1. NINDS Syncope Information Page Also known as fainting, an information sheet compiled by NINDS, the National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/health_and_medical/disorders/syncope_doc.htm

National Institute of Neurological Disorders and Stroke Accessible version Science for the Brain The nation's leading supporter of biomedical research on disorders of the brain and nervous system Browse all disorders Browse all health organizations More about Syncope Studies with patients Research literature Press releases Search NINDS... (help) Contact us My privacy NINDS is part of the National Institutes of Health NINDS Syncope Information Page Synonym(s): Fainting Reviewed 05-09-2002 Get Web page suited for printing Email this to a friend or colleague Table of Contents (click to jump to sections) What is Syncope? Is there any treatment? What is the prognosis? What research is being done? ... Additional resources from MEDLINEplus What is Syncope? Syncope is the temporary loss of consciousness due to a sudden decline in blood flow to the brain. It may be caused by an irregular cardiac rate or rhythm or by changes of blood volume or distribution. Syncope can occur in otherwise healthy people. The patient feels faint, dizzy, or lightheaded (presyncope), or loses consciousness (syncope). Is there any treatment?

2. Syncope syncope. Timothy C. Hain, MD. It is often a symptom of orthostatic hypotension, andmay also be a source of drop attacks (Dey et al, 1997). Causes of syncope http://www.tchain.com/otoneurology/disorders/medical/syncope.htm

Syncope Timothy C. Hain, MD Last edited: 7/2002. Please read our Syncope defined Causes Evaluation Prognosis Education Index Syncope (faint) is a sudden fall of blood pressure resulting in loss of consciousness. About 3% of the population have syncope at some point in life (Savage, 1985). Syncope also accounts for 3% of all emergency room visits and 6% of all hospital visits. Between 71 and 125 children and adolescents/100,000 population experience syncope each year. The incidence peaks in 1519 year olds (Driscoll, 1997). Presyncope consists of unsteadiness, weakness, or cognitive symptoms without loss of consciousness. It is often a symptom of orthostatic hypotension , and may also be a source of drop attacks (Dey et al, 1997). Causes of syncope: Arrythmia abnormal slowing or quickness of the heart bradycardia (slowness of heart beat) sick-sinus (variable) supraventricular or ventricular tachycardia (abnormally fast) hemodynamic obstruction to blood flow hypertrophic subaortic stenosis (IHSS) aortic stenosis pulmonary embolism or hypertension Neurally mediated vasovagal reaction (usually related to emotional stress) carotid sinus hypersensitivity postural hypotension (usually related to medication or dehydration) In the differential diagnosis of syncope one must also consider non-cardiac causes of loss of consciousness: seizure stroke or TIA metabolic encephalopathy psychiatric conditions Common drugs that are associated with an excess risk of syncope in the elderly include

3. CLINICAL GUIDELINE: Diagnosing Syncope..., Annals 15 Jun 97 CLINICAL GUIDELINE Diagnosing syncope Part 1. Annals of Internal Medicine 15 Jun 97. history, physical examination, and electrocardiography are the core of the syncope workup (combined diagnostic yield, 50%). http://www.acponline.org/journals/annals/15jun97/ppsyncop.htm

Annals of Internal Medicine Current Issue Past Issues Library for Internists Subscriptions ... Email this page Annals of Internal Medicine POSITION PAPER CLINICAL GUIDELINE Diagnosing Syncope Part 1: Value of History, Physical Examination, and Electrocardiography Annals of Internal Medicine 15 June 1997. 126:989-996. Related Letters Clinical Guideline: Diagnosing Syncope Part 1 Part 2 Mark Linzer, MD; Eric H. Yang, BS; N.A. Mark Estes III, MD; Paul Wang, MD; Vicken R. Vorperian, MD; and Wishwa N. Kapoor, MD, MPH, for the Clinical Efficacy Assessment Project of the American College of Physicians* Purpose: To review the literature on diagnostic testing in syncope and provide recommendations for a comprehensive, cost-effective approach to establishing its cause. Data Sources: Studies were identified through a MEDLINE search (1980 to present) and a manual review of bibliographies of identified articles. Study Selection: Papers were eligible if they addressed diagnostic testing in syncope or near syncope and reported results for at least 10 patients.

