scholarly journals Management of syncope: from evidence to clinical practice

2016 ◽  
Vol 10 ◽  
Author(s):  
Tiziana M. Attardo ◽  
Immacolata Ambrosino ◽  
Elena Magnani ◽  
Nathan Artom ◽  
Nicola Battino ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Rapid Onset ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
High Prevalence ◽  
Transient Loss ◽  
Management Optimization ◽  
Care Costs ◽  
Postural Tone

Syncope is defined as a transient loss of consciousness (T-LOC) due to temporary global cerebral hypoperfusion. It is characterized by rapid onset, short duration, loss of postural tone possibly causing patient fall, and spontaneous full recovery. Syncope has a high prevalence and incidence within the general population with a relevant impact on both quality of life and health care costs. The diagnosis of syncope is often inaccurate and subject to delay, and management is greatly variable. The main objective of this monograph is to discuss a methodological diagnostic approach to signs and symptoms suggestive of syncope, aiming for a management optimization. The present work is based on a systematic review of recent international guidelines.

Evaluation and Management of Syncope

2009 ◽  
Vol 2 (2) ◽  
pp. 65-77 ◽  
Author(s):  
Joanne L. Thanavaro
Keyword(s):  
Risk Stratification ◽  
Specific Treatment ◽  
Complete Recovery ◽  
Medical Problem ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Life Threatening ◽  
Transient Loss ◽  
Life Threatening Event ◽  
Postural Tone

Syncope is a transient loss of consciousness precipitated by cerebral hypoperfusion, which is associated with a brief absence of postural tone and usually followed by a complete recovery. This clinical condition is a common medical problem and may be attributed to a multitude of disease processes. Risk stratification identifies the safest setting for the initial evaluation as well as which patients are most likely to have a life-threatening event. Establishing the diagnosis of syncope is important so that specific treatment can be instituted to prevent future recurrences and eliminate the underlying predisposing disease. This article reviews the etiology, risk stratification, diagnosis, and therapeutic management of syncope.

scholarly journals 17 Evidence for Combined Falls and Syncope Assessment in Older Patients

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv6-iv8
Author(s):  
Rose Anne Kenny
Keyword(s):  
Risk Stratification ◽  
Older Patients ◽  
Older Persons ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Transient Loss ◽  
Esc Guidelines ◽  
Flow Through ◽  
The Brain

Abstract Syncope is a transient loss of consciousness due to cerebral hypoperfusion (reduced blood flow through the brain). Thirty percent of older persons who have syncope are unaware of loss of consciousness and the majority of events are not witnessed. In these cases, the patient presents with non-accidental/unexplained falls (Parry SW et al., 2005). Many of these events are not recognised. Given that most causes of syncope can be treated and further events prevented, the new ESC guidelines for syncope recommends inclusion of falls in syncope risk stratification (Brignole M et al., 2018) in older patients. These new risk stratification recommendations will be reviewed coupled with new prevalence and comorbidity information for falls in community samples and the long term consequences of hypotensive syndromes on cerebral function.

Syncope in the older person: a review

2005 ◽  
Vol 15 (3-4) ◽  
pp. 219-235 ◽  
Author(s):  
Samiran Nath ◽  
Rose Anne Kenny
Keyword(s):  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Older Person ◽  
Transient Loss Of Consciousness ◽  
Systemic Hypotension ◽  
Transient Loss

‘Syncope’ is derived from the Greek words ‘syn’ (meaning ‘together’) and ‘koptein’ (meaning ‘cut’). It is a syndrome characterized by transient loss of consciousness resulting from temporary and self-limited cerebral hypoperfusion, most often the result of systemic hypotension.

Cardioneuroablation as a method of therapy in vasovagal syncope

2020 ◽  
Vol 2 (55) ◽  
pp. 20-28
Author(s):  
Roman Piotrowski ◽  
Jakub Baran ◽  
Piotr Kułakowski
Keyword(s):  
Lifestyle Modification ◽  
Vasovagal Syncope ◽  
Treatment Method ◽  
Current Treatment ◽  
Loss Of Consciousness ◽  
Common Cause ◽  
Current State ◽  
Transient Loss ◽  
New Treatment

Vasovagal syncope is the most common cause of transient loss of consciousness, may significantly impair quality of life and lead to injury. Current treatment of vasovagal syncope is based on patient education, lifestyle modification, pharmacotherapy and, in extreme cases, implantation of a pacemaker. In recent years, more and more data on cardioneuroablation have been published – a new treatment method for neurally mediated asystolic syncope. This article summarizes the current state of knowledge about this method, presents indications for this procedure and shows perspectives for its development.

