1. NINDS Syncope Information Page syncope(fainting) information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS). More about syncope, Studies with patients, http://www.ninds.nih.gov/health_and_medical/disorders/syncope_doc.htm

National Institute of Neurological Disorders and Stroke Accessible version Science for the Brain The nation's leading supporter of biomedical research on disorders of the brain and nervous system Browse all disorders Browse all health organizations More about Syncope Studies with patients Research literature Press releases Search NINDS... (help) Contact us My privacy NINDS is part of the National Institutes of Health NINDS Syncope Information Page Synonym(s): Fainting Reviewed 05-09-2002 Get Web page suited for printing Email this to a friend or colleague Table of Contents (click to jump to sections) What is Syncope? Is there any treatment? What is the prognosis? What research is being done? ... Additional resources from MEDLINEplus What is Syncope? Syncope is the temporary loss of consciousness due to a sudden decline in blood flow to the brain. It may be caused by an irregular cardiac rate or rhythm or by changes of blood volume or distribution. Syncope can occur in otherwise healthy people. The patient feels faint, dizzy, or lightheaded (presyncope), or loses consciousness (syncope). Is there any treatment?

2. THE MERCK MANUAL, Sec. 16, Ch. 200, Orthostatic Hypotension And Syncope An article about orthostatic hypotension and syncope. http://www.merck.com/pubs/mmanual/section16/chapter200/200b.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 200. Orthostatic Hypotension And Syncope Topics Orthostatic Hypotension Syncope Syncope (Fainting) A sudden brief loss of consciousness, with loss of postural tone. Etiology and Pathophysiology Bradyarrhythmias (especially those with abrupt onset) can cause syncope. These include the sick sinus syndrome, with or without tachyarrhythmias, and high-grade atrioventricular block. Although bradyarrhythmias occur at all ages, they are most frequent in the elderly and are usually due to ischemia or fibrosis of the conduction system. Digitalis, -blockers (including ophthalmic -blockers), Ca blockers, and other drugs may also cause bradyarrhythmias. Supraventricular or ventricular tachyarrhythmias that cause syncope may be related to ischemia, heart failure, drug toxicity (quinidine syncope is the best known), electrolyte abnormalities, preexcitation, and other disorders. Syncope with chest pain of myocardial ischemia is usually related to arrhythmia or heart block but rarely may reflect substantial ischemic ventricular dysfunction with a reduced cardiac output. Syncope can be due to atrioventricular block in acute inferior MI. Many other mechanisms, often in combination, may limit cardiac output, such as a decrease in systemic BP due to peripheral vasodilation, decreased venous return to the heart, hypovolemia, and cardiac outflow obstruction. Diminished cerebral perfusion may also be caused by cerebral vasoconstriction, eg, induced by hypocapnia.

3. EMedicine - Syncope : Article By Rumm Morag, MD syncope syncope is defined as a transient loss of consciousness with an inability to maintain postural tone that resolves spontaneously without medical or surgical intervention. The term syncope http://www.emedicine.com/emerg/topic876.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Emergency Medicine Special Aspects Of Emergency Medicine Syncope Last Updated: September 27, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: transient loss of consciousness, blackout, fainting AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: Rumm Morag, MD , Assistant Professor, Department of Emergency Medicine, Emory Healthcare and Emory University Coauthor(s): Barry Brenner, MD, PhD , Chairman, Department of Emergency Medicine, Professor, Departments of Emergency Medicine and Internal Medicine, University of Arkansas for Medical Sciences Rumm Morag, MD, is a member of the following medical societies: American Academy of Environmental Medicine American College of Emergency Physicians American Medical Association , and Society for Academic Emergency Medicine Editor(s): David A Peak, MD

