21. Syncope Timothy C. Hain, MD. Please read our disclaimerReturn to Index. Search this site Page last modified October 8, 2003. syncope definedCausesEvaluationPrognosis Education Index syncope (faint) is a http://www.dizziness-and-balance.com/disorders/medical/syncope.htm

Syncope Timothy C. Hain, MD Please read our Return to Index Search this site Page last modified: October 8, 2003 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: Arrhythmia 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) situational syncope (occurring after urination, defecation, swallow or cough)

22. The Syncope Center Columbia-Presbyterian Medical Center The syncope Center ColumbiaPresbyterian Medical Center. The Heart Institute Columbia-Presbyterian Medical Center 212-305-9466 Causes of syncope. http://hora.cpmc.columbia.edu/dept/syncope/mdbroch.html

The Syncope Center Columbia-Presbyterian Medical Center The Heart Institute Columbia-Presbyterian Medical Center Prevalence and Prognosis Nearly half of all Americans will have one episode of syncope (fainting) in their lives. More than 100,000 patients per year present to a physician reporting repeated episodes. Syncope accounts for 3% of emergency room visits and 1% of hospitalizations. Depending on the cause of syncope, the prognosis varies from excellent to poor. Finding the cause of syncope and an effective treatment quickly are primary goals of the Syncope Center. Causes of Syncope The causes of syncope are myriad, but more than half of the episodes have a recognizable cardiovascular cause. In the absence of focal neurological symptoms or signs, a neurologic cause is rare. When structural heart disease is present, syncope often si gnals a mechanical or electrical cardiac cause. When structural heart disease is absent, a disorder of cardiovascular reflexes is the most likely cause of syncope. The causes of syncope are often categorized as: cardiovascular (arrhythmias, mechanical problems, abnormal cardiovascular reflexes)

23. THE MERCK MANUAL, Sec. 16, Ch. 200, Orthostatic Hypotension And Syncope A look at the cardiac causes, symptoms, signs, diagnoses, prognosis and treatment of orthostatic hypotension and syncope. http://www.merck.com/pubs/mmanual/section16/chapter200/200a.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 Orthostatic Hypotension Orthostatic hypotension is not a specific disease but rather a manifestation of abnormal BP regulation due to various causes. Etiology and Pathophysiology The gravitational stress of sudden standing normally causes pooling of blood in the venous capacitance vessels of the legs and trunk. The subsequent transient decrease in venous return and cardiac output results in reduced BP. Baroreceptors in the aortic arch and carotid bodies activate autonomic reflexes that rapidly normalize BP by causing a transient tachycardia. These changes reflect primarily the sympathetic mediated increase in catecholamine levels, which augments vasomotor tone of the capacitance vessels, increases heart rate and myocardial contractility, and thereby enhances cardiac output; arterial and venous vasoconstriction are mediated by similar mechanisms. Vagal inhibition also increases the heart rate. With continued standing, ADH secretion and activation of the renin-angiotensin-aldosterone system cause Na and water retention and expansion of the circulating blood volume. When afferent, central, or efferent portions of the

24. Syncope Choose the BEST answer. When done, click the grade button. If you wish, you may go back and remark the ones you have missed and grade again. You may read the answers after grading if you like. http://www.alaskaems.org/quiz/syncope.htm

25. Patient Information: Vaso-Vagal Syncope What is vasovagal syncope? Vaso-vagal syncope is the medical term for a common cause of fainting. In this disorder, the nervous http://hora.cpmc.columbia.edu/dept/syncope/vvstilt.html

