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Cardiovascular syncope: diagnostic approach and risk assessment
1University of Rochester Medical Center, Rochester, NY, USA. alon.barsheshet@heart.rochester.edu
Insights
Cardiovascular syncope, a brief loss of consciousness from reduced blood flow to the brain, requires thorough evaluation due to associated risks. This review covers causes, diagnosis, and management of syncope linked to heart conditions.
Area of Science:
- Cardiology
- Neurology
Background:
- Cardiovascular syncope is a transient loss of consciousness due to global cerebral hypoperfusion.
- It encompasses events caused by bradyarrhythmias, tachyarrhythmias, and structural cardiovascular disease.
- Evaluation is critical due to increased morbidity and mortality associated with cardiovascular syncope.
Purpose of the Study:
- To provide current data on cardiovascular syncope.
- To detail the diagnostic approach, risk stratification, and management strategies.
- To highlight specific causes, including arrhythmogenic disorders like congenital long QT syndrome.
Main Methods:
- Review of current data on cardiovascular syncope.
- Analysis of diagnostic approaches and risk stratification studies.
- Focus on specific causes such as congenital long QT syndrome.
Main Results:
- Cardiovascular syncope is linked to arrhythmias and structural heart disease.
- Risk stratification studies identify high-risk patients.
- Congenital long QT syndrome is an example of an arrhythmogenic cause of syncope and sudden cardiac death.
Conclusions:
- Thorough evaluation of cardiovascular syncope is essential.
- Risk stratification aids in identifying patients needing urgent intervention.
- Understanding specific causes like LQTS is crucial for management and prevention.
Abstract:
Cardiovascular syncope, defined as a transient loss of consciousness resulting from a global cerebral hypoperfusion characterized by rapid onset and spontaneous rapid recovery, comprises events due to bradyarrhythmias, tachyarrhythmias, and structural cardiovascular disease. The evaluation of cardiovascular syncope must be careful and thorough as this type of syncope is associated with increased subsequent morbidity and mortality. In this review we provide current data regarding specific causes of cardiovascular syncope, diagnostic approach, risk stratification, and management of patients who experience a syncope event when a cardiovascular disorder is suspected to be a precipitating factor for the syncope event. Multiple risk stratifications studies were carried out to identify patients at high risk for cardiovascular syncope; we provide several prominent examples of such risk stratifications, with special focus on the congenital long QT syndrome (LQTS) as an example of an arrhythmogenic disorder associated with syncope and sudden cardiac death in young individuals without structural heart disease.
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