4. Syncope Defined as a temporary loss of consciousness and posture, AHA lists causes and recommendations for this condition. What is syncope? syncope (SIN'kope) is temporary loss of consciousness and posture, described as "fainting" or http://www.americanheart.org/presenter.jhtml?identifier=4749

5. THE MERCK MANUAL, Sec. 16, Ch. 200, Orthostatic Hypotension And Syncope An article about orthostatic hypotension and syncope. http://www.merck.com/pubs/mmanual/section16/chapter200/200b.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 200. Orthostatic Hypotension And Syncope Topics Orthostatic Hypotension Syncope Syncope (Fainting) A sudden brief loss of consciousness, with loss of postural tone. Etiology and Pathophysiology Bradyarrhythmias (especially those with abrupt onset) can cause syncope. These include the sick sinus syndrome, with or without tachyarrhythmias, and high-grade atrioventricular block. Although bradyarrhythmias occur at all ages, they are most frequent in the elderly and are usually due to ischemia or fibrosis of the conduction system. Digitalis, -blockers (including ophthalmic -blockers), Ca blockers, and other drugs may also cause bradyarrhythmias. Supraventricular or ventricular tachyarrhythmias that cause syncope may be related to ischemia, heart failure, drug toxicity (quinidine syncope is the best known), electrolyte abnormalities, preexcitation, and other disorders. Syncope with chest pain of myocardial ischemia is usually related to arrhythmia or heart block but rarely may reflect substantial ischemic ventricular dysfunction with a reduced cardiac output. Syncope can be due to atrioventricular block in acute inferior MI. Many other mechanisms, often in combination, may limit cardiac output, such as a decrease in systemic BP due to peripheral vasodilation, decreased venous return to the heart, hypovolemia, and cardiac outflow obstruction. Diminished cerebral perfusion may also be caused by cerebral vasoconstriction, eg, induced by hypocapnia.

6. Virtual Naval Hospital: Pediatric Emergency Manual: Syncope syncope may be defined as a sudden fall in blood pressure or failure of cardiac systole resulting in cerebral http://www.vnh.org/PediatricEmergencyManual/Syncope.html

Pediatric Emergency Manual Syncope Department of Pediatrics San Antonio Uniformed Services HEC Pediatric Residency Peer Review Status: Internally Peer Reviewed INTRODUCTION: Syncope may be defined as a sudden fall in blood pressure or failure of cardiac systole resulting in cerebral hypoperfusion and subsequent transient loss of consciousness. It is commonly called fainting. Fainting is not a rare event. It is most often the result of vasovagal reactions which are usually benign. However, some causes of syncope are life-threatening. A patient with a history of syncope deserves careful evaluation because syncope, especially if it recurs, places the patient and others at risk for injury. This is especially true if the episode occurred while crossing a street, swimming, driving, climbing or operating machinery. In addition, when heart disease is the etiology for syncope, a risk of serious dysrhythmias and sudden death exists. Syncope may occur at least once in up to 50% of adolescents and accounts for 1 - 3% of all Emergency Dept. visits. The pediatricians task is to identify the small subset with significant disease. ETIOLOGIES: Causes of syncope in children and adolescents (6 major categories): Abnormal circulatory control, vascular volume or tone:

7. Syncope (fainting) A list of sites providing information on syncope fainting or temporary loss of consciousness But if it is not done right, there may be serious consequences. syncope, Part 3 - How syncope is treated http://heartdisease.about.com/cs/syncope

zfp=-1 About Heart Disease/Cardiology Search in this topic on About on the Web in Products Web Hosting Heart Disease/Cardiology with Richard N. Fogoros Your Guide to one of hundreds of sites Home Articles Forums ... Help zmhp('style="color:#fff"') Subjects ESSENTIALS Cardiology 101 - the basics Common Heart Tests Symptom Checker ... All articles on this topic Stay up-to-date! Subscribe to our newsletter. Advertising Free Credit Report Free Psychics Advertisement Syncope (fainting) Guide picks A list of sites providing information on syncope - fainting or temporary loss of consciousness Syncope, Part 1 - First, let's make sure you don't die First of a 3-part review of syncope by your Guide. This part stresses that doctors need first to rule out potentially lethal varieties of syncope. Syncope, Part 2 - When to fire your doctor Second of a 3-part series by your Guide. The appropriate evaluation of syncope is not that difficult. But if it is not done right, there may be serious consequences. Syncope, Part 3 - How syncope is treated Part 3 of a series by your Guide. Now that the cause of syncope has been diagnosed, how should it be treated? A Primer on Syncope From the Vanderbilt U. Syncope Center

8. The Center For Pediatric Hypotension Information about the investigation, evaluation, and treatment of adolescents and children with syncope, orthostatic tachycardia, and other forms of chronic orthostatic intolerance including CFS. http://www.syncope.org/

syncope.org;http://www.nymc.edu/fhp/centers/syncope; syncope.org;http://www.nymc.edu/fhp/centers/syncope;

