These syndromes should be considered along with other causes when a patient presents with syncope. [bcmj.org]

Painless and convulsive syncope due to cardiac arrhythmia were not typical presentations of acute aortic dissection. [ncbi.nlm.nih.gov]

The older patient thus may present with a fall rather than transient loss of consciousness. [ecrjournal.com]

• Falling

  The fact that most falls in older adults are unwitnessed compounds the challenge presented by patients unable to recall presyncopal complaints.[ 6 ] Syncope should thus be considered a possible contributing factor in any unexplained fall in an older adult [bcmj.org]

  PubMed Cummings SR, Nevitt MC, Kidd S, Forgetting falls. The limited accuracy of recall of falls in the elderly, J Am Geriatr Soc, 1988;36(7):613–6. [ecrjournal.com]

  Often when people fall, they develop a fear of falling, even if they were not injured in the initial fall. [sah.org.au]

  Drop attacks involve sudden falls without loss of consciousness or warning and with immediate recovery. [aafp.org]

  Non accidental falls These patients experience recurrent episodes of non accidental and unexplained falls which occur when there is transinet brain hypoperfusion and loss of consciousness. [medicaljoyworks.com]

• Anemia

  [G. synkopē, cutting short] syncope a temporary suspension of consciousness due to cerebral anemia; fainting. cardiac syncope sudden loss of consciousness due to cerebral anemia caused by ventricular asystole, extreme bradycardia or ventricular fibrillation [medical-dictionary.thefreedictionary.com]

  The term syncope (or fainting) refers to cerebral anemia. Syncope causes collapse, which may last from seconds to minutes. Most fainting spells are due to low blood pressure or lack of oxygen delivery to the brain. [canine-epilepsy.com]

  Anemia Anemia (low red blood cell count), whether it occurs acutely from bleeding or gradually for a variety of reasons, can cause fainting because there aren't enough red blood cells to deliver oxygen to the brain. [medicinenet.com]

  Low blood pressure, ineffective pumping by the heart because of heart disease (heart failure), or heart valve abnormalities may cause fainting, as can anemia (low red blood cell count), drugs (especially those for high blood pressure), lung diseases, [spectrumhealth.org]

• Pallor

  […] men and during familiarization sessions (in which BFR was applied alone) but not thereafter (BFR sessions combined with NMES): 1 subject experienced a brief syncope and 2 other subjects exhibited presyncopal symptoms (sweating, lightheadedness, and pallor [ncbi.nlm.nih.gov]

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

  […] at-risk patient Reduce Stress Treat patient in a supine position Ensure profound local anesthesia Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity Signs and symptoms: Adrenergic component Anxiety Pallor [dentalcare.com]

  In many cases, there is a characteristic preceding prodrome of dizziness, nausea, diaphoresis, and pallor. [healio.com]

• Unconsciousness

  The most common symptoms include: Unconsciousness Dizziness Pallor In some cases, unconsciousness is accompanied by myocloni 4.1 Prodromes Nausea Vomiting abdominal sensation of pressure Chills Sweating Blurred vision Aura A syncope can be followed by [flexikon.doccheck.com]

  Becoming unconscious due to a seizure, heart attack, head injury, stroke, intoxication, blow to the head, diabetic hypoglycemia or other emergency condition is not considered syncope. [hopkinsmedicine.org]

  Usually seconds Usually more than a few seconds, up to minute Incontinence Absent May be present Confusion on waking Absent Marked for 20-30 mins Tonic-clonic movements, presence and timing Occasionally & brief particularly if unconsciousness is prolonged [rch.org.au]

  In pathology, "failure of the heart's action," hence "unconsciousness." MORE RELATED WORDS FOR SYNCOPE coma noun deep unconsciousness Roget's 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group. [thesaurus.com]

  Unconsciousness Jean-Martin Charcot demonstrating hypnosis on a "hysterical" Salpêtrière patient, "Blanche" (Marie Wittmann), who is supported by Joseph Babiński.[1] Specialty Psychiatry Neurology Unconsciousness is a state which occurs when the ability [en.wikipedia.org]

• Amyloidosis

  In a small percentage of cases, the cause of orthostatic hypotensive faints is structural damage to the autonomic nervous system due to systemic diseases (e.g., amyloidosis or diabetes) or in neurological diseases (e.g., Parkinson's disease). [medscape.com]

