Follow-up
Further Inpatient Care
- Patients treated with ICDs or pacemakers require follow-up care at regular intervals.
- Patients with neurocardiogenic syncope require clinical follow-up observation to assess response to therapy.
- Results from follow-up tilt testing are not necessarily predictive of the clinical response to medical therapy; therefore, follow-up tilt testing is not generally recommended.
- Patients with structural heart disease require follow-up care as dictated by the specific heart disease.
Further Outpatient Care
- Patients treated for neurocardiogenic syncope are generally observed clinically.
- Repeat tilt testing has not been established to firmly predict clinical response to therapy.
Inpatient & Outpatient Medications
See Medication.
Transfer
Patients with syncope in the setting of structural heart disease should be transferred to facilities with EP laboratories because ventricular arrhythmias may be causing the episodes.
Deterrence/Prevention
Nonpharmacologic therapies may be of benefit in patients with neurally mediated syncope. These include salt and fluid loading, compression stockings, sleeping with the head of the bed elevated, moving slowly from a lying to a standing position, and avoiding triggers (eg, hot tubs, prolonged standing in a warm room).
Complications
Syncope due to bradyarrhythmia (primarily complete AV block) and ventricular tachyarrhythmia can be important clues to the underlying, potentially life-threatening problem. With any type of syncope, even if the cause is benign (eg, orthostatic, vasovagal), the potential exists for significant trauma, which can be devastating, particularly in elderly persons (eg, hip fracture).
Patient Education
- Patient education should focus on pathophysiologic issues and nonpharmacologic issues.
- For excellent patient education resources, visit eMedicine's Brain and Nervous System Center and Heart Center. Also, see eMedicine's patient education articles Fainting and Supraventricular Tachycardia.
Miscellaneous
Medicolegal Pitfalls
In some US states, syncope is a medical condition that is reportable to the state's drivers' license bureau. Physicians are urged to understand the laws of the state(s) in which they practice. Even in states in which reporting of syncope is not mandatory, recommending that patients not drive, and documenting this recommendation, are prudent. Regulations regarding commercial drivers and pilots are more stringent.
Special Concerns
- Syncope during pregnancy is frequently attributed to orthostatic hypotension and/or inferior vena cava compression by the gravid uterus, but patients should be evaluated carefully for other potentially life-threatening causes of syncope in this age group (eg, long QT syndrome, hypertrophic cardiomyopathy, WPW syndrome).
- Syncope in pediatric patients is frequently ascribed to epilepsy, even if the workup findings are negative. Pediatric patients should be assessed carefully for potentially life-threatening causes of syncope in this age group (eg, long QT syndrome, hypertrophic cardiomyopathy, WPW syndrome). Because many of these syndromes are familial, careful attention to the family history is imperative.
- Syncope in elderly persons can have devastating consequences, even if the etiology is benign (eg, orthostatic hypotension). Trauma due to syncope can include hip and other fractures, which can cause substantial morbidity and mortality. Thus, an aggressive workup of syncope is frequently warranted in elderly persons.
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author John Michael Gaziano, MD, MPH to the development and writing of this article.
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References
Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope--update 2004. Europace. Nov 2004;6(6):467-537.
Cannom DS. A critical appraisal of indications for the implantable cardioverter defibrillator (ICD). Clin Cardiol. May 1992;15(5):369-72. [Medline].
Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ. Aug 7 2004;329(7461):336-41.
Connolly SJ, Sheldon R, Roberts RS, Gent M. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol. Jan 1999;33(1):16-20. [Medline].
Grubb BP, Kosinski DJ. Syncope resulting from autonomic insufficiency syndromes associated with orthostatic intolerance. Med Clin North Am. Mar 2001;85(2):457-72. [Medline].
Kapoor WN. Syncope. N Engl J Med. Dec 21 2000;343(25):1856-62. [Medline].
Kapoor WN. Current evaluation and management of syncope. Circulation. Sep 24 2002;106(13):1606-9.
Linzer M, Yang EH, Estes NA 3rd, et al. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med. Jun 15 1997;126(12):989-96. [Medline].
Linzer M, Yang EH, Estes NA 3rd, et al. Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med. Jul 1 1997;127(1):76-86. [Medline].
Soteriades ES, Evans JC, Larson MG. Incidence and prognosis of syncope. N Engl J Med. Sep 19 2002;347(12):878-85. [Medline].
Sutton R, Brignole M, Menozzi C, et al. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation. Jul 18 2000;102(3):294-9. [Medline].
Further Reading
Keywords
syncope, 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