9. American Academy Of Family Physicians An article entitled ExerciseRelated syncope in the Young Athlete Reassurance, Restriction or Referral? http://www.aafp.org/afp/991101ap/2001.html

Advanced Search Exercise-Related Syncope in the Young Athlete: Reassurance, Restriction or Referral? FRANCIS G. O'CONNOR, LTC, MC, USA, Uniformed Services University of the Health Sciences, Bethesda, Maryland RALPH G. ORISCELLO, M.D., Elizabeth General Medical Center, Elizabeth, New Jersey BENJAMIN D. LEVINE, M.D., Presbyterian Hospital and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas A common event in young adults, syncope is usually benign and only rarely requires more than simple reassurance. However, exercise-related syncope always requires investigation because it may be the only symptom that precedes a sudden cardiac death. Syncope that occurs during exercise tends to be more ominous than that occurring in the postexertional state. During the physical examination, the cardiovascular system should be evaluated carefully. An electrocardiogram is mandatory and requires close scrutiny, with further testing ordered as indicated. The investigation of syncope should specifically exclude known pathologic diagnoses before a complete return to activity is permitted. In cases where a diagnosis is not clearly established, consultation or referral may be warranted. (Am Fam Physician 1999;60:2001-8.) S yncope is a common event in which there is a transient loss of consciousness and postural tone. Although syncope is generally a benign event in young adults (less than 35 years of age) and, in many cases, never reaches the attention of a physician, exercise-related syncope can signal sudden death.

10. Vasovagal Syncope And Related Disorders - April 1, 2000 - American Vasovagal syncope and Related Disorders The management of patients in whom a primary abnormality in blood pressure regulation results in hypotension and loss of consciousness presents clinical challenges. condition such as tachyarrhythmia or bradyarrhythmia. Vasovagal syncope describes this condition, as well as other http://www.aafp.org/afp/20000401/tips/9.html

Advanced Search Tips from Other Journals Previous Next Vasovagal Syncope and Related Disorders The management of patients in whom a primary abnormality in blood pressure regulation results in hypotension and loss of consciousness presents clinical challenges. The hypotension may be primary, or it may be secondary to a condition such as tachyarrhythmia or bradyarrhythmia. Vasovagal syncope describes this condition, as well as other conditions that are considered to be dysautonomic responses to upright posture, such as orthostatic hypotension and postural orthostatic tachycardia syndrome (POTS). Bloomfield and associates reviewed the pathophysiology of these two causes of syncope and developed an algorithm to guide diagnosis and treatment. see the accompanying figure on page 2212 Vasovagal Syncope and Related Disorders FIGURE. Vasovagal syncope and related disorders: a suggested algorithm for the diagnosis and treatment of vasovagal syncope and related disorders. (POTS = postural orthostatic tachycardia syndrome; HR = heart rate; BP = blood pressure; OH = orthostatic hypotension; HTN = hypertension; SSRI = selective serotonin reuptake inhibitors) Adapted with permission from Professional Postgraduate Services, a division of Physicians World Communications Group.

11. Syncope Communication Systems GmbH - Netzwerk, Router, Server, Firewall - Kompet Translate this page Dienstleistungen Produkte Firmenprofil support Kontakt, Türkçe,Dienstleistungen Produkte Firmenprofil Support Kontakt. http://www.syncope.de/

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12. Syncope Unternehmensdaten Translate this page syncope Unternehmensdaten Name syncope Communication Systems GmbH Rechtsform GmbH,Amtsgericht Hamburg, Handelsregister HRB 44066 Geschäftssitz Klaus-Groth-Str http://www.syncope.de/htm/unternd.htm

Syncope Unternehmensdaten Name Syncope Communication Systems GmbH Rechtsform GmbH, Amtsgericht Hamburg, Handelsregister HRB 44066 Geschäftssitz Klaus-Groth-Str. 84 D-20535 Hamburg Telefon: 040 25 19 87 98 Telefax: 040 25 19 87 99 Email: office@syncope.de WWW: http://www.syncope.de Bankverbindung Hamburger Sparkasse (BLZ 200 505 50) Kto.-Nr. 1081 21 22 66 SWIFT: HASP DE HH XXX Geschäftsführer Carsten Jenner Unternehmensgründung April 1990 Stammkapital DM 60.000 MitarbeiterInnen 6 MitarbeiterInnen Sonstiges UST-ID: DE 11 85 82 282 Home Dienstleistungen Produkte Firmenprofil ... International

13. Nevrokard - Heart Rate Variability, Baroreflex Sensitivity & Blood Pressure Vari Tools for analysis of heart rate, blood pressure (Finapresacquired data), arterial flow variability (baroreflex index sensitivity), Perimed laser Doppler microcirculation data; tilt table, vasovagal syncope. http://www.nevrokard.medistar.si/

We design and deliver Nevrokard research tools for analysis of heart rate variability - HRV indicating autonomic nervous system and vagus nerve reactivity; blood pressure variability - BPV, e.g. Finapres data, and baroreceptor reflex sensitivity - BRS; analysis of Perimed laser Doppler microcirculation and skin blood flow data LDDA This page uses frames, but your browser doesn't support them.