4. Virtual Hospital: University Of Iowa Family Practice Handbook, Fourth Edition: C For Providers. University of Iowa Family Practice Handbook, Fourth Edition, Chapter 3. Cardiology syncope. James M. Fox, MD. Division of Cardiology, Department of Internal Medicine. University of Iowa College of Medicine syncope is a sudden, brief loss of consciousness (LOC) and, strictly speaking, is related to abrupt Only two CNS lesions can cause syncope bilateral cortical dysfunction (e.g http://www.vh.org/adult/provider/familymedicine/FPHandbook/Chapter03/06-3.html

For Providers University of Iowa Family Practice Handbook, Fourth Edition, Chapter 3 Cardiology: Syncope James M. Fox, MD Division of Cardiology, Department of Internal Medicine University of Iowa College of Medicine Peer Review Status: Externally Peer Reviewed by Mosby Definition . Differentiate between near syncope and vertigo because the differential diagnosis is different. See Chapter 9 for work-up and differential of vertigo. Syncope is a sudden, brief loss of consciousness (LOC) and, strictly speaking, is related to abrupt cerebral hypoperfusion. Only two CNS lesions can cause syncope: bilateral cortical dysfunction (e.g., from hypoperfusion, etc.) or reticular activating system injury. Near syncope is a sense of impending LOC or weakness, occurs more frequently, and provides valuable diagnostic clues, since the patient usually has better recollection of the event. Frequency of causes . 55% vasovagal, 10% cardiac, 10% neurologic, 5% metabolic or drug-induced, 5% "other," and 10% undiagnosed causes. Causes of Syncope and Near Syncope Cardiac and circulatory Cardioinhibitory (bradycardia, enhanced parasympathetics), neurocardiogenic (e.g., vasovagal), vasodepressor (decreased systemic vascular resistance) are

5. STARS - Syncope Trust And Reflex Anoxic Seizures Charitable organisation offering support and information on these autonomic disorders. http://www.stars.org.uk

6. Ann Intern Med -- Linzer Et Al. 126 (12): 989 electrocardiographyare the core of the syncope workup (combined diagnostic yield 50%). Second, neurologic suspected or those with exertional syncope are at higher riskfor adverse http://www.acponline.org/journals/annals/15jun97/ppsyncop.htm

Search Annals: Advanced search Home Current Issue Past Issues ... ACP Online Article Table of Contents Abstract of this article Figures/Tables List Related articles in Annals ... Articles citing this article Services Send comment/rapid response letter Notify a friend about this article Alert me when this article is cited Add to Personal Archive New Download to Citation Manager ACP Search PubMed Articles in PubMed by Author: Linzer, M. Kapoor, W. N. Related Articles in PubMed PubMed Citation ... PubMed POSITION PAPER CLINICAL GUIDELINE Diagnosing Syncope: Part 1: Value of History, Physical Examination, and Electrocardiography Mark Linzer, MD Eric H. Yang, BS N.A. Mark Estes III, MD Paul Wang, MD ... Wishwa N. Kapoor, MD, MPH Purpose: To review the literature on diagnostic testing in syncope and provide recommendations for a comprehensive, cost-effective approach to establishing its cause. Data Sources: Studies were identified through a MEDLINE search (1980 to present) and a manual review of bibliographies of identified articles. Study Selection: Papers were eligible if they addressed diagnostic testing in syncope or near syncope and reported results for at least 10 patients.

7. Syncope (fainting) on syncope fainting or temporary loss of consciousness. syncope, Part 1 - First, let's make sure you don't die. First of a 3-part review of syncope by your Guide http://heartdisease.about.com/cs/syncope