  Many diseases such as diabetes mellitus, amyloidosis, and Parkinson disease can cause dysautonomia ( Table 1 ). 2 Many patients, especially young female patients, may never have an identifiable cause of orthostatic hypotension. [ahajournals.org]

  These conditions include diabetes, alcoholism, malnutrition, and amyloidosis (in which waxy protein builds up in the tissues and organs). [webmd.com]

  Because ECG showed normal voltage and the patient did not exhibit any signs or symptoms of an infiltrative heart disease, amyloidosis is not likely.3x3Korff, S., Katus, H.A., and Giannitsis, E. Differential diagnosis of elevated troponins. [mayoclinicproceedings.org]

  […] with marked tachycardia Primary autonomic failure Multiple sclerosis, multiple system atrophy (e.g., Shy-Drager syndrome), Parkinson disease/parkinsonism, Wernicke encephalopathy Orthostatic hypotension with postural change Secondary autonomic failure Amyloidosis [aafp.org]

• Sneezing

  These include: Neurocardiogenic syncope Carotid sinus syncope Visceral reflex syncopes Micturition syncope (mostly while standing under night-time vagotonia) Postprandial syncope Pain syncope Pressure syncopes ( defecation syncope, cough syncope, sneezing [flexikon.doccheck.com]

  Triggers include: Coughing, sneezing, laughing, swallowing Pressure on the chest after exertion or exercise Defecating Urinating ( post-micturition syncope : occurs in men while standing to urinate) Eating a meal Sudden abdominal pain Blowing a brass [hopkinsmedicine.org]

  Swallowing, talking, sneezing, and touching trigger points in the tonsils, ear, pharynx, and larynx produce painful stimuli interpreted as increased pressure in the carotid sinus. [aafp.org]

  Situational syncopes are triggered by specific circumstances such as coughing/sneezing, swallowing, defecation, visceral pain, micturition (or immediately postmicturition), postexercise, postprandial, and weightlifting; they are often forms of reflex [medlink.com]

• Hyperpnea

  […] loss of color with an ashen-gray skin tone Perspires heavily Reports "feeling bad" or "feeling faint" Reports feeling nauseous Exhibits slightly lower blood pressure and tachycardia In the late stage the patient exhibits: Pupillary dilation Yawning Hyperpnea [dentalcare.com]

• Nausea

  Uusally associated with a prodrome (nausea/vomiting/vertigo/sweating). No post-ictal state, vs. seizures. [pedclerk.bsd.uchicago.edu]

  Pallor, sweating, lack of concentration, disorientation, and nausea are features suggestive of postural hypotension and brain hypoperfusion. [clevelandclinicmeded.com]

  […] colour (pallor, cyanosis) duration of loss of consciousness breathing pattern (snoring) movements (tonic, clonic, tonic-clonic or minimal myoclonus, automatism) and their duration, onset of movement in relation to fall, tongue biting End of attack
  Nausea [lifeinthefastlane.com]

  Premonitory symptoms, such as nausea, diaphoresis, abdominal discomfort, and blurred vision, are caused by autonomic activation and are distinguishing features of neurally mediated syncope. [ncbi.nlm.nih.gov]

  A detailed history of the event is critical including the setting (warm, standing, sitting, during exertion, pain, anxiety, etc.), associated symptoms (nausea, chest pain, palpitations), and any signs observed by bystanders. [accessmedicine.mhmedical.com]

• Hypotension

  Table 5: Abnormal Hemodynamic Patterns During Tilt Test Vasovagal response Cardioinhibitory response, hypotension and bradycardia or asystole Vasodepressor response, hypotension without bradycardia Mixed response Postural hypotension Reduction in systolic [clevelandclinicmeded.com]

  Orthostatic hypotension can be diagnosed at the bedside and may require no further testing. [bcmj.org]

  For instance, patients with severe autonomic failure experience severe hypotension either after assuming the upright position or after food consumption (orthostatic and postprandial hypotension, respectively). [mc.vanderbilt.edu]

  Orthostatic hypotension is usually due to inadequate preload (from dehydration or hemorrhage), but may also be secondary to autonomic dysfunction or drugs. [accessmedicine.mhmedical.com]

