
	Syncope Syncope refers to a spontaneous, temporary loss of consciousness. Syncope is also referred to as fainting, although the term fainting implies the benign forms of loss of consciousness. The patient is observed to fall to the floor suddenly and unexpectedly. There may be a brief period of involuntary movements resembling a seizure and there may be a labored breathing pattern. The patient usually appears very pale. There may be brief period of uncertainty as to whether the patient has a pulse or is breathing, prompting concerns about initiating CPR. Usually within one minute, there are signs of arousal leading to return of consciousness. Although the patient may appear confused briefly, he quickly becomes alert and oriented. In the majority of instances, syncope occurs in the absence of any associated abnormal heart condition. This is particularly true when it occurs in younger, healthy persons. Although the more benign forms of syncope are common among older patients, advanced age may imply a greater likelihood that serious causes could be present. The vast majority of syncope is caused by one of the following three conditions: -A sudden drop in blood pressure in the absence of a rhythm -disturbance. -The sudden onset of rapid heart beat (tachycardia) leading -to a sudden drop in blood pressure. -A seizure disorder Seizure disorder is the least common. Sudden drops in blood pressure occurring in the absence of a heart rhythm disorder occur in a variety of settings. The most common are referred to as vasodepressor or vasovagal syncope. These are collectively referred to as neurocardiogenic syncope and may occur either spontaneously or in association with certain circumstances such as pain, emotional upset, coughing, voiding/defecation, or being stuck by a needle. Neurocardiogenic syncope is also the most common explanation for loss of consciousness during church or following a meal. In nearly every instance, the patients recover consciousness either on their own or after minimal stimulation. The majority of these patients have no underlying cardiovascular disease, but when present, the disease state generally has no relationship to their loss of consciousness. For example, blockage of the carotid arteries may be present but doesnít cause syncope. Other conditions known to be associated with a primary drop in blood pressure include the use of medications (blood pressure lowering drugs), advanced age or diabetes mellitus. Relative dehydration is often a common denominator. The sudden onset of rapid heart rhythms or tachycardias is the second most common cause of syncope. These are discussed in the following sections. The reason for a drop in blood pressure accompanying sudden onset of tachycardia is related to the marked decrease in the opportunity for the heart to fill with blood to make the next beat a full volume pulse. This is in contrast to slow heart rhythm problems (bradycardias), which do not cause a drop in blood pressure. In most instances, the cause of syncope can be diagnosed from the facts provided by the history alone. When in doubt or if under- lying heart disease is suspect based upon the patients known past medical history, an echocardiogram is often the most useful tool to clarify whether structural heart disease exists. When present, it may be necessary to perform electrophysiologic testing in order to exclude the presence of an underlying serious rhythm disturbance. Electrophysiologic testing and Head up tilt testing is also useful as a confirmatory measure when the diagnosis is in doubt. In some instances, either external or implantable event recorders can be helpful. Syncope www.medtronic.com/reveal/ Please click name, for information regarding the following patient problems. Palpitations Syncope Rapid Heart Rhythms - Tachycardias Sudden Cardiac Death - Cardiac Arrest Slow Heart Rhythms - Bradycardias Long QT Syndrome - LQTS