zJs=10 zJs=11 zJs=12 zJs=13 zc(5,'jsc',zJs,9999999,'') About Heart Disease / Cardiology Home Essentials ... BEWARE: Medical Offers are Ads zau(256,152,180,'gob','http://z.about.com/5/ad/go.htm?gs='+gs,''); Dealing With Heart Disease Reducing Cardiac Risk Cholesterol, triglycerides Heart Healthy Diet ... Help zau(256,138,125,'el','http://z.about.com/0/ip/417/0.htm','');w(xb+xb); Stay Current Subscribe to the About Heart Disease / Cardiology newsletter. zau(256,152,100,'hs','http://z.about.com/5/ad/hs.htm?zIhsid=00',''); Search Heart Disease / Cardiology Syncope (fainting) Guide picks A list of sites providing information on syncope - fainting or temporary loss of consciousness Syncope, Part 1 - First, let's make sure you don't die First of a 3-part review of syncope by your Guide. This part stresses that doctors need first to rule out potentially lethal varieties of syncope. Syncope, Part 2 - When to fire your doctor Second of a 3-part series by your Guide. The appropriate evaluation of syncope is not that difficult. But if it is not done right, there may be serious consequences. Syncope, Part 3 - How syncope is treated

8. Exercise-Related Syncope In The Young Athlete: Reassurance, Restriction Or Refer An article entitled ExerciseRelated syncope in the Young Athlete Reassurance, Restriction or Referral? http://www.aafp.org/afp/991101ap/2001.html

Advanced Search Exercise-Related Syncope in the Young Athlete: Reassurance, Restriction or Referral? FRANCIS G. O'CONNOR, LTC, MC, USA, Uniformed Services University of the Health Sciences, Bethesda, Maryland RALPH G. ORISCELLO, M.D., Elizabeth General Medical Center, Elizabeth, New Jersey BENJAMIN D. LEVINE, M.D., Presbyterian Hospital and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas A common event in young adults, syncope is usually benign and only rarely requires more than simple reassurance. However, exercise-related syncope always requires investigation because it may be the only symptom that precedes a sudden cardiac death. Syncope that occurs during exercise tends to be more ominous than that occurring in the postexertional state. During the physical examination, the cardiovascular system should be evaluated carefully. An electrocardiogram is mandatory and requires close scrutiny, with further testing ordered as indicated. The investigation of syncope should specifically exclude known pathologic diagnoses before a complete return to activity is permitted. In cases where a diagnosis is not clearly established, consultation or referral may be warranted. (Am Fam Physician 1999;60:2001-8.) S yncope is a common event in which there is a transient loss of consciousness and postural tone. Although syncope is generally a benign event in young adults (less than 35 years of age) and, in many cases, never reaches the attention of a physician, exercise-related syncope can signal sudden death.

9. The Center For Pediatric Hypotension Information about the investigation, evaluation, and treatment of adolescents and children with syncope, orthostatic tachycardia, and other forms of chronic orthostatic intolerance including CFS. http://www.syncope.org/

syncope.org;http://www.nymc.edu/fhp/centers/syncope; syncope.org;http://www.nymc.edu/fhp/centers/syncope;

10. Syncope syncope. sin'ko-pee. from Gk Isidore 1.35.3; Mosellanus ("syncope" "concisio") a3v; Susenbrotus (1540) 20; Sherry (1550) 27 ("syncope " "consicio http://humanities.byu.edu/rhetoric/Figures/S/syncope.htm

syncope sin'-ko-pee from Gk. syn and koptein , "to strike off" consicio cutting from the midst Cutting letters or syllables from the middle of a word. A kind of metaplasm Examples Omission of a medial letter: When "library" is pronounced "libary" Omission of an medial syllable: You, that are thus so tender o'er his follies, Will never do him good, not one of you. The Winter's Tale O'ermaster't as you may. Hamlet Related Figures metaplasm Figures of Omission synaloepha Omitting one of two concurrent vowels at the end of one word and the beginning of another epenthesis The addition of a letter or syllable to the middle of a word. apocope Omitting a letter or syllable at the end of a word. See Also Four Categories of Change: Subtraction Sources: Isidore 1.35.3; Mosellanus ("syncope" "concisio") a3v; Susenbrotus (1540) 20; Sherry (1550) 27 ("syncope," "consicio"); Wilson (1560) 202 ("cutting from the midst"); Peacham (1577) E2v Gideon O. Burton

