (13) Epidemiology [portal.mefanet.cz]

Epidemiologic features of isolated syncope: the Framingham Study. Stroke. 1985; 16 626-629 2 Ganzeboom K S. et al. Prevalence and triggers of syncope in medical students. Am J Cardiol. 2003; 91 1006-1008, A8 3 Blanc J J. et al. [thieme-connect.com]

Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J 2004;25:1749-53. [acc.org]

Definition and Epidemiology Syncope is the sudden loss of consciousness, associated with inability to maintain postural tone, with immediate and spontaneous recovery without requiring electrical or chemical cardioversion. [frontiersin.org]

[…] noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology [link.springer.com]

Conclusions We have observed a novel finding of right insular atrophy in patients with NCS with a positive response to HUT, implicating a role of right insular dysfunction in the pathophysiologic mechanism underlying NCS. [ajnr.org]

A review of pathophysiology and therapy of patients with vasovagal syncope. Pharmacotherapy 2000;20: 158-65. [PubMed] [Google Scholar] 4. [ncbi.nlm.nih.gov]

Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006;113(9):1164–1170. [innovationsincrm.com]

Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006;113:1164-1170. 26. Di Girolamo E, Di Iorio C, Sabatini P, et al. [uspharmacist.com]

Prevention While most cases of neurocardiogenic syncope cannot be prevented, you can take some steps to reduce your chances – as mentioned above – or spot the signs and reduce your chance of injury during an episode. [baptisthealth.com]

Circulation 2009; 119: 1703-1710 Hypertrophic CardiomyopathyImplantable Defibrillators for Prevention of SDTherapeutic ICD Interventions Regarding Presentation No Sync. or CA Cardiac Arrest Sync.or CA Syncope Begley DA. [slideserve.com]

I do a lot on the prevention side. If I start to feel sick, I sit wherever I can to avoid falling...salt intake water etc etc...it just doesn't seem to control the heart rate from doing it's thing though.... Thank you so much for the link! [medhelp.org]

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5. Bergfeldt L. Differential diagnosis of cardiogenic syncope and seizure disorders. Heart 2003;89(3): 353-8.
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7. Rockx MA, Hoch JS, Klein GJ, et al. Is ambulatory monitoring for "community-acquired" syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring. Am Heart J. 2005;150(5):1065.
8. Dovgalyuk J, Holstege C, Mattu A, et al. The electrocardiogram in the patient with syncope. Am J Emerg Med. 2007;25(6):688-701.