What is vaso-vagal syncope? Vaso-vagal syncope is the medical term for a common cause of fainting. In this disorder, the nervous reflexes which control heart rate and blood pressure behave abnormally causing a drop in blood pressure and a fainting spell. The nerves which control the heart rate and blood pressure are regulated through pressure sensors in the arteries and veins called the baroreceptors. The baroreceptors detect changes in blood pressure. These baroreceptors detect a fall in blood pressure and send signals via the nerves to increase the heart rate and constrict blood vessels bringing the blood pressure back to normal. Conversely, baroreceptors detect abnormally elevated blood pressure and send signals to slow heart rate and relax blood vessels to lower blood pressure back to normal. These reflexes are called the baroreflexes. Vaso-vagal syncope results from an abnormality in the baroreflexes. When you stand up, the force of gravity causes some of the blood from your heart and your chest cavity to pool in your legs. This produces a slight drop in blood pressure which is detected by the baroreceptors and is adjusted through the baroreflexes. In patients with vaso-vagal syncope, after a period of standing in the upright position, baroreflex adjustments fail and blood pressure and heart rate decrease causing fainting. Vaso-vagal syncope can be diagnosed by tilt table testing and can be prevented by treatment.

26. Syncope An explanation of what syncope is, neurally mediated syncope, AHA recommendations and further resources to related issues. http://216.185.112.5/presenter.jhtml?identifier=4749

27. Ann Intern Med -- Linzer Et Al. 127 (1): 76 POSITION PAPER. CLINICAL GUIDELINE. Diagnosing syncope Part 2 Unexplained syncope. Mark Linzer electrocardiography. Unexplained syncope. syncope http://www.acponline.org/journals/annals/01jul97/ppsync2.htm

Search Annals: Advanced search Home Current Issue Past Issues ... ACP Online Article Table of Contents Abstract of this article Figures/Tables List 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 2: Unexplained Syncope 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 that remains unexplained after initial clinical assessment. Data Sources: MEDLINE search. Study Selection: Published papers were selected if they addressed diagnostic testing in syncope, near syncope, or dizziness. Data Extraction: Studies were identified as population studies, referral studies, or case series. Data Synthesis: After a thorough history, physical examination

28. Evaluating Cardiac Syncope syncope, Part 1 Cardiac syncope. I am your Guide, From Richard N. Fogoros, Your Guide to Heart Disease / Cardiology. What causes syncope? http://heartdisease.about.com/library/weekly/aa092700a.htm

zJs=10 zJs=11 zJs=12 zJs=13 zc(5,'jsc',zJs,9999999,'') About Heart Disease / Cardiology Other heart topics The Dysautonomias ... 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 Email to a friend Print this page Stay Current Subscribe to the About Heart Disease / Cardiology newsletter. Suggested Reading Part 2 - Non-cardiac Syncope Part 3 - Treatment of Syncope Most Popular How to increase your HDL levels The South Beach Diet Contoversy Symptom checker Cholesterol and triglycerides ... Is Chocolate Really Good For You? What's Hot Is Chocolate Really Good For You? Exercise for heart failure aneurysm cardiac electrical system - AV conduction ... Cardiac arrhythmias - ventricular fibrillation Syncope, Part 1 - Cardiac Syncope From Richard N. Fogoros

29. THE MERCK MANUAL, Sec. 16, Ch. 200, Orthostatic Hypotension And Chapter 200. Orthostatic Hypotension And syncope. Topics. Orthostatic Hypotension. syncope. click here for navigation help. syncope (Fainting). http://www.merck.com/mrkshared/mmanual/section16/chapter200/200b.jsp

30. THE MERCK MANUAL OF GERIATRICS, Sec. 2, Ch. 18, Syncope Chapter 18. syncope. (Fainting). A sudden, transient loss of consciousness syncope is a symptomnot a disease. Studies suggest that about 25% of http://www.merck.com/mrkshared/mm_geriatrics/sec2/ch18.jsp

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32. Vasovagal Syncope And Related Disorders - April 1, 2000 - American Academy Of Fa Vasovagal syncope and Related Disorders. The extremities. The mean time to syncope in patients undergoing a tilttable test is 25 minutes. http://www.aafp.org/afp/20000401/tips/9.html