14. Hospital Practice: Cardiac Arrhythmia Care and management of atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmia and a look at syncope. http://www.hosppract.com/issues/1999/0901/gold.htm

Cardiac Arrhythmia: Current Therapy MICHAEL R. GOLD and MARK E. JOSEPHSON University of Maryland and Harvard University Rhythm disturbances can range from the harmless to the life-threatening, and treatment varies accordingly, from watchful waiting to emergency intervention. Traditional antiarrhythmic medications have largely been supplanted by newer agents; pharmacologic therapy is giving way to device-based treatment, including pacemakers, defibrillators, and catheter ablation. Dr. Gold is Director, Cardiac Electrophysiology Service, and Associate Professor of Medicine, University of Maryland School of Medicine, Baltimore. Dr. Josephson is Professor of Medicine, Harvard Medical School, and Director, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston. During the past few years, the treatment of many cardiac arrhythmias has tended to move away from drug therapy and toward device-based therapy. The latter may involve pacemakers, implantable defibrillators, or catheter ablation, depending on the type of arrhythmia. When drug therapy is the preferred route, the agents used are different from those selected several years ago. The treatment changes affect the management of the most common arrhythmias seen in primary care practice, including atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular arrhythmia. Atrial Fibrillation The prevalence of atrial fibrillation increases with age; this arrhythmia is most often seen in patients older than 65 years. Atrial fibrillation is typically associated with some form of cardiovascular disease, such as hypertension, coronary artery disease, or valvular heart disease, but it can also occur secondary to metabolic disorders such as thyrotoxicosis. In a minority of young patients, there is no obvious cause, a condition known as lone atrial fibrillation.

15. CLINICAL GUIDELINE, Annals 1 Jul 97 POSITION PAPER. CLINICAL GUIDELINE. Diagnosing syncope. Part 2 Unexplained syncope.Annals of Internal Medicine 1 July 1997. 1277686. Unexplained syncope. http://www.acponline.org/journals/annals/01jul97/ppsync2.htm

Annals of Internal Medicine Current Issue Past Issues Library for Internists Subscriptions ... Email this page Annals of Internal Medicine POSITION PAPER CLINICAL GUIDELINE Diagnosing Syncope Part 2: Unexplained Syncope Annals of Internal Medicine 1 July 1997. 127:76-86. Clinical Guideline: Diagnosing Syncope Part 1 Part 2 Mark Linzer, MD; Eric H. Yang, BS; N.A. Mark Estes III, MD; Paul Wang, MD; Vicken R. Vorperian, MD; and Wishwa N. Kapoor, MD, MPH, for the Clinical Efficacy Assessment Project of the American College of Physicians* Purpose: To review the literature on diagnostic testing in syncope that remains unexplained after initial clinical assessment. Data Sources: MEDLINE search. Study Selection: Published papers were selected if they addressed diagnostic testing in syncope, near syncope, or dizziness. Data Extraction: Studies were identified as population studies, referral studies, or case series. Data Synthesis: After a thorough history, physical examination, and electrocardiography, the cause of syncope remains undiagnosed in 50% of patients. In such patients, information may be derived from the results of carefully selected diagnostic tests, especially 1) electrophysiologic studies in patients with organic heart disease, 2) Holter monitoring or telemetry in patients known to have or suspected of having heart disease, 3) loop monitoring in patients with frequent events and normal hearts, 4) psychiatric evaluation in patients with frequent events and no injury, and 5) tilt-table testing in patients who have infrequent events or in whom vasovagal syncope is suspected. Hospitalization is indicated for high-risk patients, especially those with known heart disease and elderly patients.

