Fast Five Quiz: Syncopal Events

Richard H. Sinert, DO

Disclosures

January 30, 2020

According to the ESC, explanation of the diagnosis, provision of reassurance, and explanation of the risk for recurrence and the avoidance of triggers and situations are indicated in all patients. Modification or discontinuation of a hypotensive drug regimen should be considered in patients with vasodepressor syncope, if possible.

The ESC guidelines state that cardiac pacing should be considered to reduce syncope recurrence in patients older than 40 years with spontaneous documented symptomatic asystolic pauses > 3 sec or asymptomatic pauses > 6 sec due to sinus arrest or atrioventricular block, or both. Cardiac pacing should also be considered to reduce syncope recurrence in patients with cardioinhibitory carotid sinus syndrome who are older than 40 years with recurrent frequent unpredictable syncope. Cardiac pacing may also be considered to reduce syncope recurrence in patients with tilt-induced asystolic response who are older than 40 years with recurrent frequent unpredictable syncope, as well as patients with clinical features of adenosine-sensitive syncope. Cardiac pacing is not indicated in the absence of a documented cardioinhibitory reflex.

Isometric physical counterpressure maneuvers should be considered in patients with prodromes who are older than 60 years. Tilt training may be considered for the education of young patients.

The guidelines also suggest that fludrocortisone may be considered in young patients with the orthostatic form of vasovagal syncope, low to normal arterial blood pressure, and no contraindication to the drug. Midodrine may be considered in patients with the orthostatic form of vasovagal syncope. Beta-adrenergic–blocking drugs are not indicated.

Read more about the treatment of syncope.

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