Advanced Search Tips from Other Journals Previous Next Vasovagal Syncope and Related Disorders The management of patients in whom a primary abnormality in blood pressure regulation results in hypotension and loss of consciousness presents clinical challenges. The hypotension may be primary, or it may be secondary to a condition such as tachyarrhythmia or bradyarrhythmia. Vasovagal syncope describes this condition, as well as other conditions that are considered to be dysautonomic responses to upright posture, such as orthostatic hypotension and postural orthostatic tachycardia syndrome (POTS). Bloomfield and associates reviewed the pathophysiology of these two causes of syncope and developed an algorithm to guide diagnosis and treatment. see the accompanying figure on page 2212 Vasovagal Syncope and Related Disorders FIGURE. Vasovagal syncope and related disorders: a suggested algorithm for the diagnosis and treatment of vasovagal syncope and related disorders. (POTS = postural orthostatic tachycardia syndrome; HR = heart rate; BP = blood pressure; OH = orthostatic hypotension; HTN = hypertension; SSRI = selective serotonin reuptake inhibitors) Adapted with permission from Professional Postgraduate Services, a division of Physicians World Communications Group.

33. CDSC GUIDELINES - SYNCOPE EM guidemap syncope. Click on any of the headings or sub-headings to rapidly navigate to the relevant section of the guidemap. Risk factors for syncope. http://www.homestead.com/emguidemaps/files/syncope.htm

EM guidemap - Syncope Click on any of the headings or sub-headings to rapidly navigate to the relevant section of the guidemap Introduction and general principles History of present illness clinical clue table Risk factors for syncope ... suggested algorithm for workup of syncope Introduction and general principles syncope is defined as a transient loss of consciousness associated with a loss of postural tone, and most diseases causing syncope produce a transient LOC by temporarily decreasing cerebral blood flow An emergency physician, when faced with a syncope-patient in an ED setting, should first seek to exclude life-threatening causes of syncope, which require immediate diagnostic evaluation/treatment + hospital admission AMI PE aortic dissection cardiac tamponade tension pneumothorax leaking AAA active internal bleeding malignant cardiac arrhythmias ectopic pregnancy SAH carotid artery/vertebral artery dissection air embolism If there are no overt life-threatening causes of syncope, then an emergency physician should attempt to identify patients with situational syncope, vasovagal syncope and benign orthostatic (postural) syncope - who are candidates for home discharge after any necessary stabilization treatment in the ED not occur during exertion, and hospital admission and/or an extensive workup is rarely necessary

34. Syncope - HeartCenterOnline For Patients: Heart Health Encyclopedia American Heart Association member edited encyclopedia article on syncope (Fainting). Includes signs and syncope. (Syncopal Attack, Neurally http://www.heartcenteronline.com/Syncope.html

Professionals Enter Here Home Register Member Log In ... Increase Type Size Featured Centers Blood Pressure Bypass Surgery Cholesterol Defibrillator (ICD) Heart Failure Stent Free Newsletter! News Quizzes Community ... Physician Finder siteURL = "/myheartdr/animations/flash_content/"; //modify for clients basefolder = "HCO"; BASEurl = siteURL + "BMCfile/" + basefolder + "/atlasvar.js"; popupURL = siteURL + "BMCfile/popupNF.js"; Syncope (Syncopal Attack, Neurally Mediated Syncope, NMS, Fainting, Neurocardiogenic Syncope, Vasovagal Syncope, Carotid Sinus Syncope) Summary About syncope Types and differences Other symptoms ... Treatment and prevention Edited By: Kenneth M. Stein M.D., FACC Next Page Visit The Arrhythmia Center Visit The Blood Pressure Center Summary Also known as fainting , syncope (SIN-cuh-pee) is a brief, sudden loss of consciousness. It is a symptom of an underlying cause or condition, not a disease itself. Syncope may be due to harmless causes, or it may be due to more serious underlying cardiovascular or neurologic conditions. In patients with heart disease, the possibility that a fainting spell may have been due to an abnormal heart rhythm ( arrhythmia ) needs to be carefully considered. Therefore, patients with heart disease (and, indeed, anyone) should inform their physician of any episodes of fainting or near-fainting as soon as possible after the event.

