Management of syncope in adults
- Brian Olshansky, MD
Brian Olshansky, MD
- Section Editor — Cardiac Arrhythmias
- Adjunct Professor of Medicine
- Des Moines University
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 "Evaluation of syncope in adults".)
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 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 .
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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- Metabolic disorders
- Iatrogenic syncope
- Orthostatic hypotension
- Cardiovascular disease with obstruction
- Implantable cardioverter-defibrillator therapy
- - Documented, suspected, or induced ventricular tachycardia
- - Other ICD indications
- Genetic syndromes
- Supraventricular arrhythmias
- Sinus bradycardia or AV block
- Vasovagal syncope
- Carotid sinus hypersensitivity
- RATE OF RECURRENT SYNCOPE
- DRIVING RESTRICTIONS
- Underlying cardiovascular disease
- SUMMARY AND RECOMMENDATIONS