Neurocardiogenic syncope natural history: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
Vasovagal syncope appears to have a benign prognosis.<ref name="pmid12239256">{{cite journal| author=Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ et al.| title=Incidence and prognosis of syncope. | journal=N Engl J Med | year= 2002 | volume= 347| issue= 12 | pages= 878-85 | pmid=12239256 | doi=10.1056/NEJMoa012407 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12239256 }} </ref> | Vasovagal syncope appears to have a benign prognosis.<ref name="pmid12239256">{{cite journal| author=Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ et al.| title=Incidence and prognosis of syncope. | journal=N Engl J Med | year= 2002 | volume= 347| issue= 12 | pages= 878-85 | pmid=12239256 | doi=10.1056/NEJMoa012407 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12239256 }} </ref> Patients recover completely within minutes to hours and have excellent prognosis as far as survival is concerned.<ref name="pmid7631619">{{cite journal| author=Ruiz GA, Peralta A, Gonzalez-Zuelgaray J, Duce E| title=Evolution of patients with clinical neurocardiogenic (vasovagal) syncope not subjected to specific treatment. | journal=Am Heart J | year= 1995 | volume= 130 | issue= 2 | pages= 345-50 | pmid=7631619 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7631619 }} </ref> If syncope is symptomatic of an underlying condition, then the prognosis will reflect the course of the disorder and not the syncope itself,<ref name="pmid4050832">{{cite journal |author=Eagle KA, Black HR, Cook EF, Goldman L |title=Evaluation of prognostic classifications for patients with syncope |journal=Am. J. Med. |volume=79 |issue=4 |pages=455–60 |year=1985 |month=October |pmid=4050832 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9343(85)90032-4 |accessdate=2012-05-17}}</ref><ref name="pmid6630777">{{cite journal |author=Morady F, Shen E, Schwartz A, Hess D, Bhandari A, Sung RJ, Scheinman MM |title=Long-term follow-up of patients with recurrent unexplained syncope evaluated by electrophysiologic testing |journal=J. Am. Coll. Cardiol. |volume=2 |issue=6 |pages=1053–9 |year=1983 |month=December |pmid=6630777 |doi= |url= |accessdate=2012-05-17}}</ref> and the patient should be stratified with respect to the risk of a cardiovascular event and/or sudden cardiac death and further evaluation is required. <ref name="pmid21135810">{{cite journal| author=Veltmann C, Borggrefe M, Wolpert C, Schimpf R| title=Evaluation and management of syncope. | journal=Minerva Cardioangiol |year= 2010 | volume= 58 | issue= 6 | pages= 701-15 | pmid=21135810 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21135810 }} </ref> | ||
Among the cardiovascular cause, hemodynaically important [[aortic stenosis]] is an important prognostic indicator.<ref name="pmid6866032">{{cite journal |author=Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS |title=A prospective evaluation and follow-up of patients with syncope |journal=N. Engl. J. Med. |volume=309 |issue=4 |pages=197–204 |year=1983 |month=July |pmid=6866032 |doi=10.1056/NEJM198307283090401 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198307283090401?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-05-17}}</ref> | Among the cardiovascular cause, hemodynaically important [[aortic stenosis]] is an important prognostic indicator.<ref name="pmid6866032">{{cite journal |author=Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS |title=A prospective evaluation and follow-up of patients with syncope |journal=N. Engl. J. Med. |volume=309 |issue=4 |pages=197–204 |year=1983 |month=July |pmid=6866032 |doi=10.1056/NEJM198307283090401 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198307283090401?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-05-17}}</ref> | ||
Revision as of 14:54, 17 May 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Vasovagal syncope usually has an easily identified triggering event such as emotional stress, trauma, pain, the sight of blood, or prolonged standing. Syncope recurs in a few patients, while others just experience a single episode. Mortality associated with syncope is largely due to underlying etiology if any.
Natural History
The natural history is extremely variable; some patients experience single episode while others have recurrent episodes. [1]
In an european study, 465 patients were evaluated for the early (1 month) and late (2 years) death rate and syncopal relapses of patients referred for syncope to 11 general hospitals emergency departments. The following results were found:[2]
- The death rate was higher (17% of all deaths) in the first month of observation
- Reoccurrence of the syncopal episode was low overall in both the short and the long term (0.3% and 0.8% in the first month and in the second year, respectively).
- Mortality was higher in patients having previous cardiovascular disease or in those displaying ECG abnormalities. Both of these two factors represent the main predictors of short- or long-term mortality on multivariate analysis
Prognosis
Vasovagal syncope appears to have a benign prognosis.[3] Patients recover completely within minutes to hours and have excellent prognosis as far as survival is concerned.[4] If syncope is symptomatic of an underlying condition, then the prognosis will reflect the course of the disorder and not the syncope itself,[5][6] and the patient should be stratified with respect to the risk of a cardiovascular event and/or sudden cardiac death and further evaluation is required. [7] Among the cardiovascular cause, hemodynaically important aortic stenosis is an important prognostic indicator.[8]
Complication
The main danger of fainting fits or vasovagal syncope is the risk of injury by falling while unconscious.
The mortality in syncope patients depends on the underlying cause:[9]
- Cardiac causes (arrhythmias or cardiovascular disease) have a 20-30% mortality.
- Non-cardiac causes have 5-10% mortality.
However, a major drawback in determining the true mortality rate is that most individuals with transient loss of consciousness do not seek medical advice.
Reference
- ↑ Alboni P, Brignole M, Degli Uberti EC (2007). "Is vasovagal syncope a disease?". Europace. 9 (2): 83–7. doi:10.1093/europace/eul179. PMID 17272328.
- ↑ Ungar A, Del Rosso A, Giada F, Bartoletti A, Furlan R, Quartieri F; et al. (2010). "Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study". Eur Heart J. 31 (16): 2021–6. doi:10.1093/eurheartj/ehq017. PMID 20167743.
- ↑ Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ; et al. (2002). "Incidence and prognosis of syncope". N Engl J Med. 347 (12): 878–85. doi:10.1056/NEJMoa012407. PMID 12239256.
- ↑ Ruiz GA, Peralta A, Gonzalez-Zuelgaray J, Duce E (1995). "Evolution of patients with clinical neurocardiogenic (vasovagal) syncope not subjected to specific treatment". Am Heart J. 130 (2): 345–50. PMID 7631619.
- ↑ Eagle KA, Black HR, Cook EF, Goldman L (1985). "Evaluation of prognostic classifications for patients with syncope". Am. J. Med. 79 (4): 455–60. PMID 4050832. Retrieved 2012-05-17. Unknown parameter
|month=ignored (help) - ↑ Morady F, Shen E, Schwartz A, Hess D, Bhandari A, Sung RJ, Scheinman MM (1983). "Long-term follow-up of patients with recurrent unexplained syncope evaluated by electrophysiologic testing". J. Am. Coll. Cardiol. 2 (6): 1053–9. PMID 6630777. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Veltmann C, Borggrefe M, Wolpert C, Schimpf R (2010). "Evaluation and management of syncope". Minerva Cardioangiol. 58 (6): 701–15. PMID 21135810.
- ↑ Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS (1983). "A prospective evaluation and follow-up of patients with syncope". N. Engl. J. Med. 309 (4): 197–204. doi:10.1056/NEJM198307283090401. PMID 6866032. Retrieved 2012-05-17. Unknown parameter
|month=ignored (help) - ↑ White CM, Tsikouris JP (2000). "A review of pathophysiology and therapy of patients with vasovagal syncope". Pharmacotherapy. 20 (2): 158–65. PMID 10678294.