An individual that has experienced a cardiogenic syncope may describe the presence of an aura prior to the event, consisting of dizziness, amaurosis, diaphoresis, nausea or blurred vision. The duration of the aura is different in various cases, depending on the mechanism of the disease. If the substrate is arrhythmic, the aura lasts for about 3 seconds, whereas in vasovagal episodes its duration may be as long as 2.5 minutes. This period is followed by a complete, short duration loss of consciousness. Convulsions, myoclonic jerks or tonic spasms caused by brain hypoperfusion [1] may occur during the episode. Urine and fecal matter loss, confusion and oral trauma suggest epilepsy, whereas dysarthria and focal neurologic signs imply cerebrovascular disease. The recovery after a cardiogenic syncope is usually complete and spontaneous.

• Falling

  Other episodes of psychomotor type occurred in subsequent days, but there were no falls or tonic convulsions. [jnnp.bmj.com]

  Injuries from a fall can be serious, so if you know you’re prone to these episodes, take steps to reduce your risk of falling. [baptisthealth.com]

  Indeed, the heart rate increases slowly as the arterial pressure falls. [courses.washington.edu]

• Dizziness

  Vertigo, dizziness, and imbalance rank amongst the most common presenting symptoms in neurology, ENT, geriatric medicine, and general practice. [books.google.com]

  dizziness,? which generally refers to an alteration in balance, vision, or perception of the environment, without the loss of consciousness. [dysautonomiainternational.org]

  He began experiencing medical difficulties including sleeping problems, dizziness and headaches due to blood vessel dilation. [benglasslaw.com]

  An individual that has experienced a cardiogenic syncope may describe the presence of an aura prior to the event, consisting of dizziness, amaurosis, diaphoresis, nausea or blurred vision. [symptoma.com]

• Seizure

  However, simultaneous ECG-EEG recording of a tonic seizure could not be obtained. [jnnp.bmj.com]

  Relations between syncope, seizure, and arrhythmia. There are clinically important relations between syncope and seizure disorders. [ncbi.nlm.nih.gov]

• Giddiness

  See also separate Dizziness, Giddiness and Feeling Faint article. [patient.info]

A careful history inquiry is a key tool in evaluating a syncope patient [2]. It should always be combined with clinical examination and a 12 lead electrocardiogram (class A recommendations [3]). The victim should be asked about the position of the body before symptoms set in [4] [5], the activity he or she was involved in and other precipitating factors. Anamnesis should determine if the person has a history of myocardial infarction, structural heart disease, arrhythmia, channelopathy or cardiomyopathy. Prior medication (diuretics, beta blockers, vasodilators, nitrates, antiarrhythmic, tricyclic antidepressants) is always important to know.

The physical evaluation must highlight the vital signs and heart auscultation. Tachycardia is suggestive for an acute cardiovascular event, such as a myocardial infarction, pulmonary embolism or signifies an ongoing tachyarrhythmia. An acute coronary syndrome may also be accompanied by bradycardia, especially if a cardiac conduction defect is present. Murmurs also point to a cardiac cause of the syncope but do not warrant it. Cardiovascular evaluation should be completed by assessment of the jugular veins, auscultation of lung rales, palpation of the liver and possible abdominal masses signifying abdominal aneurysms and evaluation of peripheral edema.

A Schellong test is a useful maneuver, indicating orthostatic hypotension if positive. A carotid sinus massage should only be performed by an experienced physician since it can induce prolonged cardiac pauses or severe bradycardia. The maneuver is to be avoided if carotid bruits are present.

Multiple recurrences during a short period of time require immediate cause diagnosis and therapeutic intervention.

Blood workup is nonspecific in this disease, but certain tests may show predisposing factors for a cardiogenic syncope: abnormal electrolytes levels, heart enzymes or B-type natriuretic peptide [6]. An echocardiography is indicated when mechanical cardiac causes are suspected, whereas an electrocardiogram is useful in all cardiogenic syncope patients. A normal aspect implies good prognosis, but clinical judgment may still dictate the need for Holter monitoring or loop event recording [7]. The standard electrocardiogram may show atrioventricular blocks of various degrees [8], Brugada syndrome, Wolff-Parkinson-White syndrome or acute ischemia. Sinus pauses, sustained and nonsustained ventricular tachycardia episodes may also be substrates for a cardiogenic syncope. A positive tilt table test indicates a vasodepressor mechanism.

