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Management of syncope in adults

Author
Brian Olshansky, MD
Section Editor
Leonard I Ganz, MD, FHRS, FACC
Deputy Editor
Brian C Downey, MD, FACC

INTRODUCTION

Syncope is the abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery. Although it can be alarming for the individual, witnesses, family, and physicians, it is most often benign and self-limited. Nevertheless, injuries associated with syncopal attacks occur in 35 percent of patients, and recurrent episodes can be psychologically devastating. In addition, syncope can be a premonitory sign of cardiac arrest, especially in patients with organic heart disease.

Issues relating to the management of the patient with syncope will be reviewed here. The pathogenesis, etiology, and the evaluation of this disorder are discussed elsewhere. (See "Pathogenesis and etiology of syncope" and "Syncope in adults: Clinical manifestations and diagnostic evaluation".)

The management of the patient with syncope is the same as that for presyncope, which is the prodromal symptom of fainting. Such patients usually present with symptoms of dizziness. (See "Approach to the patient with dizziness".)

TREATMENT

Treatment is based upon the underlying cause of syncope (table 1 and table 2) and is directed at preventing recurrence and/or, in some cases, death. A brief review of the available treatment options for each of the possible underlying disorders is presented below. Detailed discussions of the treatment of individual disorders are presented separately. The treatment options discussed are in general agreement with guidelines published in 2009 by a task force of the European Society of Cardiology [1].

Metabolic disorders — Although metabolic abnormalities (such as hypoglycemia or hypoxia) infrequently cause syncope, they can cause impaired consciousness that may be difficult to distinguish from syncope. Metabolic abnormalities, anemia, and hypovolemia can be effectively managed by specific therapy to correct these abnormalities.

                

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Literature review current through: Nov 2016. | This topic last updated: Wed Jul 22 00:00:00 GMT+00:00 2015.
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References
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