Background: Syncope is not a common manifestation of COVID-19, but it may occur in this context and it can be the presenting symptom in some cases. Different mechanisms may explain the pathophysiology behind COVID-19 related syncope. In this report, we aimed to examine the current frequency and etiology of syncope in COVID-19. Methods: A systematic review across PubMed, ISI Web of Knowledge and SCOPUS was performed, according to PRISMA guidelines, in order to identify all relevant articles regarding both COVID-19 and syncope. Results: We identified 136 publications, of which 99 were excluded. The frequency of syncope and pre-syncope across the selected studies was 4.2% (604/14,437). Unexplained syncope was the most common type (87.9% of the episodes), followed by reflex syncope (7.8% of the cases). Orthostatic hypotension was responsible for 2.2% of the cases and syncope of presumable cardiac cause also accounted for 2.2% of cases. Arterial hypertension was present in 52.0% of syncope patients. The use of angiotensin receptor blockers or angiotensin converting enzyme inhibitors were not associated with an increased incidence of syncope (chi-square test 1.07, p 0.30), unlike the use of beta-blockers (chi-square test 12.48, p < 0.01). Conclusion: Syncope, although not considered a typical symptom of COVID-19, can be associated with it, particularly in early stages. Different causes of syncope were seen in this context. A reevaluation of blood pressure in patients with COVID-19 is suggested, including reassessment of antihypertensive therapy, especially in the case of beta-blockers.

BackgroundSyncope is not a common manifestation of COVID-19, but it may occur in this context and it can be the presenting symptom in some cases. Although several mechanisms may explain the pathophysiology behind COVID-19 related syncope, a valid relationship has not been established yet. In this systematic review, we aimed to examine the current incidence of syncope in COVID-19 patients and to explore different patterns observed in this setting.MethodsA systematic review across PubMed, ISI Web of Knowledge and SCOPUS was performed, according to PRISMA guidelines, in order to identify all relevant articles regarding both COVID-19 and syncope.ResultsWe identified 81 publications, of which 62 were excluded. The cumulative incidence of syncope and pre-syncope across the selected studies was 7.1% (256/3584 patients). Unspecified syncope was the most common type (76.2% of the reported episodes), followed by reflex syncope (18.1% of the cases). Orthostatic hypotension was responsible for 3.6% of the cases and syncope of presumable cardiac cause accounted for 2.0%. Arterial hypertension was present in 64.7% of the patients and either angiotensin receptor blockers or angiotensin converting enzyme inhibitors were used by 39.5% of hypertensive patients with syncope.ConclusionSyncope, although not considered a typical symptom of the COVID-19 disease, can be associated with it, particularly in early stages. Different types of syncope were seen in this context, each with different implications requiring distinct approaches. A careful reevaluation of blood pressure whenever a patient develops COVID-19 is suggested, including reassessment of antihypertensive therapy.