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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Syncope natural history, complications and prognosis

Introduction

Overview

Overview

Patients with syncope are at risk of the development of complications, such as trauma from frequent falls and Sudden cardiac death. The prognosis of syncope depends on underlying causes. Syncope caused by cardiovascular diseases may be life-threatening and is an important cause of sudden cardiac death. Prognosis of vasovagal syncope is favorable.

Natural history, Complications and Prognosis

Natural history, Complications and Prognosis

Natural History

If the underlying cause of syncope is left untreated and syncope occurs frequently, patients with syncope may suffer from trauma of the head and neck and sudden cardiac death due to fatal cardiac arrhythmia.

Uncommon conditions associated with syncope Clinical aspect Cause of syncope
Cardiac tamponade Hypotension, tachycardia, cardiogenic shock Tachycardia, hypotension, abrupt bradycardia
Constrictive pericarditis Heart failure symptoms, exertional dyspnea, orthopnea, edema Cough syncope
Left ventricular non compaction Trabeculation or recess in left ventricle Tachyarrhythmia
Takotsubo cardiomyopathy Apical ballooning , basal hyperkinesia , following stressful event, chest pain and ECG change mimicking ischemia Uncommon cause of syncope, multifactorial
Pulmonary embolus Cardiac arrest and pulseless electrical activity following hypoxia, tachycardia, hypotension and shock Bradycardia, hypotension
Pulmonary arterial hypertension Exertional syncope, especially in younger patients Peripheral vasodilation following exercise, low cardiac output state
Amyloidosis Amyloid deposition in heat, kidney, peripheral and autonomic nervous system AV block, arrhythmia, low cardiac output due to restrictive cardiomyopathy
Hemochromatosis Dilated cardiomyopathy due to iron deposition Myocardial involvement, sick sinus syndrome, AV block
Myocarditis Chest pain, arrhythmia, left ventricular systolic dysfunction, hemodynamic collapse Ventricular tachycardia, AV block, transient hemodynamic collapse
Lyme disease Myocarditis accompanied by erythma migrant, neurologic involvement AV block, vasovagal syncope
disease Cardiomyopathy caused by trypanosomiasis Ventricular tachycardia, AV block
Friedreich ataxia Hypertrophic Cardiomyopathy (HCM), gait ataxia, bladder dysfunction Tachycardia, bradycardia, SCD is common
Cardiac tumors Triad of valve obstruction , emboli, systemic signs and symptoms Obstruction of blood flow
Prosthetic valve thrombosis Asymptomatic or symptomatic heart failure Embolic event, valve obstruction
Anomalous coronary artery Common cause of exertional syncope and SCD specially in young athletes Bezold jarisch reflex,hypotension, VT, AV block
Subclavian steal syndrome Significant stenosis in subclavian artery leading flow reversal in vertebral artery and vertebrobasilar ischemia and syncope Syncope following upper extremities activity
Aortic dissection Neurologic symptoms, heart failure symptoms, myocardial infarction Increased risk of in-hospital death, tamponade, neurologic deficit in patients with syncope
Coarctation of the aorta (COA) Heart failure symptoms, dissection of aorta Associated with bicuspid aortic valve stenosis
Rheumatoid arthritis Systemic inflammatory disorder Complete heart block
Carcinoid syndrome, Pheochromocytoma, Mastocytosis,  Vasoactive intestinal peptide tumor Vasodilation, flushing, pruritus, gastrointestinal symptoms Transient hypotension
Beta thalassemia major Dilated cardiomyopathy , severe anemia, multiple organ failure Arrhythmia
Migraine Association between headache and syncope Vasovagal syncope, orthostase intolerance
Seizure-induced bradycardia, hypotension Temporal lobe epilepsy Postictal bradyarrhythmia due to temporal lobe or limbic system

Complications

Patients with syncope are at risk of the development of the following complications:[17]

  • Frequent falls resulting in injuries to head and neck
  • Development of cardiovascular disorders
  • Sudden cardiac death
  • Death

Prognosis

The prognosis of syncope depends on underlying causes.[18][19]

