Search
presyncope; near-syncope
Presyncope is a feeling of faintness without loss of consciousness (not true syncope) generally associated with cardiovascular disease.
Etiology:
1) cardiac
a) usually accompanied by other symptoms
- chest pain
- shortness of breath
- dyspnea on exertion
b) valvular disease (aortic stenosis)
c) hypertrophic obstructive cardiomyopathy
d) low cardiac output
e) arrhythmias
2) vascular
a) more common than cardiac causes
b) generally benign
c) vasovagal response (most common)
d) medications
e) dysautonomia
f) decreased baroreceptor sensitivity associated with aging
Pathology: diffuse cerebral ischemia
History:
1) medications, especially:
a) phenothiazines
b) nitrates
c) alpha-1 blockers
2) symptoms of cardiovascular disease
Physical examination:
1) orthostatic blood pressure
2) auscultation for cardiac murmurs
Clinical manifestations:
1) perspiration
2) pallor
3) palpitations
4) feeling of faintness
5) no loss of consciousness
Laboratory:
1) electrocardiogram (EKG)
2) echocardiogram
3) chest X-ray
4) Holter
Management:
- depends upon the underlying disorder
- treat as syncope in the elderly [4]
Related
syncope
General
dizziness
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1013-15
- Medical Knowledge Self Assessment Program (MKSAP) 11, 18.
American College of Physicians, Philadelphia 1998, 2018.
- Bruera & Neumann Canadian Medical Assoc. J (CAMJ):158:1717, 1998
- Bastani A, Su E, Adler DH et al.
Comparison of 30-day serious adverse clinical events for elderly
patients presenting to the emergency department with near-syncope
versus syncope.
Ann Emerg Med 2018 Dec 7
PMID: 30529112
https://www.annemergmed.com/article/S0196-0644(18)31420-3/fulltext