• Focal Spikes

  A standard EEG showed focal spike and wave with delta slowing on the right centrotemporal region (C4-T4). [jnnp.bmj.com]

However, more research is needed to determine the diagnostic value of these methods.6 Treatment of neurocardiogenic syncope Treatment consists of education, manoeuvres to avert syncope, drug treatment, and pacemakers. [ncbi.nlm.nih.gov]

Despite the significant advances in the treatment of cardiovascular diseases over the past decades, cardiogenic syncope continues to be associated with a significantly worse prognosis when compared with non-cardiogenic syncope. [ncbi.nlm.nih.gov]

Keywords Syncope Prognosis Cardiogenic syncope Emergency department This is a preview of subscription content, log in to check access. Notes Conflict of interest None. References 1. [link.springer.com]

A normal aspect implies good prognosis, but clinical judgment may still dictate the need for Holter monitoring or loop event recording. [symptoma.com]

[…] also known as vasovagal syncope), which is the most common cause of syncope in both children and adults, accounting for 50-66% of unexplained syncope.1 2 The distinction between neurocardiogenic syncope and other causes of fainting is essential, as the prognosis [bmj.com]

The reality is that the majority of syncopal episodes have a cardiovascular etiology. The most prominent cause is due to structural or ischemic heart disease leading to bradyarrhythmias and tachyarrhythmias. [eplabdigest.com]

Syncope Summary Etiology Clinical features Diagnostics Differential diagnoses Treatment Complications [amboss.com]

[…] consciousness, either with momentary premonitory symptoms or without warning, due to cerebral anemia caused by ventricular asystole, extreme bradycardia, or ventricular fibrillation. neurocardiogenic syncope a particularly serious type of vasovagal attack ; the etiology [medical-dictionary.thefreedictionary.com]

Directly after the event, important clues to the etiology, such as seizure activity, incontinence and immediate vital signs (including body temperature), should be sought. [aafp.org]

Objectives List the cardiac etiologies of syncope. Differentiate between the various cardiac etiologies of syncope. Discuss the treatment of syncope of cardiac etiology. [emsworld.com]

Embryology (33) Neurosurgery (30) Infectology (27) Otorhinolaryngology (26) Emergency Medicine (20) Rheumatology (20) Obstetrics, Gynaecology (19) Endocrinology, Metabolism (18) Occupational Medicine and Toxicology (18) Microbiology (16) Haematology (13) Epidemiology [portal.mefanet.cz]

Epidemiologic features of isolated syncope: the Framingham Study. Stroke. 1985; 16 626-629 2 Ganzeboom K S. et al. Prevalence and triggers of syncope in medical students. Am J Cardiol. 2003; 91 1006-1008, A8 3 Blanc J J. et al. [thieme-connect.com]

Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J 2004;25:1749-53. [acc.org]

Definition and Epidemiology Syncope is the sudden loss of consciousness, associated with inability to maintain postural tone, with immediate and spontaneous recovery without requiring electrical or chemical cardioversion. [frontiersin.org]

[…] noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology [link.springer.com]

Conclusions We have observed a novel finding of right insular atrophy in patients with NCS with a positive response to HUT, implicating a role of right insular dysfunction in the pathophysiologic mechanism underlying NCS. [ajnr.org]

A review of pathophysiology and therapy of patients with vasovagal syncope. Pharmacotherapy 2000;20: 158-65. [PubMed] [Google Scholar] 4. [ncbi.nlm.nih.gov]

Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006;113(9):1164–1170. [innovationsincrm.com]

Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006;113:1164-1170. 26. Di Girolamo E, Di Iorio C, Sabatini P, et al. [uspharmacist.com]

I do a lot on the prevention side. If I start to feel sick, I sit wherever I can to avoid falling...salt intake water etc etc...it just doesn't seem to control the heart rate from doing it's thing though.... Thank you so much for the link! [medhelp.org]

Prevention While most cases of neurocardiogenic syncope cannot be prevented, you can take some steps to reduce your chances – as mentioned above – or spot the signs and reduce your chance of injury during an episode. [baptisthealth.com]

1. Walsh K, Hoffmayer K, Hamdan MH. Syncope: diagnosis and management. Curr Probl Cardiol. 2015;40 (2):51-86
2. Huff JS, Decker WW, Quinn JV, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49(4):431-44.
3. Atkins D, Hanusa B, Sefcik T, et al. Syncope and orthostatic hypotension. Am J Med. 1991;91(2):179-85.
4. Calkins H, Shyr Y, Frumin H, et al. The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope. Am J Med. 1995;98(4):365-73.
5. Bergfeldt L. Differential diagnosis of cardiogenic syncope and seizure disorders. Heart 2003;89(3): 353-8.
6. Reed MJ, Newby DE, Coull AJ, et al. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010;23. 55(8):713-21.
7. Rockx MA, Hoch JS, Klein GJ, et al. Is ambulatory monitoring for "community-acquired" syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring. Am Heart J. 2005;150(5):1065.
8. Dovgalyuk J, Holstege C, Mattu A, et al. The electrocardiogram in the patient with syncope. Am J Emerg Med. 2007;25(6):688-701.