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
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
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
Tests to avoid
- electroencephalogram (EEG)
- carotid artery imaging
- neurologic imaging (CT, MRI)
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
Treatment algorithm
vasovagal faint
situational faint
carotid sinus syndrome
Contributors
Authors
Bryant Lin, MD

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

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
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 ОтличияРекомендации
- 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
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Больше Лифлеты для пациентаКалькуляторы
San Francisco Syncope Rule TreeCalc
ROSE score: risk stratification of syncope in the emergency department
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