1 Kenny RA, Kapoor WN. Epidemiology and social costs. In: Benditt D, Blanc J-J, et al. eds. The Evaluation and Treatment of Syncope . Elmsford, NY: Futura;2003:23-27. 2 Kapoor W. Evaluation and outcome of patients with syncope. Medicine . 1990;69:160-175. 3 Brignole M, Disertori M, Menozzi C, et al. Management of syncope referred urgently to general hospitals with and without syncope units. Europace . 2003;5:293-298. 4 Blanc J-J, L’ Her C, Touiza A, et al. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J . 2002;23:815-820. 5 Campbell A, Reinken J, Allan B, et al. Falls in old age: A study of frequency and related clinical factors. Age and Ageing . 1981;10:264-270.
There is severe impairment of neurocardiovascular reflex which leeds to pooling of a significant of blood in the leg vessels.
Stimulation of baro receptors in the carotid body would send neuronal signals to NTS in the brain stem via glossopharyngeal nerve.This inturn would lead to increased parasympathetic nervous tone, inhibiting SA and AV node causing bradycardia.There is also sympathetic withdrawl leading to vasodilataion and hypotension.
Common in elderly and they are most vulnerable due to .. Decreased baro receptor …
Also known as POTS is seen in younger women who usually present dizzyness or faint on sudden standing.
Figure 2. Overall Survival of Participants with Syncope, According to Cause, and Participants without Syncope. P<0.001 for the comparison between participants with and those without syncope. The category &quot;Vasovagal and other causes&quot; includes vasovagal, orthostatic, medication-induced, and other, infrequent causes of syncope.
SYNCOPE: WHAT HAPPENS WHEN YOUR LIGHTS GO OUT ? Syed Raza MD,MRCP (UK),FCCP, Dip.Card (UK)
Self-limited loss of consciousness and postural tone
Relatively rapid onset
Variable warning symptoms
Spontaneous, complete, and usually prompt recovery without medical or surgical intervention
Underlying mechanism: transient global cerebral hypoperfusion.
Impact of Syncope 1 Kenny RA, Kapoor WN. In: Benditt D, et al. eds. The Evaluation and Treatment of Syncope . Futura;2003:23-27. 2 Kapoor W. Medicine . 1990;69:160-175. 3 Brignole M, et al. Europace . 2003;5:293-298. 4 Blanc J-J, et al. Eur Heart J . 2002;23:815-820. 5 Campbell A, et al. Age and Ageing . 1981;10:264-270.
40% will experience syncope at least once in a lifetime 1
1-6% of hospital admissions 2
1% of emergency room visits per year 3,4
10% of falls by elderly are due to syncope 5
Major morbidity reported in 6% 1 eg, fractures, motor vehicle accidents
The North American Vasovagal Pacemaker Study (VPS)
>6 lifetime episodes
+ tilt-table test
Primary outcome: first recurrence of syncope
Vascular, coronary, myocardial or conduction system disease
J. Am. Coll Cardiol . 1999;33:16-20 Pacemaker No pacemaker Recurrence of Syncope 6/27 (22%) 19/27 (70%) Time to recurrence 112 days 54 days
Soteriades E et al. N Engl J Med 2002;347:878-885 Overall Survival of Participants with Syncope, According to Cause, and Participants without Syncope
Driving Implications Group 1 Entitlement Group 2 Entitlement Simple faint –definite provocation with prodromal symptoms No driving restrictions No driving restrictions Unexplained syncope with low risk of recurrence Can drive 4 weeks after the event Can drive 3 months after the event Unexplained syncope & high risk of recurrence A abnormal ECG B structural heart disease C syncope at the wheel or results in injury D more than 1 episode in last 6 months Can drive 4 weeks after the event if cause identified and treated If no cause – 6 months off Can drive after 3 months if the cause identified and treated If no cause, licence revoked for year Loss of consciousness with no clinical pointers Full neuro/cardiac Ix with no pointers Licence revoked for 6 months Licence revoked for 1 year Cough syncope Stop driving until symptoms controlled Stop driving If smokes or respiratory disease have to be controlled for 5 years