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causes of syncope
Etiology:
1) cardiac
- aortic stenosis
- pulmonary embolism
- atrial myxoma
- pulmonary hypertension
- atrioventricular block
- pulmonic stenosis
- hypertrophic cardiomyopathy
- sick sinus syndrome
- mitral stenosis
- supraventricular tachycardia
- myocardial infarction
- ventricular tachycardia
- paroxysmal ventricular fibrillation associated with
- prolonged QT interval
- Wolf-Parkinson-White syndrome
- Brugada syndrome
- commotio cordis
2) pharmaceutical agents*
- antiarrhythmic agents
- digitalis
- anticonvulsants
- diuretics
- antihypertensive agents
- narcotics
- antipsychotics
- nitrates
- beta-blockers
- tricyclic antidepressants
3) neurally-mediated disturbance of blood pressure control
- carotid sinus syndrome
- cough
- micturition syncope
- psychogenic causes
- gastrointestinal events
- defecation*
- swallowing
- postprandial hypotension*
- vasovagal syncope
4) neurologic & psychiatric
- anxiety disorder
- panic attack
- cerebrovascular spasm
- seizure
- depression
- subclavian steal
- migraine
- vertebrobasilar ischemia
- narcolepsy
5) orthostasis
- drugs
- venous pooling
- autonomic insufficiency
- intravascular volume depletion
- decreased reflex peripheral vasoconstriction [1]
6) miscellaneous
- hyperventilation
- hypoglycemia
- hypoxia
- thyroid disease
* combination of hypotensive medications taken with meals with subsequent effect of Valsalva maneuver during defecation is common cause of syncope in elderly
Pathology:
- underlying pathology is total cerebral hypoperfusion
Related
syncope
References
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004; 7th edition 2010
- Geriatric Review Syllabus, 10th edition (GRS10)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2019