• Orthostatic Hypotension

  In contrast, in patients with orthostatic hypotension due to autonomic failure, these cardiovascular homeostatic reflexes are chronically impaired. [accessmedicine.mhmedical.com]

  Orthostatic Hypotension Orthostatic (upright) hypotension (low blood pressure when standing) can also cause fainting because blood has trouble going against gravity to reach the brain. [hopkinsmedicine.org]

  Positional syncope may indicate orthostatic hypotension. [aafp.org]

  Orthostatic hypotension can be diagnosed at the bedside and may require no further testing. [bcmj.org]

• Palpitations

  Efficacy of implantable loop recorders in establishing symptom-rhythm correlation in young patients with syncope and palpitations. Pediatrics, 112(3), 228-233. Snyder, C., (2010). Refer or reassure: guidance on managing patients with syncope. [pedclerk.bsd.uchicago.edu]

  It is not recommended in patients without heart disease, normal ECG, and no palpitations associated with syncope. [clevelandclinicmeded.com]

  Someone with pre-syncope may be lightheaded (dizzy) or nauseated, have a visual "gray out" or trouble hearing, have palpitations, or feel weak or suddenly sweaty. [hopkinsmedicine.org]

  There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85  beats per minute (BPM). [ncbi.nlm.nih.gov]

  A detailed history of the event is critical including the setting (warm, standing, sitting, during exertion, pain, anxiety, etc.), associated symptoms (nausea, chest pain, palpitations), and any signs observed by bystanders. [accessmedicine.mhmedical.com]

• Slow Pulse

  pulse Neurally mediated syncope (vasovagal), cardiac syncope (bradyarrhythmia) Tonic-clonic movement or posture Seizure None Vasovagal or cardiac syncope in older patients, cardiac syncope in younger patients Table 3. [aafp.org]

  Symptoms include deep and fast respiration, weak and slow pulse and respiratory pauses that may last for 60 seconds. [en.wikipedia.org]

• Systolic Murmur

  It is associated with ventricular hypertrophy (eg. secondary to aortic stenosis ) or cardiac failure Ejection systolic murmur Crescendo-decrescendo murmur; usually harsh and low pitched. [rcemlearning.co.uk]

  Other important features of the physical examination include neurologic findings such as diplopia, dysarthria, nystagmus, ataxia and pupillary asymmetry, as well as cardiac findings such as carotid bruit, jugular venous distension, rales, a systolic murmur [mc.vanderbilt.edu]

  A harsh, late-peaking, basal murmur radiating to the carotid arteries suggests aortic stenosis; a systolic murmur that increases with the Valsalva maneuver and disappears with squatting suggests hypertrophic cardiomyopathy. [merckmanuals.com]

• Cold, Clammy Skin

  clammy skin Skin paleness Slow, weak pulse Jerky, abnormal movements which usually are seen once someone has actually passed out Infrequently, blood pressure can drop enough to cause a reactive seizure These symptoms can be associated with other health [barrowneuro.org]

  Marked pallor in conjunction with cold clammy skin favors neural-reflex syncope (vasovagal or situational syncope). [thecardiologyadvisor.com]

  Physical findings often reported by bystanders (if the physician asks) in these cases include marked pallor, damp and cold (“clammy”) skin, and confusion. [scielo.edu.uy]

• Increased Sweating

  Additionally, wearing heavy equipment (such as football pads or firefighter bunker gear) and a uniform increases sweating, resulting in dehydration. [ksi.uconn.edu]

• Renal Insufficiency

  Moreover, comorbidities might promote syncope such as renal insufficiency, maybe favoured by hypotension and cardio-renal adaptations. [nature.com]

• Dizziness

  Certain movements can also be done to keep dizziness from leading to fainting. [cincinnatichildrens.org]

  Cardiac syncope often occurs suddenly, without dizziness or other pre-syncope symptoms. [hopkinsmedicine.org]

  […] syncope in a Sentence syncope has been reported in a small percentage of patients taking the drug Recent Examples on the Web According to the Harford County Health Department, heat illness takes many forms, including heat fatigue, heat syncope (sudden dizziness [merriam-webster.com]