Definition, epidemiology, classification, and pathophysiology

ESC CardioMed ◽  
2018 ◽  
pp. 2017-2021
Author(s):  
J. Gert van Dijk ◽  
Roland D. Thijs
Keyword(s):  
Cardiac Output ◽  
Orthostatic Hypotension ◽  
Epileptic Seizures ◽  
Cerebral Hypoperfusion ◽  
Loss Of Consciousness ◽  
Low Cardiac Output ◽  
Transient Loss Of Consciousness ◽  
Reflex Syncope ◽  
Cardiac Syncope ◽  
Transient Loss

Syncope can closely resemble other disorders with which it shares an apparent short-lived transient loss of consciousness. Together, these disorders are labelled as ‘transient loss of consciousness (T-LOC)’. Syncope is the form of T-LOC caused by cerebral hypoperfusion; the other main T-LOC forms are several types of epileptic seizures and the psychogenic conditions that resemble either syncope or epileptic seizures. The main forms of syncope are reflex syncope, syncope due to orthostatic hypotension, and cardiac syncope, also comprising cardiopulmonary causes and disorders of the great vessels. All forms of syncope share cerebral hypoperfusion and arterial hypotension as a final common pathway. They differ in the mechanism of hypotension: cardiac syncope is largely due to a low cardiac output, but in orthostatic hypotension and reflex syncope both low peripheral resistance and low cardiac output contribute to syncope. The clinical expression of the main forms is tightly linked to their pathophysiology, which is therefore important for differential diagnosis.

Quality of Life Within One Year Following Presentation After Transient Loss of Consciousness

2007 ◽  
Vol 100 (4) ◽  
pp. 672-676 ◽  
Author(s):  
Nynke van Dijk ◽  
Mirjam A. Sprangers ◽  
Kimberly R. Boer ◽  
Nancy Colman ◽  
Wouter Wieling ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss ◽  
One Year

Opioids and the Hypothalamic-Pituitary-Gonadal (HPG) Axis

2020 ◽  
Vol 105 (9) ◽  
pp. e3105-e3113 ◽  
Author(s):  
Leen Wehbeh ◽  
Adrian S Dobs
Keyword(s):  
Evidence Synthesis ◽  
Signs And Symptoms ◽  
Testosterone Replacement Therapy ◽  
Opioid Use ◽  
Randomized Controlled ◽  
High Prevalence ◽  
Reasonable Approach ◽  
Large Heterogeneity ◽  
Higher Doses

Abstract Context Hypogonadism is a well-established consequence of opioid use. It has been reported in both men and women, although more widely studied in men. Evidence Acquisition PubMed was searched for articles in English until December 2019 for opioids and hypogonadism. Bibliography of retrieved articles was searched for relevant articles. Evidence Synthesis The prevalence of opioid-induced hypogonadism (OIH) varies between studies but was reported to be 69% in a recent systematic review. There is large heterogeneity in the studies, with different factors shown to have stronger association with hypogonadism such as specific types of opioids, higher doses, and longer durations of use. The consequences of OIH include sexual dysfunction, depression, decreased quality of life, and low bone density. There is paucity of randomized controlled trials assessing the efficacy of testosterone replacement therapy (TRT) for OIH in men, and even less studies on treating OIH in women. TRT studies in men reported varying outcomes with some studies favoring and others showing no clear benefit of TRT on different measures. Conclusions Despite the high prevalence of OIH, it remains underrecognized and undertreated with multiple endocrine and metabolic consequences. A reasonable approach in patients using opioids includes informing them of this complication and its potential consequences, screening for signs and symptoms of hypogonadism then sex hormone levels if prolonged opioid use > 3 months, and treating patients diagnosed with hypogonadism, if and when clinically indicated, with sex hormones if chronic opioids are planned to be continued for ≥ 6 months.

Clinical Factors Associated with Quality of Life in Patients with Transient Loss of Consciousness

2006 ◽  
Vol 17 (9) ◽  
pp. 998-1003 ◽  
Author(s):  
NYNKE VAN DIJK ◽  
MIRJAM A. SPRANGERS ◽  
NANCY COLMAN ◽  
KIMBERLY R. BOER ◽  
WOUTER WIELING ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Loss Of Consciousness ◽  
Clinical Factors ◽  
Transient Loss Of Consciousness ◽  
Factors Associated ◽  
Transient Loss

scholarly journals Syncope in Children and Adolescents

2017 ◽  
Vol 34 (3) ◽  
pp. 193-198
Author(s):  
Ljiljana Pejčić ◽  
Marija Ratković Janković ◽  
Radmila Mileusnić-Milenović ◽  
Karin Vasić ◽  
Ivana Nikolić
Keyword(s):  
Sudden Death ◽  
Cerebral Hypoperfusion ◽  
Small Subset ◽  
Loss Of Consciousness ◽  
Pediatric Age Group ◽  
Life Threatening ◽  
History Of ◽  
Transient Loss ◽  
Great Fear ◽  
Life Threatening Event

Summary In the pediatric age group, most cases of syncope represent benign, neutrally-mediated alterations in vasomotor tone. Due to the global cerebral hypoperfusion, syncope is defined as a transient loss of consciousness followed by spontaneous recovery and/or a state of presyncope, including dizziness, lightheadedness, pallor, diaphoresis and palpitations which may precede the loss of consciousness. These symptoms could be a sign of a life-threatening event in a small subset of patients, even though most causes of syncope in childhood are benign, and life-threatening causes of syncope generally have cardiac etiology. In all these cases, routine evaluation includes history, physical examination and a 12-lead standard electrocardiogram which should be performed. Further investigation is indicated by worrying features which include syncope that occurs without warning, syncope during exercise, history of familial sudden death, and abnormalities on clinical exam or electrocardiography. The fact is that syncope generates great fear of injury or sudden death among parents and doctors, and the main aim of the present paper is to help the physician involved in the care of children to differentiate the life-threatening causes of syncope from the common, more benign neutrally-mediated syncope.

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