35. Syncope syncope. A loss of consciousness due to transient impairment of cerebral blood flow. Occasionally, incontinence of urine. Causes of syncope. http://www.mcevoy.demon.co.uk/Medicine/Neurology/Syncope.html

Syncope A loss of consciousness due to transient impairment of cerebral blood flow Must be distinguished from epilepsy Circumstances of attack May be provoked by pain, shock or bad news May follow prolonged standing in hot conditions May occur on sudden standing (associated with orthostatic hypotension) Warning of attack / prodrome Usually preceded by a period of malaise, dizziness, nausea, visual blurring and a felling of impending loss of consciousness It is often found that the attack can be averted by lying down with feet raised at this stage Duration of the attack The usual exception if when onlookers sit the patient up during the attack Recovery from the attack is rapid and complete; the patient can be expected to be oriented and rational Appearance of attack Limp Pale and sweaty Pulse may be difficult to feel Seconday hypoxic convulsion may occur, especially if the patient is not lying flat Occasionally, incontinence of urine Causes of Syncope Vasovagal attack Cardiogenic syncope Cough, sneeze or micturition syncope Breath holding attack ... Carotid sinus sensitivity Vasovagal attack Vagal overactivity produces bradycardia and fall in blood pressure with peripheral vasodilatation May be provoked by emotional or painful stimuli Occur in otherwise healthy adolescents and young adults More common soon after getting up from lying or sitting Symptoms always start while standing or sitting More frequent in women than men May be associated with menstruation Also associated with febrile illness, sleep deprivation and prolonged fasting

36. Vasovagal Syncope -- ECureMe.com Vasovagal syncope, more about Vasovagal syncope, Simple faint, vasodepressor syncope, or neurocardiogenic syncope. Vasovagal http://www.ecureme.com/emyhealth/data/Vasovagal_Syncope.asp

DisplayAd("468","60"); Select a Health Topic ADD/ADHD Allergy Alternative Medicine Arthritis Asthma Beyond Dieting Body Aches and Pains Breast Cancer Cancer Awareness Cardio Health Children's Health Colon Cancer Contraception COPD/Emphysema Dental Health Diabetes Elder Care Emergency Room Epilepsy Erectile Dysfunction Eye Care Fertility Fitness Gastrointestinal Health Glands and Hormones Gynecologic Health Hair Loss Headache Healthcare Today Healthy Aging HIV and AIDS Infectious Diseases Kidney Health Leukemia Liver Health Lung Cancer Lymphoma Multiple Sclerosis Men's Health Mental Health Nutrition Osteoporosis Parkinson's Disease Sexual Health Skin Health Sleep Disorders Special Events Stroke Surgeries and Procedures Teen Health Thyroid Health Urologic Health Vascular Disease Women's Health Workplace Health June 2, 2004 Resource Links Physician Search Your Questions, E-mail Doctor ... Hospital Directory Vasovagal Syncope more about Vasovagal Syncope Simple faint, vasodepressor syncope, or neurocardiogenic syncope Vasovagal syncope, the most common cause of fainting, occurs in otherwise healthy people. It can affect people of all ages, but is particularly common in young women. It is also known as Neurocardiogenic Syncope or vasodepressor syncope. As these terms suggest, the cause is low heart rate or blood pressure, leading to inadequate circulation to the brain. This results in fainting, or loss of consciousness (i.e.

