New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope.

Abstract

This article aims to give advice on how to identify and manage patients with syncope who are at risk of severe outcomes, that is, at risk of trauma, potentially life-threatening episodes or frequent recurrences reducing quality of life. The first step of syncope diagnostic assessment is to identify patients with cardiac syncope, and once established, these patients must receive the adequate mechanism-specific treatment. If cardiac syncope is unlikely, reflex (neurally mediated) syncope and orthostatic hypotension are the most frequent causes of transient loss of consciousness. For these presentations, efficacy of therapy is largely determined by the mechanism of syncope rather than its aetiology or clinical features. The identified mechanism of syncope should be carefully assessed and assigned either to hypotensive or bradycardic phenotype, which will determine the choice of therapy (counteracting hypotension or counteracting bradycardia). The results of recent trials indicate that 'mechanism-specific therapy' is highly effective in preventing recurrences. Established mechanism-specific treatment strategies include withdrawal of hypotensive drugs, applying fludrocortisone and midodrine for the hypotensive phenotype and cardiac pacing in the bradycardic phenotype.

• Authors: Michele Brignole, Giulia Rivasi
• Journal: Heart (British Cardiac Society) (Heart) Vol. 107 Issue 11 Pg. 864-873 (06 2021) ISSN: 1468-201X [Electronic] England
• PMID: 33462120 (Publication Type: Journal Article, Review)
• Copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antihypertensive Agents
• Purinergic P1 Receptor Antagonists
• Atomoxetine Hydrochloride
• Midodrine
• Theophylline
• Adenosine
• Fludrocortisone

Topics

• Accidental Falls
• Adenosine (blood)
• Antihypertensive Agents (adverse effects)
• Atomoxetine Hydrochloride (therapeutic use)
• Atrioventricular Node (innervation, surgery)
• Bradycardia (complications, therapy)
• Cardiac Pacing, Artificial
• Decision Trees
• Deprescriptions
• Fludrocortisone (therapeutic use)
• Humans
• Hypotension (complications, prevention & control)
• Midodrine (therapeutic use)
• Parasympathectomy
• Purinergic P1 Receptor Antagonists (therapeutic use)
• Risk Assessment
• Sinoatrial Node (innervation, surgery)
• Syncope (etiology, prevention & control)
• Theophylline (therapeutic use)