Cardiac syncope, an overview

By Cristiano Antonino On Jun 18, 2023

Syncope is a temporary loss of consciousness that can affect anyone irrespective of age and health status; it is likely that one will experience a syncopal episode during a lifetime

If not related to heart disease, syncope has a benign prognosis.

In cardiac patients, it may be a premonitory symptom of a fatal event that should not be underestimated.

What is cardiac syncope?

Cardiac syncope is a loss of consciousness that occurs when the heart, due to a pathology, is unable to pump the right amount of blood to the brain.

Cardiac syncopes are caused by alterations in heart rhythm, in which case we will speak of arrhythmic cardiac syncopes, or by the presence of structural heart or lung disease, in which case we will have structural cardiac syncopes.

Arrhythmic syncopes are caused by bradycardia and tachycardia here by excessive reduction to increased cardiac activity, structural syncopes are caused by diseases of the heart muscle and valves or by pulmonary vessels.

It is rare for individuals without heart disease to have cardiac syncope

Cardiac syncope should last no longer than 5 minutes, a longer duration may mean psychogenic pseudo-syncope; fatigue and drowsiness may persist after the event has resolved.

There will be loss of motor control during the ‘fall to the ground’ with related loss of postural control, muscle rigidity or flaccidity, absence of normal limb movements and presence of abnormal movements due to sudden muscle contractions or abnormal postures, impaired sphincter control with incontinence; there will also be loss of response to verbal stimuli and no or abnormal response to tactile or pain stimuli.

It is likely that the patient may have amnesia from the period during which they were unconscious.

Symptoms preceding cardiogenic syncope may be palpitations, sudden chest pain; however, there will be no sweating, nausea and pallor as in other types of syncope.

It may be accompanied by febrile states or may be a consequence of severe emotional stress.

We will speak of a causal risk of syncope when there is an underlying triggering factor/condition causing the syncope, in which case cardiac syncope may be of concern; we will speak of a consequential risk when there is a risk of suffering physical injury as a result of the fall and, this event may adversely affect the subject’s daily activities and psychological aspect.

Cardiac syncopes, in patients with pathologies and heart disease, must not be underestimated and investigations must therefore be performed in order to undertake appropriate treatment

A family history must first be investigated to investigate the presence of cardiovascular disease, the intake of drugs that may have caused the syncope, and the mode of presentation and the content in which it occurred.

An objective test will try to recognise alterations in heart rhythm, probable structural heart disease or systemic heart disease.

With an electrocardiogram one will check for probable arrhythmic problems, with a Holter one will investigate arrhythmic problems over the course of 24 hours that might remain hidden with a normal ECG.

With a Loop Record implant, the electrical activity of the heart will be recorded for up to 3 years, and is an implant indicated for those patients who have recurrent episodes of syncope and the cause has not been identified with other tests.

During this recording phase, the diagnosis will only be made if there is a temporal correlation between cardiac syncope and an arrhythmic episode.

A stress test will be performed if syncope has occurred during or immediately after physical activity.

Echocardiography will be used to investigate if structural heart disease is suspected.

An endocavitary electrophysiological study will be used when, in the case of suspected arrhythmias, the cause could not be discovered with previous tests.

The risk of syncope can be reduced by following a few precautions: drinking plenty of water, avoiding standing for long periods without moving, changing from a sitting to a standing position calmly and avoiding sudden movements, and exercising regularly.

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