Syncope (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Syncope is temporary loss of consciousness and posture. It most often occurs when the blood pressure is too low and the heart does not pump a normal supply of oxygen to the brain. Usual causes of syncope include cardiovascular diseases, stroke or transient ischemic attack, vasovagal response or orthostatic hypotension. Signs and symptoms include loss of consciousness, light-headedness, dizziness, feeling unsteady or weak when standing, even falling. It is important to identify the cause of syncope. Many patients may recover after several minutes to hours. Once recover, the patient should be sent to hospital to confirm the causes of his/her syncope. Usual tests include cardiac enzymes level, echocardiography, electrocardiogram, head images such as CT and MRI. Tilt table test may be helpful for vasovagal syncope. Treatment and prognosis of syncope depends on the underlying causes. Syncopy caused by cardiovascular diseases may be life-threatening. Outcomes of most vasovagal syncope patients may be relatively better.

What are the symptoms of Syncope?
Syncope itself is a symptom. Patients with syncope may feel:
 * Temporary loss of consciousness
 * Blacking out
 * Light-headedness
 * Dizziness
 * Grogginess, feeling unsteady or weak when standing, even falling

Similar symptoms may be seen in other diseases such as:
 * Dizziness
 * Seizure
 * Vertigo
 * Coma
 * Shock

What causes Syncope?

 * Cardiac causes
 * Arrhythmia, such as ventricular tachycardia, sick sinus syndrome, long Q-T syndrome
 * Abnormal cardiovascular structure, such as aortic stenosis, aortic dissection, hypertrophic cardiomyopathy.
 * Hypertension


 * Brain causes
 * Transient ischemic attack (TIA)
 * Stroke


 * Vasovagal syncope: This is the most frequent and benign cause of syncope.
 * Cough syncope
 * Defecation syncope
 * Micturition syncope
 * Swallow syncope
 * Carotid sinus hypersensitivity


 * Orthostatic hypotension
 * Hypoglycemia

When to seek urgent medical care?
Syncope is a sign of temporary loss of consciousness and many patients may recover after several minutes to hours. Once recover, the patient should be sent to hospital to confirm the causes.

Diagnosis
The goal of the following is to make sure the cause of your syncope. But even though, doctors can not tell the causes for some patients.
 * Lab tests
 * Complete blood count, liver function, renal function and serum electrolyte levels
 * Cardiac enzymes


 * Echocardiography: In patients with known heart disease, echocardiography is needed to check the heart structure and assess left ventricular function. It uses sound waves to produce an image of the valves, ventricles and atrium. The image shows the structure of the mitral valve and its movement during the beating of the heart.
 * Electrocardiogram (ECG), Holter monitoring and electrophysiologic studies: Electrocardiogram and Holter monitoring can tell electric activities of the heart. They can supply informations about heart rhythm and indirectly, heart size. It may help doctor determine the relationship between syncope and arrhythmia. Compared to Holter monitor, electrophysiologic studies have a higher diagnostic yield, it needs to order to any patient with a suspected arrthymia.
 * Head images: Head images such as CT and MRI, may be useful to check brain diseases that cause syncope. A CT scan can show brain structureand locate lesions and its surrounding tissues. An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body.
 * Tilt table test: This test help reveal abnormal cardiovascular reflexes that produce syncope. During the test, you stand and your initial blood pressure and heart rate are recorded as the baseline. Then the table is tilted at 70 degrees for 45 minutes. Your blood pressure and heart rate are recorded again. At the same time, the nurse observes whether the patient appear symptoms such as nausea or vomiting. A positive result suggest the possibility of vasovagal syncope.

Treatment options
Treatments of syncope depends on the causes.
 * Cardiac syncope
 * Arrthymia: For patient whose syncope is caused by bradycardia or heart block, a pacemaker may be considerd to solve the problems. An implantable cardioverter defibrillator (ICD) may help the patient with repeated ventricular tachycardia. Sometimes, antiarrhythmic drugs may be helpful for some patients. These treatments should be ordered by the cardiologists.
 * Abnormal cardiovascular structure: For these kinds of patients, based on the diseases and patients' general stutas, the doctors may consider surgery to correct the abnormities and decrease the possibility of syncope.


 * Neurologic syncope
 * Medications: Medications, such as aspirin, warfarin or heparin
 * Surgery


 * Vasovagal syncope
 * Educating patients not to wear tight collars, not to cough with difficulty, to try to piss in a seated status.
 * Avoiding wounded when falling


 * Orthostatic hypotension
 * Be careful when changing positions from sitting to standing

Where to find medical care for Syncope?
Directions to Hospitals Treating Syncope

What to expect (Outlook/Prognosis)?
Prognosis of syncope depends on:
 * Underlying causes: Syncopy caused by cardiovascular diseases may be life-threatening. Prognosis of vasovagal syncope is relatively better.
 * Whether the patient is associated with severe complcations, such as falling leads to cerebral hemorrhage.

Prevention

 * Treating cardiovascular diseases and neural diseases.
 * Taking certain precautions when changing positions from sitting to standing
 * Avoiding or changing the situations that cause a syncope episode: Not to wear tight collars, not to cough with difficulty, or try to piss in a seated status.