  How to Get Rid of Dizziness Getting rid of feeling dizzy depends on what is causing the dizziness, some treatments to get rid of dizziness include: Home remedies can relieve nausea and vomiting, for example, ginger tea. [medicinenet.com]

• Confusion

  On the other hand, seizures are easily confused with syncope and remain in the differential diagnosis of the patient who appears to have had syncope (see Figure 31-1). [accessmedicine.mhmedical.com]

  The overlap of these clinical conditions leads to confusion regarding syncope classification that can hinder evaluation strategies, and pose challenges for diagnosis and treatment, particularly in young women. [ncbi.nlm.nih.gov]

  […] consciousness breathing pattern (snoring) movements (tonic, clonic, tonic-clonic or minimal myoclonus, automatism) and their duration, onset of movement in relation to fall, tongue biting End of attack
  Nausea, vomiting, sweating, feeling of cold, confusion [lifeinthefastlane.com]

  End of the episode: confusion, muscle aches, colour, injury, incontinence. Previous presyncopal or syncopal episodes, previous cardiac and medical history, family history (sudden cardiac death, epilepsy etc. Medications. [emed.ie]

• Vertigo

  Uusally associated with a prodrome (nausea/vomiting/vertigo/sweating). No post-ictal state, vs. seizures. [pedclerk.bsd.uchicago.edu]

  Syncope must be differentiated from vertigo, coma, drop attacks, dizziness, sudden cardiac death, and seizures. Vertigo (i.e., sensation of movement) does not include loss of consciousness. [aafp.org]

  RESULTS: In the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. [ncbi.nlm.nih.gov]

  Syncope must be separated from seizures and other states of altered consciousness such as dizziness, vertigo, coma, and narcolepsy. [healthcentral.com]

• Drop Attacks

  These falls/attacks are called cryptogenic drop attacks. References:[5][12] The differential diagnoses listed here are not exhaustive. Treatment Complications References:[5] We list the most important complications. The selection is not exhaustive. [amboss.com]

  Autonomic failure 8.1.2 Epilepsy and ictal asystole 8.1.3 Cerebrovascular disorders 8.1.4 Migraine 8.1.5 Cataplexy 8.1.6 Drop attacks 8.2 Neurological tests 8.2.1 Electroencephalography 8.2.2 Brain computed tomography and magnetic resonance imaging 8.2.3 [escardio.org]

  The classification chosen here only represents one possibility. 2.1 Vascular syncopes Orthostatic hypotension Stenosis of the cerebral arteries Subclavian-Steal-syndrome (" drop attack ") Takayasuís arteriitis Aneurysm of the internal carotid artery 2.2 [flexikon.doccheck.com]

  Drop attacks involve sudden falls without loss of consciousness or warning and with immediate recovery. [aafp.org]

• Dysautonomia

  Exercise Many people who have dysautonomia also display a tendency to have vasovagal syncope; indeed, it seems likely that many people with recent vasovagal syncope may actually have a form of dysautonomia. [verywellhealth.com]

  Dysautonomia can interfere with the body’s ability to prevent blood from pooling in the lower extremities (legs and buttocks) and gut, which can result in low blood pressure with standing. [ahajournals.org]

  What is familial dysautonomia (FD)? Familial Dysautonomia (FD) is a genetic disease primarily causing dysfunction of the autonomic and sensory nervous systems. [rarediseasesnetwork.org]

  Additional relevant MeSH terms: Layout table for MeSH terms Syncope Syncope, Vasovagal Unconsciousness Consciousness Disorders Neurobehavioral Manifestations Neurologic Manifestations Nervous System Diseases Signs and Symptoms Orthostatic Intolerance Primary Dysautonomias [clinicaltrials.gov]

  Dysautonomia and neurocardiogenic syncope. McLeod KA. Curr Opin Cardiol. 2001 Mar;16(2):92-6. 4. Physiological phenomenology of neurally-mediated syncope with management implications. Schroeder C et al, PLoS One. 2011;6(10):e26489. [dysautonomiainternational.org]

In the absence of clinical suspicion, a routine diagnostic workup for APE in patients with syncope cannot be recommended. [ncbi.nlm.nih.gov]

Even at best, the SF Syncope Rule is not 100% sensitive, so if there is any concern for serious underlying disease, the patient should undergo further workup. [mdcalc.com]