16. Postural Orthostatic Tachycardia Syndrome A definition of POTS and its relation to Chronic Fatigue Syndrome and the pathophysiology. http://www.nymc.edu/fhp/centers/syncope/POTS.htm

Contents: POTS Defined POTS and CFS Pathophysiology of POTS Return to Home Page POTS Defined Patterns of heart rate and blood pressure variation are shown in the figure and are from our paper which was the first to directly discuss POTS in the pediatric population. goto top POTS and CFS POTS has been proposed as a mechanism for symptoms of the Chronic Fatigue Syndrome in a series of adult patients. POTS and CFS may share a common pathophysiology particularly in the young . Recently, a review of patients with delayed orthostatic hypotension (delayed POTS) demonstrated a high degree of association with chronic fatigue. Our preliminary data have shown that POTS physiology underlies orthostatic intolerance in the large majority of adolescents with the chronic fatigue syndrome (CFS). In those patients we demonstrated loss of heart rate variability consistent with vagal withdrawal, increased blood pressure variability consistent with enhanced modulation of sympathetic tone, and impaired baroreflex with a phase shift causing wide blood pressure swings uncompensated by compensatory HR changes. Preliminary vascular data suggest that these autonomic findings are associated with changes in arterial and venous properties of the lower limbs during orthostasis causing fluid collection in excess of ordinary "pooling" observed in control patients.

17. EMedicine - Syncope : Article By Rumm Morag, MD syncope syncope is defined as a transient loss of consciousness with an inabilityto maintain postural tone that resolves spontaneously without medical or http://www.emedicine.com/emerg/topic876.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Emergency Medicine Special Aspects Of Emergency Medicine Syncope Last Updated: September 27, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: transient loss of consciousness, blackout, fainting AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: Rumm Morag, MD , Staff Physician, Department of Emergency Medicine, The Brooklyn Hospital Center Coauthor(s): Barry Brenner, MD, PhD , Chairman, Department of Emergency of Medicine, Professor, Departments of Emergency Medicine and Internal Medicine, University of Arkansas for Medical Sciences Rumm Morag, MD, is a member of the following medical societies: American Academy of Environmental Medicine American College of Emergency Physicians American Medical Association , and Society for Academic Emergency Medicine Editor(s): David A Peak, MD

18. Syncope Communication Systems GmbH - Netzwerk, Router, Server, Firewall - Kompet Dienstleistungen Produkte Firmenprofil Support Kontakt http://www.jenner.de/

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19. EMedicine - Syncope : Article By Leonard Ganz, MD syncope syncope, defined as a transient loss of consciousness and postural tonewith spontaneous recovery, is an extremely common medical problem. syncope. http://www.emedicine.com/MED/topic3385.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Medicine, Ob/Gyn, Psychiatry, and Surgery Cardiology Syncope Last Updated: December 19, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: loss of consciousness, loss of postural tone, decreased cerebral perfusion, brainstem hypoxia, carotid sinus pressure, coronary artery disease, nonischemic cardiomyopathy, non-ischemic cardiomyopathy, ventricular tachyarrhythmia, congenital long QT syndrome, Wolff-Parkinson-White syndrome, WPW syndrome, Brugada syndrome, hypertrophic cardiomyopathy, syncopal episode, blackout, dizzy spell, seizure, dizziness, aortic stenosis, pulmonary embolus, pulmonary hypertension, acute myocardial infarction, acute MI, tamponade, aortic dissection, atrial fibrillation, atrial flutter, supraventricular tachycardia, SVT, torsades de pointes, ventricular tachycardia, VT, ventricular fibrillation, AV block, atrioventricular block, A/V block, A-V block, sick sinus syndrome AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: Leonard Ganz, MD

20. THE MERCK MANUAL, Sec. 16, Ch. 200, Orthostatic Hypotension And Syncope A look at the cardiac causes, symptoms, signs, diagnoses, prognosis and treatment of orthostatic hypotension and syncope. http://www.merck.com/pubs/mmanual/section16/chapter200/200a.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 200. Orthostatic Hypotension And Syncope Topics Orthostatic Hypotension Syncope Orthostatic Hypotension Orthostatic hypotension is not a specific disease but rather a manifestation of abnormal BP regulation due to various causes. Etiology and Pathophysiology The gravitational stress of sudden standing normally causes pooling of blood in the venous capacitance vessels of the legs and trunk. The subsequent transient decrease in venous return and cardiac output results in reduced BP. Baroreceptors in the aortic arch and carotid bodies activate autonomic reflexes that rapidly normalize BP by causing a transient tachycardia. These changes reflect primarily the sympathetic mediated increase in catecholamine levels, which augments vasomotor tone of the capacitance vessels, increases heart rate and myocardial contractility, and thereby enhances cardiac output; arterial and venous vasoconstriction are mediated by similar mechanisms. Vagal inhibition also increases the heart rate. With continued standing, ADH secretion and activation of the renin-angiotensin-aldosterone system cause Na and water retention and expansion of the circulating blood volume. When afferent, central, or efferent portions of the

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