References

References

  1. ↑ . doi:10.2169/internalmedicine.52.8818. Check |doi= value (help). Missing or empty |title= (help)
  2. ↑ Vasquez, Andres F.; Seger, John J. (2009). “An Uncommon Case of Heart Failure”. Southern Medical Journal. 102 (11): 1183–1185. doi:10.1097/SMJ.0b013e3181b63b1c. ISSN 0038-4348.
  3. ↑ Rovetta R, Bonadei I, Vizzardi E, D’Aloia A, Metra M (August 2014). “Syncope as presentation of recurrent Tako-Tsubo cardiomyopathy”. Minerva Cardioangiol. 62 (4): 366–8. PMID 25012104.
  4. ↑ Prandoni P, Lensing AW, Prins MH, Ciammaichella M, Perlati M, Mumoli N, Bucherini E, Visonà A, Bova C, Imberti D, Campostrini S, Barbar S (October 2016). “Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope”. N Engl J Med. 375 (16): 1524–1531. doi:10.1056/NEJMoa1602172. PMID 27797317.
  5. ↑ Strobel JS, Fuisz AR, Epstein AE, Plumb VJ (October 1999). “Syncope and inducible ventricular fibrillation in a woman with hemochromatosis”. J Interv Card Electrophysiol. 3 (3): 225–9. doi:10.1023/a:1009891406964. PMID 10490478.
  6. ↑ Akashi R, Kizaki Y, Kawano H, Takahara Y, Nakao K, Yonemitsu N, Kusumoto S, Maemura K (2012). “Seizures and syncope due to complete atrioventricular block in a patient with acute myocarditis with a normal left ventricular systolic function”. Intern Med. 51 (21): 3035–40. doi:10.2169/internalmedicine.51.8410. PMID 23124146.
  7. ↑ Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV (1989). “Lyme disease surveillance in the United States, 1983-1986”. Rev Infect Dis. 11 Suppl 6: S1435–41. PMID 2682955.
  8. ↑ . doi:10.1016/j.amjcard.2008.12.013. Check |doi= value (help). Missing or empty |title= (help)
  9. ↑ Perryman RA, Bayne E, Miller RH (April 1991). “Bull-worker syncope: congenital subclavian steal syndrome following isometric exercise”. Pediatr Cardiol. 12 (2): 105–6. doi:10.1007/BF02238413. PMID 1866327.
  10. ↑ Squarzoni G, Bariani L, Fogli B, Ughi M, Manfredini R, Fersini C (1991). “[Arterial hypertension and syncope in an adult patient with coarctation of the aorta]”. Riv Eur Sci Med Farmacol (in Italian). 13 (1–2): 33–5. PMID 1796194.
  11. ↑ Kremastinos DT, Farmakis D, Aessopos A, Hahalis G, Hamodraka E, Tsiapras D, Keren A (May 2010). “Beta-thalassemia cardiomyopathy: history, present considerations, and future perspectives”. Circ Heart Fail. 3 (3): 451–8. doi:10.1161/CIRCHEARTFAILURE.109.913863. PMID 20484195.
  12. ↑ Reynen K (December 1995). “Cardiac myxomas”. N Engl J Med. 333 (24): 1610–7. doi:10.1056/NEJM199512143332407. PMID 7477198.
  13. ↑ Monté CP, de Krom MC, Weber WE, de Zwaan C, van Kranen-Mastenbroek VH (March 2007). “The ictal bradycardia syndrome”. Acta Neurol Belg. 107 (1): 22–5. PMID 17569230.
  14. ↑ Ahern M, Lever JV, Cosh J (August 1983). “Complete heart block in rheumatoid arthritis”. Ann Rheum Dis. 42 (4): 389–97. doi:10.1136/ard.42.4.389. PMC 1001249. PMID 6882034.
  15. ↑ Silber H, Khan SS, Matloff JM, Chaux A, DeRobertis M, Gray R (January 1993). “The St. Jude valve. Thrombolysis as the first line of therapy for cardiac valve thrombosis”. Circulation. 87 (1): 30–7. doi:10.1161/01.cir.87.1.30. PMID 8419020.
  16. ↑ Velazquez-Ceceña JL, Lubell DL, Nagajothi N, Al-Masri H, Siddiqui M, Khosla S (2009). “Syncope from dynamic left ventricular outflow tract obstruction simulating hypertrophic cardiomyopathy in a patient with primary AL-type amyloid heart disease”. Tex Heart Inst J. 36 (1): 50–4. PMC 2676515. PMID 19436787.
  17. ↑ Auer, J. (2008). “Syncope and trauma. Are syncope-related traumatic injuries the key to find the specific cause of the symptom?”. European Heart Journal. 29 (5): 576–578. doi:10.1093/eurheartj/ehm637. ISSN 0195-668X.
  18. ↑ Soteriades, Elpidoforos S.; Evans, Jane C.; Larson, Martin G.; Chen, Ming Hui; Chen, Leway; Benjamin, Emelia J.; Levy, Daniel (2002). “Incidence and Prognosis of Syncope”. New England Journal of Medicine. 347 (12): 878–885. doi:10.1056/NEJMoa012407. ISSN 0028-4793.
  19. ↑ Saklani, Pradyot; Krahn, Andrew; Klein, George (2013). “Syncope”. Circulation. 127 (12): 1330–1339. doi:10.1161/CIRCULATIONAHA.112.138396. ISSN 0009-7322.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Sahar Memar Montazerin, M.D.[3]