神经介导的反射性晕厥

最后审阅: 6 九月 2022
最后更新: 30 六月 2022

小结

定义

病史和体格检查

其他诊断因素

  • 复发性晕厥病史
  • 无结构性心脏病
  • 激发因素
  • 恶心
  • 眩晕
  • 苍白
  • 发汗
  • 视力或听力下降
  • 躯体损伤
  • 发作后疲乏
  • 心悸
  • 心动过缓
  • 无猝死家族史
  • 神经痛
其他诊断因素

危险因素

  • 既往晕厥
  • 心律失常、心肌梗死、心力衰竭或心肌病既往病史
  • 重度主动脉瓣狭窄
  • 长期站立
  • 情绪应激(尤其在温热的拥挤环境中)
  • 脱水/低血容量
  • 曾出现恶心和/或呕吐
  • 曾出现严重疼痛
更多 危险因素

诊断性检查

首要检查

  • 12 导联心电图
  • 血清血红蛋白
  • 血浆血糖
  • 血清 β-hCG(人绒毛膜促性腺激素)
  • 心肌酶
  • D-二聚体
  • 血清皮质醇
  • 尿素或血清肌酐
更多 首要检查

需考虑的检查

  • 超声心动图
  • 倾斜试验
  • 颈动脉窦按摩 (CSM)
  • 插入式循环记录器
  • 电生理学检查
  • 咽鼓管捏鼻鼓气法
  • 主动站立试验
  • 冷加压试验
  • 咳嗽试验
更多 需考虑的检查

新兴检查

  • 三磷酸腺苷 (ATP) 试验

治疗流程

急症处理

血管迷走性晕厥

情境性晕厥

颈动脉窦综合征

撰稿人

作者

Bryant Lin, MD
Bryant Lin

Clinical Assistant Professor of Medicine

Division of Primary Care and Population Health

Stanford University School of Medicine

Stanford

CA

利益声明

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

利益声明

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

鸣谢

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.

利益声明

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.

同行评议者

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

Consultant Cardiologist

Hull and East Riding of Yorkshire NHS Trust

Castle Hill Hospital

East Yorkshire

UK

利益声明

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

利益声明

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

利益声明

AP declares that he has no competing interests.

  • 鉴别诊断

    • 直立性晕厥(体位或直立不耐受性晕厥综合征)
    • 心动过缓
    • 心动过缓:房室传导障碍
    更多 鉴别诊断
  • 指南

    • 对于可能导致短暂性意识丧失的疾病,推荐倾斜试验和其他激发性心血管自主神经试验
    • 关于晕厥评估和管理的临床实践更新。
    更多 指南
  • 患者教育信息

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    心房颤动:如何有效治疗?

    更多 患者教育信息
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