Syncope

Question 1

1. What is the most common cause of syncope?

Answer 1

Vasovagal syncope is the most common cause and is classically seen after stress or fear.

Arrhythmias and orthostatic hypotension are also common.

Always remember to consider hypoglycemia as a cause.

Question 2

What other conditions should you consider that mimic syncope?

Answer 2

The other main categories to worry about are as follows:
1. Cardiac problems (arrhythmias, hypertrophic cardiomyopathy, valvular disease, tamponade) Always check an electrocardiogram (ECG). Further testing with echocardiography or treadmill stress testing can be performed according to the ECG findings and degree of suspicion.

2. Neurologic disorders (e.g., seizures, migraine headache, brain tumor). Consider an electroencephalogram or a computed tomography (CT) or magnetic resonance imaging (MRI) scan if the history suggests seizures or an intracranial lesion.
3. Vascular disease (consider transient ischemic attacks or carotid stenosis, which can be ruled out with carotid artery ultrasound/duplex scanning, although this is not a common cause of syncope).
4. Medication effects (e.g., anticholinergic agents, beta-blockers, narcotics, vasodilators, alpha-agonists, antipsychotics). As many as half of patients have syncope of unknown cause according to a standard diagnostic evaluation. Hi

Question 3

Cardiac problems that cause syncope and tx.

Answer 3

arrhythmias, hypertrophic cardiomyopathy, valvular disease, tamponade

Always check an electrocardiogram (ECG). Further testing with echocardiography or treadmill stress testing can be performed according to the ECG findings and degree of suspicion.

Question 4

Neurologic disorders that cause syncope and tx.

Answer 4

seizures, migraine headache, brain tumor

Consider an electroencephalogram or a computed tomography (CT) or magnetic resonance imaging (MRI) scan if the history suggests seizures or an intracranial lesion.

Question 5

Vascular diseases to consider with syncope and dx.

Answer 5

consider transient ischemic attacks or carotid stenosis

can be ruled out with carotid artery ultrasound/duplex scanning

although this is not a common cause of syncope

Question 6

Medication effects that cause syncope.

Answer 6

anticholinergic agents, beta-blockers, narcotics, vasodilators, alpha-agonists, antipsychotics.

As many as half of patients have syncope of unknown cause according to a standard diagnostic evaluation.