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Neurally mediated reflex syncope

Последний просмотренный: 30 May 2025
Last updated: 17 Dec 2024

Резюме

Определение

History and exam

Other diagnostic factors

  • history of recurrent faints
  • absence of structural heart disease
  • provocative factor
  • nausea
  • low risk for adverse outcomes
  • lightheadedness
  • pallor
  • diaphoresis
  • diminished vision or hearing
  • physical injury
  • fatigue after episode
  • palpitations
  • bradycardia
  • absence of family history of sudden death
  • neuralgia
Full details

Risk factors

  • prior syncope
  • prior history of arrhythmias, myocardial infarction, heart failure, or cardiomyopathy
  • severe aortic stenosis
  • prolonged standing
  • emotional stress (especially in a warm, crowded environment)
  • dehydration/hypovolemia
  • preceding episode of nausea and/or vomiting
  • preceding episode of severe pain
Full details

Diagnostic investigations

1st investigations to order

  • 12-lead ECG
  • serum hemoglobin
  • plasma blood glucose
  • serum beta-hCG (human chorionic gonadotropin)
  • cardiac enzymes
  • D-dimer level
  • serum cortisol
  • BUN and serum creatinine
Full details

Tests to avoid

  • electroencephalogram (EEG)
  • carotid artery imaging
  • neurologic imaging (CT, MRI)
Full details

Investigations to consider

  • echocardiogram
  • tilt-table test
  • carotid sinus massage (CSM)
  • insertable loop recorder
  • electrophysiologic study
  • Valsalva maneuver
  • active standing test
  • cold pressor test
  • cough test
Full details

Treatment algorithm

ACUTE

vasovagal faint

situational faint

carotid sinus syndrome

Contributors

Authors

Bryant Lin, MD
Bryant Lin

Clinical Assistant Professor of Medicine

Division of Primary Care and Population Health

Stanford University School of Medicine

Stanford

CA

Disclosures

BL declares that he has no competing interests.

Paul J. Wang, MD, FACC, FHRS
Paul J. Wang

Professor of Medicine

Stanford Arrhythmia Service

Stanford University School of Medicine

Stanford

CA

Disclosures

PJW receives fellowship support, honoraria, and clinical trial support from Medtronic, which manufactures LINQ, an implantable loop recorder.

Acknowledgements

Dr Bryant Lin and Dr Paul J. Wang would like to gratefully acknowledge Dr David G. Benditt and Dr John T. Nguyen, previous contributors to this topic.

Раскрытие информации

DGB has consultant and equity positions: Medtronic Inc., St Jude Medical Inc., Transoma Inc., Cardionet Inc. DGB is also an author of several references cited in this topic. JTN declares that he has no competing interests.

Рецензенты

Sanjiv Petkar, MBBS, MD, DM (Cardiology), MRCP

Consultant Cardiologist

Hull and East Riding of Yorkshire NHS Trust

Castle Hill Hospital

East Yorkshire

UK

Раскрытие информации

SP has received sponsorship in the past from Medtronic, Inc. and St Jude Medical, Inc. for attending conferences. He has received speaker's fees from Medtronic, Inc. In addition, he was in receipt of a research grant from Medtronic, Inc. to the University of Manchester.

Kenneth A. Ellenbogen, MD

Kontos Professor of Cardiology

Medical College of Virginia

Richmond

VA

Раскрытие информации

KAE declares that he has no competing interests.

Andrew Parfitt, MBBS, FFAEM

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident Emergency Medicine

St Thomas' Hospital

London

UK

Раскрытие информации

AP declares that he has no competing interests.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines, and the Heart Rhythm Society. Heart Rhythm. 2017 Aug;14(8):e155-217.Полный текст  Аннотация

Brignole M, Moya A, de Lange FJ, et al; ESC Scientific Document Group. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883-948.Полный текст  Аннотация

Moya A, Brignole M, Menozzi C, et al; International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Mechanism of syncope in patients with isolated syncope and in patients with tilt-positive syncope. Circulation. 2001 Sep 11;104(11):1261-7.Полный текст  Аннотация

Sandhu RK, Raj SR, Manlucu J, et al; Primary Writing Committee. Canadian Cardiovascular Society clinical practice update on the assessment and management of syncope. Can J Cardiol. 2020 Aug;36(8):1167-77.Полный текст  Аннотация

Reed MJ, Newby DE, Coull AJ, et al. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010 Feb 23;55(8):713-21.Полный текст  Аннотация

Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol. 1996 Jul;28(1):263-75. Аннотация

Raviele A, Giada F, Menozzi C, et al; Vasovagal Syncope and Pacing Trial Investigators. A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The Vasovagal Syncope and Pacing Trial (SYNPACE). Eur Heart J. 2004 Oct;25(19):1741-8.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Отличия

    • Orthostatic syncope (postural or orthostatic intolerance syncope syndromes)
    • Bradycardia
    • Bradycardia: AV conduction disorders
    Больше Отличия
  • Рекомендации

    • Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness
    • 2018 ESC guidelines for the diagnosis and management of syncope
    Больше Рекомендации
  • Лифлеты для пациента

    Atrial fibrillation

    Febrile seizures

    Больше Лифлеты для пациента
  • Калькуляторы

    San Francisco Syncope Rule TreeCalc

    ROSE score: risk stratification of syncope in the emergency department

    Больше Калькуляторы
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