Evaluation of syncope

最后审阅: 17 Sep 2025
最后更新: 25 Jun 2025

小结

鉴别诊断

常见

  • Neurally mediated (including vasovagal)
  • Orthostatic hypotension
  • Acute coronary syndrome
  • Ventricular arrhythmias
  • Atrioventricular block
  • Acute atrial fibrillation
  • Congestive heart failure
  • Volume depletion
  • Sinus node dysfunction
  • Aortic stenosis
  • Upper gastrointestinal bleeding
  • Lower gastrointestinal bleeding
  • Migraine
  • Seizure
完整详情

不常见

  • Wolff-Parkinson-White syndrome/preexcitation syndrome
  • Cardiac tamponade
  • Aortic dissection
  • Pulmonary embolism
  • Ruptured abdominal aortic aneurysm
  • Brugada syndrome
  • Long QT syndrome
  • Hypertrophic cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
  • Mitral stenosis
  • Atrial myxoma
  • Cardiac sarcoidosis
  • Paroxysmal supraventricular tachycardia
  • Subclavian steal syndrome
  • Implantable cardiac device malfunction
  • Ectopic pregnancy
  • Hypoglycemia
  • Primary adrenal insufficiency
  • Subarachnoid hemorrhage
  • Psychogenic nonepileptic seizures
  • Postural orthostatic tachycardia syndrome
完整详情

撰稿人

作者

Shamai Grossman, MD, MS

Associate Professor of Medicine and Emergency Medicine

Harvard Medical School Department

Vice Chair for Health Care Quality

Director, Observation Medicine

Beth Israel Deaconess Medical Center

Boston

MA

利益声明

SG is on the medical advisory board for Inovytec. SG is an author of references cited in this topic.

Christopher Fischer, MD

Chair, Assistant Professor

Mount Auburn Hospital,

Harvard Medical School

Boston

MA

利益声明

CF is an author of a reference cited in this topic.

鸣谢

Dr Shamai Grossman and Dr Christopher Fischer would like to gratefully acknowledge Dr Sanjeev Wasson, Dr Sarabjeet Singh and Dr Nishant Kalra, the previous contributors to this topic. SS and NK declare that they have no competing interests.

同行评议者

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

Consultant Cardiologist

Heart and Lung Centre

New Cross Hospital

Wolverhampton

UK

利益声明

SP has received funds for attending conferences, and fees for speaking and consultation, from Medtronic Inc. SP was also in receipt of funding for research, between 2007 and 2009, from Medtronic Inc. to the University of Manchester. SP was a Guideline Development Group member of the National Institute for Health and Care Excellence (formerly National Institute for Clinical Excellence) guidelines on transient loss of consciousness ('blackouts') management in adults and young people, published in August 2010.

Nicholas Gall, MSc, MD, FRCP

Consultant Cardiologist

Department of Cardiology

King's College Hospital

London

UK

利益声明

NG declares that he has no competing interests.

Robert Gauer, MD

Hospitalist

Department of Internal Medicine

Womack Army Medical Center

Fort Liberty

NC

利益声明

RG declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

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.

关键文献

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. Circulation. 2017 Aug 1;136(5):e60-122.全文  摘要

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

American College of Radiology. ACR appropriateness criteria: syncope​. 2020 [internet publication].全文

参考文献

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

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