These obstructions can restrict increases in cardiac output on exercise rendering this insufficient to maintain the circulation. Non-arrhythmic causes of cardiac syncope are usually related to structural heart diseases with obstruction of outflow and/or inflow of blood. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output, causing the syncope. Indeed, arrhythmias are the most common cause of cardiac syncope (Table 1). The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope refers to cardiac syncope specifically due to rhythm disorders. It is of great importance to stratify the risk and try to determine the cause. Therefore, it should not constitute a final diagnosis. It should be noted that syncope is a symptom that encompasses a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. It must be differentiated from other T-LOC that do not meet these characteristics, such as T-LOC of traumatic origin, some types of epilepsy, or certain psychiatric disorders. Syncope is a total loss of consciousness (T-LOC) secondary to cerebral hypoperfusion, characterized by rapid onset, short duration, and complete spontaneous recovery. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. Indeed, arrhythmias are the most common cause of cardiac syncope. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhy thmic syncope is cardiac syncope specifically due to rhythm disorders. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. Syncope is a concerning symptom that affects a large proportion of patients.
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