The Clinical Course of Presyncope in the Differential Diagnosis of Syncope

Abstract

Syncope is a transient loss of consciousness caused by transient, general cerebral hypoperfusion, characterized by rapid onset, short duration and spontaneous recovery [1,2].The most frequent type of syncope is reflex syncope (neurally-mediated syncope), among which vasovagal syncope is the most frequent type [3].Vasovagal syncope, which constitutes up to 40% of syncope of unclear origin, is defined as a rapid loss of consciousness due to excessive reaction of the autonomic nervous system [1,4].During syncope a rapid decrease in systolic blood pressure occurs and, in consequence, a significant decrease in cerebral blood flow is noted [1,5].Cardiac syncope constitutes the second most prevalent type of syncope. The main reasons of cardiogenic syncope are rhythm disturbances such as supraventricular and ventricular tachycardia and bradyarrhytmia (as a combination of sinus node dysfunction, atrioventricular node dysfunction and malfunction of implantable devices). They lead to hemodynamic instability, which may cause a critical decrease in cardiac output and in cerebral blood flow [1,2].Determining the cause of syncope is a significant part of syncope evaluation. In the current ESC guidelines for the diagnosis and management of syncope two aspects of patients with syncope were stressed. These are the determination of the exact cause of syncope in order to imple- Aim. To evaluate the clinical signs and symptoms in the differential diagnosis of syncope. Material and methods. We investigated 160 patients (64 men and 96 women), aged 18-77 years with reflex or cardiac syncope over the last 3 years. The following were investigated: age, sex, age at first syncope, number of presyncopal episodes, number of syncopal episodes, number of sudden syncope without prodromal signs and the circumstances of syncope. Moreover, we assessed the frequencies of prodromal signs in the differential diagnosis of syncope. Results. Patients with reflex syncope were younger compared to patients with cardiac syncope (41,3±16,5 vs. 61,8±12,8; P<0,001) and had lower weight and body mass index (BMI). Reflex syncope patients more often presented with presyncope (10 (2, 20) vs. 2 (1, 3); p=0,01)) and syncope (8,1±7,8 vs. 5,4±1,6; P<0,001). Dyspnea, heart palpitations, feeling of cold or heat, visual disturbances and tinnitus were associated with reflex syncope (P<0,01). КЛИНИЧЕСКОЕ ТЕЧЕНИЕ СИНКОПЕ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ СИНКОПАЛЬНЫХ СОСТОЯНИЙ Conclusion.The course of syncope may facilitate a diagnostic process of reflex and cardiac syncope.

Features of vitamin B6 profile in children and adolescents with vasovagal syncope

“…Найпоши ренішим видом короткотривалої непритомно сті є рефлекторне синкопе, серед якого левову частку становить вазовагальне синкопе (ВВС). ВВС виникає у 40% усіх синкопальних станів неуточненої етіології та обумовлене дисбалан сом вегетативної нервової системи [27].…”