37. Virtual Naval Hospital: Pediatric Emergency Manual: Syncope Fainting at Medtronic.com Welcome to your online source for information about recurrent, unexplained fainting. Fainting is also called syncope (sing koh-pee). http://www.vnh.org/PediatricEmergencyManual/Syncope.html

Pediatric Emergency Manual Syncope Department of Pediatrics San Antonio Uniformed Services HEC Pediatric Residency Peer Review Status: Internally Peer Reviewed INTRODUCTION: Syncope may be defined as a sudden fall in blood pressure or failure of cardiac systole resulting in cerebral hypoperfusion and subsequent transient loss of consciousness. It is commonly called fainting. Fainting is not a rare event. It is most often the result of vasovagal reactions which are usually benign. However, some causes of syncope are life-threatening. A patient with a history of syncope deserves careful evaluation because syncope, especially if it recurs, places the patient and others at risk for injury. This is especially true if the episode occurred while crossing a street, swimming, driving, climbing or operating machinery. In addition, when heart disease is the etiology for syncope, a risk of serious dysrhythmias and sudden death exists. Syncope may occur at least once in up to 50% of adolescents and accounts for 1 - 3% of all Emergency Dept. visits. The pediatricians task is to identify the small subset with significant disease. ETIOLOGIES: Causes of syncope in children and adolescents (6 major categories): Abnormal circulatory control, vascular volume or tone:

38. Medtronic Reveal - For Health Professionals - The Cost Of Syncope The Cost of syncope. Resource Utilization and Range of Charges. The Cost of syncope Undiagnosed syncope can be expensive in terms of healthcare utilization. http://www.medtronic.com/reveal/hpcost.html

The Cost of Syncope Estimating the Costs of Syncope Case Studies Case 1: Infrequent, Recurrent, Unexplained Case 2: Simple, Frequent, Recurrent, Explained Cost Estimating Worksheet (A Microsoft Excel file will be downloaded.) Resource Utilization and Range of Charges The Cost of Syncope Undiagnosed syncope can be expensive in terms of healthcare utilization. The following cases and accompanying worksheet can be useful in understanding how much is currently being spent on syncope patients. The worksheet is designed to take the physician, or other interested party, through a deliberate thought process as he or she documents actual spending for a patient during a typical year or until a diagnosis is achieved. Estimating the Costs Other Costs Societal costs such as loss of productivity, inability to drive and perform other activities of daily living, lowered quality of life, and functional impairment should also be considered when defining the true costs of undiagnosed syncope. However, inclusion of these costs are outside the scope of this analysis. Return to Top Go to the next case study Case 1: Infrequent, Recurrent, Unexplained

39. SYNCOPE ET LIPOTHYMIE Translate this page syncope ET LIPOTHYMIE. Définitions syncope perte de connaissance brève (quelques secondes à moins de 3 minutes en principe), complète (avec secondairement http://www.elcwp.org/Documents/SuppCare/SyllUrgences/Syncope.html

SYNCOPE ET LIPOTHYMIE Définitions Syncope : perte de connaissance brève (quelques secondes à moins de 3 minutes en principe), complète (avec secondairement amnésie lacunaire de l'épisode) qui s'accompagne, par dissolution du tonus, soit d'une chute brutale, soit d'un affaissement progressif Lipothymie : équivalent mineur de la syncope (symptomatologie très variée : impression de malaise diffus, fatigue extrême, dérobade des jambes, brouillard visuel, acouphènes, étourdissements, oppression respiratoire, palpitations, sueurs) Abord et urgences Selon le mécanisme physiopathologique hypotension a) chute des résistances vasculaires systémiques : syncopes vasculaires réflexes syncopes vasovagales de situation (viscérales et réflexes): syncope de la miction, de la défécation, tussives (ictus laryngé), de la déglutition, au cours de crises douloureuses paroxystiques, instrumentales, par hyperpression thoracique (Valsalva). syncopes vasovagales essentielles : contexte particulier (émotion, peur, douleur, atmosphère confinée, station débout prolongée,...). hypersensibilité sino-carotidienne : survenue lors du massage du sinus carotidien d'une pause sinusale de 3 secondes au minimum et/ou d'une chute tensionnelle systolique de 50 mmHg au moins.

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