Third, all participating hospitals used a standardized protocol for the diagnostic workup of syncope that was based on international guidelines, 1,2 but a specific workup was not mandated by the study protocol. [nejm.org]

• Electrocardiogram Change

  Red Flags for Cardiac Syncope Onset during exertion History of cardiac disease Electrocardiogram changes Lack of prodrome Palpitations at onset Chest pain Occurrence while supine Age > 60 years Family history of sudden death Other ECG abnormalities suggest [reliasmedia.com]

Treatment 5.1 General principles of treatment of syncope 5.2 Treatment of reflex syncope 5.2.1 Education and lifestyle modifications 5.2.2 Discontinuation/reduction of hypotensive therapy 5.2.3 Physical counter-pressure manoeuvres 5.2.4 Tilt training [escardio.org]

There are 2 main treatment strategies: conservative/nonpharmacologic therapy and medical treatment. [clevelandclinicmeded.com]

The assessment of treatment efficacy must also include a careful evaluation of treatment side effects. Agents that have been used include beta-blockers, fludrocortisone, SSRIs, midodrine, disopyramide and yohimbine. [mc.vanderbilt.edu]

Through the extensive Danish registries we examined the characteristics and prognosis of the patients hospitalized due to syncope in a nationwide study. [ncbi.nlm.nih.gov]

The prognosis after a single syncopal event for all age groups is generally benign. In particular, syncope of noncardiac and unexplained origin in younger individuals has an excellent prognosis; life expectancy is unaffected. [accessmedicine.mhmedical.com]

If syncope is symptomatic of an underlying condition, then the prognosis will reflect the course of the disorder. Prognosis Syncope is a dramatic event and can be life-threatening if not treated properly. [ninds.nih.gov]

Prognosis in cardiac syncope is much worse than in reflex-mediated conditions. [frontiersin.org]

Given the wide variety of etiologies and concern over potentially missing an important etiology, diagnostic testing can become elaborate, expensive, and frequently low yield. [journalofhospitalmedicine.com]

Cardiac etiology is more common in elderly and noncardiac etiology (vasovagal) common in young adults. No significant difference in incidence between men and women. [ncbi.nlm.nih.gov]

Etiology 1. Cardiac (Structural and Electrical). Often associated with exercise, and always warrants follow up with a pediatric cardiologist. [pedclerk.bsd.uchicago.edu]

Table 3 lists clinical features suggesting specific etiologies.2 Table 3: Clinical Features Suggesting Specific Etiologies Reflex syncope Absence of heart disease Longstanding and recurrent syncope After unexpected pain, smell or sight After prolonged [clevelandclinicmeded.com]

Traditionally the data on epidemiology of syncope has been taken from smaller studies from different clinical settings with wide differences in patient morbidity. [ncbi.nlm.nih.gov]

EPIDEMIOLOGY AND NATURAL HISTORY Syncope is a common presenting problem, accounting for approximately 3% of all emergency room visits and 1% of all hospital admissions. [accessmedicine.mhmedical.com]

There are also some difficulties interpreting epidemiological estimates because of inconsistencies in methodology and definitions used between studies. [bestpractice.bmj.com]

Definitions, classification and pathophysiology 3.1 Definitions 3.2 Classification and pathophysiology of syncope and transient loss of consciousness 3.2.1 Syncope 3.2.2 Non-syncopal forms of (real or apparent) transient loss of consciousness 4. [escardio.org]

In addition, long sinus pauses were noted during carotid sinus massage, suggesting that the two distinct entities may be associated, and further supporting the mechanism of neurally mediated syncope in the pathophysiology of swallow-induced syncope. [ncbi.nlm.nih.gov]

Prevention & Risk Assessment Prevention & Risk Assessment What causes syncope? The common reason behind each syncopal or fainting episode is a temporary lack of oxygen-rich (red) blood getting to the brain. [childrensnational.org]

VVS is not always completely preventable. However, a person may be able to reduce the number of fainting episodes that they experience. [medicalnewstoday.com]

Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, et al. (2006) Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 113: 1164-1170. [omicsonline.org]

Bed elevation works by preventing the loss of intravascular volume due to nocturnal diuresis. [bcmj.org]

Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006 ; 113 :1164–1170. Link Google Scholar 86. [circ.ahajournals.org]