11. Syncope syncope (SIN kope) is temporary loss of consciousness and posture, described as. syncope What is syncope? syncope (SIN ko-pe) is http://www.americanheart.org/presenter.jhtml?identifier=4749

12. Syncope syncope. Timothy C. Hain, MD. It is often a symptom of orthostatic hypotension, and may also be a source of drop attacks (Dey et al, 1997). Causes of syncope http://www.tchain.com/otoneurology/disorders/medical/syncope.htm

Syncope Timothy C. Hain, MD Last edited: 7/2002. Please read our Syncope defined Causes Evaluation Prognosis Education Index Syncope (faint) is a sudden fall of blood pressure resulting in loss of consciousness. About 3% of the population have syncope at some point in life (Savage, 1985). Syncope also accounts for 3% of all emergency room visits and 6% of all hospital visits. Between 71 and 125 children and adolescents/100,000 population experience syncope each year. The incidence peaks in 1519 year olds (Driscoll, 1997). Presyncope consists of unsteadiness, weakness, or cognitive symptoms without loss of consciousness. It is often a symptom of orthostatic hypotension , and may also be a source of drop attacks (Dey et al, 1997). Causes of syncope: Arrythmia abnormal slowing or quickness of the heart bradycardia (slowness of heart beat) sick-sinus (variable) supraventricular or ventricular tachycardia (abnormally fast) hemodynamic obstruction to blood flow hypertrophic subaortic stenosis (IHSS) aortic stenosis pulmonary embolism or hypertension Neurally mediated vasovagal reaction (usually related to emotional stress) carotid sinus hypersensitivity postural hypotension (usually related to medication or dehydration) In the differential diagnosis of syncope one must also consider non-cardiac causes of loss of consciousness: seizure stroke or TIA metabolic encephalopathy psychiatric conditions Common drugs that are associated with an excess risk of syncope in the elderly include

13. Syncope Sources Presented At Multigon.com syncope Sources Available on Multigon.com. syncope information presented at Multigon.com. syncope sources available by clicking above. http://www.multigon.com/syncope_n.html

Syncope Sources Available on Multigon.com Syncope information presented at Multigon.com. Syncope sources available by clicking above. Find syncope on Multigon.com. Researchers are investigating the appearance of high intensity transient signals in the TCD. Transcranial Doppler (TCD) is a non invasive ultrasound technology used to evaluate blood flow velocity in major basal intracranial arteries. Emerging applications of TCD include the classification and quantification of intracranial emboli. The accuracy and clinical significance of this technique has not yet been scientifically established. Evaluation of intracranial effects of extracranial stenosis, including assessment of collateral flow pathways. Multigon encourages you to browse our website or contact us for more information on transcranial Doppler. Evaluation and monitoring of intracranial blood flow during surgical procedures. Related terms include moyamoya sickle cell immunochemiluminometric assay technique sickle cel canine stroke symptoms charles morgan neurology , and micro carotid artery . The Neurovision™ TCD system has been engineered to meet the distinct requirements of the clinical environment. Evaluation of vasomotor reserve, Support of the diagnosis of brain death. A thorough neurovascular exam should include TCD, as carotid obstructions seen with duplex imaging.

14. Neurocardiogenic Syncope - Malignant Vasovagal - Causes Of Fainting Neurocardiogenic syncope, also known as Vasovagal syncope, and Carotid Sinus Syndrome are important, treatable, underdiagnosed causes of recurrent blackouts. http://www.syncope.co.uk/

