Neurocardiogenic syncope

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By Jasvinder Chawla MD MBA

Neurocardiogenic syncope is also known as or subsumes Vasovagal syncope and Fainting. –ed

Neurocardiogenic syncope is one of the main causes of fainting. Cardiac and cerebrovascular regulatory mechanisms seem to be involved in its pathogenesis. Patients often describe specific triggers such as sudden postural changes, eg, upright position, extreme emotional stress, pain, or trauma. Cardiologic evaluation is mandatory; head-up tilt test is useful for diagnostic workup. Prevention remains the best management, and pharmacotherapy should be reserved only when necessary. Neurocardiogenic syncope is significantly involved with the psychological distress, and that may actually be more relevant to the patient than the number of syncopal episodes experienced.

Key points:

  • Orthostatic hypotension is defined as reduction in systolic blood pressure of at least 20 mm Hg or a reduction of diastolic blood pressure of at least 10 mm Hg with 3 minutes of standing.
  • Syncope denotes loss of consciousness secondary to inadequate blood supply to the brain.
  • Usually, no focal neurologic symptoms are observed during and after these attacks unless the patient has a preexisting neurologic deficit.
  • Almost all cases of neurocardiogenic syncope are postural related and occur in the standing position.
  • It remains essential to recognize common etiologies because a number of pharmacological agents cause or increase the effect of syncope.
  • The Framingham Heart Study in 2002 concluded that patients with cardiac syncope were at increased risk for death from any cause and cardiovascular events.
  • Most cases of neurocardiogenic syncope do not require pharmacotherapy or extensive evaluation.