Syncope and presyncope in patients with COVID‐19

Abstract

Introduction: Recent studies have described several cardiovascular manifestations of COVID-19 including myocardial ischemia, myocarditis, thromboembolism, and malignant arrhythmias. However, to our knowledge, syncope in COVID-19 patients has not been systematically evaluated. We sought to characterize syncope and/or presyncope in COVID-19. Methods: This is a retrospective analysis of consecutive patients hospitalized with laboratory-confirmed COVID-19 with either syncope or presyncope. This "study" group (n = 37) was compared with an age and gender-matched cohort of patients without syncope ("control") (n = 40). Syncope was attributed to various categories. We compared telemetry data, treatments received, and clinical outcomes between the two groups. Results: Among 1000 COVID-19 patients admitted to the Mount Sinai Hospital, the incidence of syncope/presyncope was 3.7%. The median age of the entire cohort was 69 years (range 26-89+ years) and 55% were men. Major comorbidities included hypertension, diabetes, and coronary artery disease. Syncopal episodes were categorized as (a) unspecified in 59.4% patients, (b) neurocardiogenic in 15.6% patients, (c) hypotensive in 12.5% patients, and (d) cardiopulmonary in 3.1% patients with fall versus syncope and seizure versus syncope in 2 of 32 (6.3%) and 1 of 33 (3.1%) patients, respectively. Compared with the "control" group, there were no significant differences in both admission and peak blood levels of d-dimer, troponin-I, and CRP in the "study" group. Additionally, there were no differences in arrhythmias or death between both groups. Conclusions: Syncope/presyncope in patients hospitalized with COVID-19 is uncommon and is infrequently associated with a cardiac etiology or associated with adverse outcomes compared to those who do not present with these symptoms.

Syncope and COVID-19 disease – a systematic review

“…Of the 19 included articles, 8 were case reports (8) (9) (10) (11) (12) (13) (14) (15), 6 were retrospective analyses (3) (7) (16) (17) (18) (19), 3 were case-series (6) (20) (21) and 2 were prospective studies (22) (23). Given the nature of the topic at hand, every article was published in 2020.…”

“…The majority of studies, 8, described syncopal episodes of unspecified etiology. (3) (7) (16) (17) (18) (21) (22) (23) Six studies attributed the cause to orthostatic hypotension (3) (6) (8) (12) (14) (15), while another 5 studies alluded to possible cardiac syncope (3) (9) (10) (11) (13). In turn, reflex syncope was highlighted in 4 of the studies.…”

“…Orthostatic hypotension accounted for 3.6% (9/248) and presumable cardiac syncope was responsible for 2.0% (5/248). Regarding comorbidities, hypertension was heavily represented in 11 studies (3) (6) (7) (8) (9) (14) (16) (19) (20) (21) (22), making it the most prevalent comorbid condition exhibited by the participants. This was closely followed by Diabetes mellitus, obesity, dyslipidemia and heart disease.…”

“…(1) Regarding the cardiovascular manifestations, heart failure, thromboembolism, myocarditis, arrhythmias, pericarditis and acute coronary syndromes have been described in this context. (2, 3). On the other hand, the most common neurological symptoms reported in COVID-19 have been smell and taste disturbances, headache, myalgia, and altered mental status.…”

“…Recently, some case-series have emerged reporting syncope as a possible symptom of the COVID-19 infection, whether it developed at the onset or during the course of the disease. (3) It is important to mention that some of these reports outline its occurrence days before the main respiratory symptoms. (6) If a valid relationship between COVID-19 and syncope is established, a number of patients could be isolated in a timely manner, minimizing the contagious phase.…”