Neurocardiogenic Syncope Neurocardiogenic syncope (Vasovagal Syncope) Recurrent unexplained blackouts may cause great anxiety. Despite intensive investigation syncopal attacks often remain unexplained. In the late 1980s it was discovered that Tilt Table Testing could induce syncopal attacks in a high proportion of patients with previously unexplained collapses. The term Neurocardiogenic Syncope was used to describe this specific type of syncope. Since then Neurocardiogenic Syncope has been recognised as an important, treatable cause of syncope. Diagnosis and management of this condition is explained in the following web pages. Site Map WebPosition Gold by FirstPlace Software helps make your site No. 1 in the search engines. Try out this exciting new Web Marketing tool today document.write('<'); document.write('! '); allergen-free food

15. Nevrokard - Heart Rate Variability, Baroreflex Sensitivity & Blood Pressure Vari Tools for analysis of heart rate, blood pressure (Finapresacquired data), arterial flow variability (baroreflex index sensitivity), Perimed laser Doppler microcirculation data; tilt table, vasovagal syncope. http://www.nevrokard.medistar.si/

We design and deliver Nevrokard research tools for analysis of heart rate variability - HRV indicating autonomic nervous system and vagus nerve reactivity; blood pressure variability - BPV, e.g. Finapres data, and baroreceptor reflex sensitivity - BRS; analysis of Perimed laser Doppler microcirculation and skin blood flow data LDDA This page uses frames, but your browser doesn't support them.

16. THE MERCK MANUAL OF GERIATRICS, Sec. 2, Ch. 18, Syncope Section 2. Falls, Fractures, and Injury. Chapter 18. syncope. ( Fainting) A sudden, transient loss of consciousness characterized by unresponsiveness and loss of postural control. syncope is a symptomnot a disease. institutionalized elderly patients have experienced syncope during the past 10 years and http://www.merck.com/pubs/mm_geriatrics/sec2/ch18.htm

Section 2. Falls, Fractures, and Injury this section includes Chapter 18. Syncope Chapter 19. Chronic Dizziness and Postural Instability Chapter 20. Falls Chapter 21. Gait Disorders ... Chapter 23. The Elderly Driver Chapter 18. Syncope (Fainting) A sudden, transient loss of consciousness characterized by unresponsiveness and loss of postural control. Etiology Many disorders can cause syncope ( see Table 18-1 ). Often a cause is neither immediately obvious nor ultimately discovered. Although syncope per se does not increase the risk of death in the elderly, it is associated with physical disability and subsequent functional decline. Abrupt reduction in cardiac output can cause syncope. This reduction may be caused by a number of cardiac disorders, most of which are more common in elderly than in younger patients. Myocardial infarction accounts for 2 to 6% of syncope among elderly patients; however, unless syncope is accompanied by other cardiac symptoms and ECG changes, myocardial infarction is unlikely. Transient ischemia and arrhythmias are other possibilities. Orthostatic hypotension is usually asymptomatic, but it can cause syncope. Among institutionalized elderly persons, orthostatic hypotension causes 6% of syncopal episodes. Orthostatic hypotension has many causes, (

17. Cough_syncope Up, Situational syncope. Sometimes specific scenarios trigger syncope, for example coughing bouts, swallowing cold liquids, straining at stool, or micturition. http://www.syncope.co.uk/situational.htm

Situational syncope Sometimes specific scenarios trigger syncope, for example coughing bouts, swallowing cold liquids, straining at stool, or micturition. Syncope may also occur immediately after peak exercise. This contrasts with collapses occurring during exercise, for example if the person has aortic stenosis. Treatment of situational syncope is avoidance of, or amelioration of the trigger. document.write('<'); document.write('! ');

18. Hospital Practice: Cardiac Arrhythmia Care and management of atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmia and a look at syncope. http://www.hosppract.com/issues/1999/0901/gold.htm

