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Syncope

	OBJECTIVES

 
After completing this article, readers should be able to:

1. Describe the steps involved in identifying the correct diagnosis of syncope.
   
2. Identify the only mandatory screening test in syncope.
   
3. Describe the ramifications of syncope with exercise.
   
4. Identify the most common diagnosis in syncope and why it is dangerous.
   
5. List the differential diagnosis and treatment of syncope.
   

	Definition

 
Syncope is a transient loss of consciousness and muscle tone. Loss of cerebral oxygenation and perfusion is the usual mechanism. It often is benign but may cause injury (15% of cases). Syncope can be caused by serious cardiac disease, which should be suspected whenever syncope occurs with exercise.

	Epidemiology

 
Up to 3% of emergency department visits by adults and 6% of hospital admissions are due to syncope. Among children, only 0.125% of emergency department visits are due to syncope. Nevertheless, 47% of college students report having fainted, and 15% of children suffer from syncope before the end of adolescence. The lay public realizes that healthy children who faint frequently are free of serious disease and may not require emergency medical attention. About 75% of children who faint have neurocardiac (vasovagal) syncope due to neurally mediated hypotension and bradycardia; most others have seizures, migraine, or cardiac disease.

	Pathogenesis

 
The causes of syncope can be categorized as cardiac, noncardiac, and neurocardiac (Table ).

     CARDIAC SYNCOPE
Cardiac syncope is due to outflow obstruction (aortic stenosis, hypertrophic cardiomyopathy), myocardial dysfunction (cardiomyopathy, carditis, ischemia), or arrhythmias (ventricular tachycardia, long Q-T syndromes, Wolff-Parkinson-White syndrome). Cardiac disease is suggested when syncope accompanies exercise. Cardiac syncope is potentially fatal and always deserves careful evaluation and treatment.

     NONCARDIAC SYNCOPE
This form of syncope includes many entities, some of which are distinguished easily by a careful history and are not true syncope. Seizures often manifest unusual eye or limb movements, may be prolonged, and—unlike syncope—usually are followed by . . . [Full Text of this Article]

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