Cardiac Arrhythmia: Current Therapy MICHAEL R. GOLD and MARK E. JOSEPHSON University of Maryland and Harvard University Rhythm disturbances can range from the harmless to the life-threatening, and treatment varies accordingly, from watchful waiting to emergency intervention. Traditional antiarrhythmic medications have largely been supplanted by newer agents; pharmacologic therapy is giving way to device-based treatment, including pacemakers, defibrillators, and catheter ablation. Dr. Gold is Director, Cardiac Electrophysiology Service, and Associate Professor of Medicine, University of Maryland School of Medicine, Baltimore. Dr. Josephson is Professor of Medicine, Harvard Medical School, and Director, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston. During the past few years, the treatment of many cardiac arrhythmias has tended to move away from drug therapy and toward device-based therapy. The latter may involve pacemakers, implantable defibrillators, or catheter ablation, depending on the type of arrhythmia. When drug therapy is the preferred route, the agents used are different from those selected several years ago. The treatment changes affect the management of the most common arrhythmias seen in primary care practice, including atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular arrhythmia. Atrial Fibrillation The prevalence of atrial fibrillation increases with age; this arrhythmia is most often seen in patients older than 65 years. Atrial fibrillation is typically associated with some form of cardiovascular disease, such as hypertension, coronary artery disease, or valvular heart disease, but it can also occur secondary to metabolic disorders such as thyrotoxicosis. In a minority of young patients, there is no obvious cause, a condition known as lone atrial fibrillation.

19. Postural Orthostatic Tachycardia Syndrome A definition of POTS and its relation to Chronic Fatigue Syndrome and the pathophysiology. http://www.nymc.edu/fhp/centers/syncope/POTS.htm

Postural Tachycardia Syndrome H ome NIH Study Science ... Search Contents: POTS Defined POTS and CFS Pathophysiology of POTS Return to Home Page POTS Defined Patterns of heart rate and blood pressure variation are shown in the figure and are from our paper which was the first to directly discuss POTS in the pediatric population. goto top POTS and CFS POTS has been proposed as a mechanism for symptoms of the Chronic Fatigue Syndrome in a series of adult patients. POTS and CFS may share a common pathophysiology particularly in the young . Recently, a review of patients with delayed orthostatic hypotension (delayed POTS) demonstrated a high degree of association with chronic fatigue. Our preliminary data have shown that POTS physiology underlies orthostatic intolerance in the large majority of adolescents with the chronic fatigue syndrome (CFS). In those patients we demonstrated loss of heart rate variability consistent with vagal withdrawal, increased blood pressure variability consistent with enhanced modulation of sympathetic tone, and impaired baroreflex with a phase shift causing wide blood pressure swings uncompensated by compensatory HR changes. Preliminary vascular data suggest that these autonomic findings are associated with changes in arterial and venous properties of the lower limbs during orthostasis causing fluid collection in excess of ordinary "pooling" observed in control patients.

20. EMedicine - Syncope : Article By Leonard Ganz, MD syncope syncope, defined as a transient loss of consciousness and postural tone with spontaneous recovery, is an extremely common medical problem. syncope. http://www.emedicine.com/MED/topic3385.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Medicine, Ob/Gyn, Psychiatry, and Surgery Cardiology Syncope Last Updated: June 12, 2003 Rate this Article Email to a Colleague Synonyms and related keywords: loss of consciousness, loss of postural tone, decreased cerebral perfusion, brainstem hypoxia, carotid sinus pressure, coronary artery disease, nonischemic cardiomyopathy, non-ischemic cardiomyopathy, ventricular tachyarrhythmia, congenital long QT syndrome, Wolff-Parkinson-White syndrome, WPW syndrome, Brugada syndrome, hypertrophic cardiomyopathy, syncopal episode, blackout, dizzy spell, seizure, dizziness, aortic stenosis, pulmonary embolus, pulmonary hypertension, acute myocardial infarction, acute MI, tamponade, aortic dissection, atrial fibrillation, atrial flutter, supraventricular tachycardia, SVT, torsades de pointes, ventricular tachycardia, VT, ventricular fibrillation, AV block, atrioventricular block, A/V block, A-V block, sick sinus syndrome, implanted cardioverter/defibrillators, ICDs AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: Leonard Ganz, MD

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