Cardiac – affecting the heart – causes
Cardiovascular (I00-I99).
- Adams-Stokes seizure – syncope (brief loss of consciousness) due to brief asystole (cessation of electrical and mechanical cardiac action for more than 2 seconds) as a result of sinus node arrest, SA block, or AV block [patient looks dead and has prominent facial flushing on recovery] (information on the course should be obtained via an observer/someone present)
- Arrhythmogenic syndromes
- Long-QT syndrome – belongs to the group of ion channel diseases (channelopathies); heart disease with pathologically prolonged QT interval in the electrocardiogram (ECG); disease is either congenital (inherited) or acquired, then usually as a result of an adverse drug reaction (see below “Cardiac arrhythmia caused by drugs“); can lead to sudden cardiac death (PHT) in otherwise heart-healthy people.
- Brugada syndrome – is attributed to the “primary congenital cardiomyopathies” and there to the so-called ion channel diseases; in 20% of cases of the disease is an autosomal dominant point mutation of the SCN5 gene to reason; Characteristic are the occurrence of syncope (brief loss of consciousness) and cardiac arrest, which first occurs due to cardiac arrhythmias such as polymorphic ventricular tachycardia or ventricular fibrillation; patients with this disease are apparently completely heart healthy, but can already suffer sudden cardiac death (PHT) in adolescence and early adulthood.
- Arrhythmogenic right ventricular cardiomyopathy (ARVC; ARVCM; synonyms: Arrhythmogenic right ventricular dysplasia cardiomyopathy; ARVD; ARVC) – deposition of connective and adipose tissue in the muscle tissue of the right ventricle (heart chamber).
- Heart valve defects (vitias) such as aortic stenosis, mitral valve stenosis or pulmonary stenosis.
- Cardiac arrhythmias – both bradycardic (slow) and tachycardic (fast) disorders (e.g., ventricular tachycardia!)
- Bradycardic arrhythmias: Sick sinus syndrome (cardiac arrhythmias due to dysfunction of the sinus node and conduction of excitation at the atrial level); AV block II and III degrees.
- Tachycardic arrhythmias: Supraventricular tachycardias; ventricular tachycardias/ventricular fibrillation (e.g., after myocardial infarction, ion channel diseases such as Brugada syndrome or long QT syndrome [Romano-Ward syndrome]).
- Brainstem ischemia – reduced blood flow to the brainstem.
- Hypertrophic obstructive cardiomyopathy (HOCM) – heart muscle disease that may be associated with the following symptoms and complications: Dyspnea (shortness of breath), angina (“chest tightness”; sudden onset of pain in the heart area), cardiac arrhythmias, syncope (brief loss of consciousness), and sudden cardiac death (PHT).
- Carotid sinus syndrome (carotid sinus syndrome; synonyms: hypersensitive carotid sinus syndrome (HCSS), hypersensitive carotid sinus syndrome) – hyperactive carotid sinus reflex, the cause of bradycardia to short-term asystole (complete cessation of electrical and mechanical cardiac action for more than 2 seconds; in carotid sinus syndrome: 6 seconds or a drop in blood pressure of at least 50 mmHg systolic)/acute circulatory arrest with syncopal symptoms; carotid sinus hypersensitivity can be detected in 20% of all patients over 60 years of age, but less than 1% have detectable carotid sinus syndrome
- Pulmonary embolism (LE; occlusion of a pulmonary vessel by a thrombus (blood clot), usually due to venous thrombosis)
- 1.4% of patients experienced syncope; 0.9% occurred during the next 2 years of follow-up
- LE is responsible for one in six severe syncope episodes
- The prevalence (disease incidence) for LE in patients who presented to an emergency department for evaluation of syncope was less than 1%.
- Myocardial infarction (heart attack), silent.
- Orthostatic hypotension (OH): drop in blood pressure during standing due to insufficient peripheral vasoconstriction (vasoconstriction).
- Pericardial tamponade (pericardial tamponade) – compression of the heart by fluid such as blood in the pericardium.
- Pulmonary hypertension (pulmonary hypertension).
- Subarachnoid hemorrhage (SAB; hemorrhage between the spinal meninges and the soft meninges; incidence: 1-3%); symptomatology: proceed according to “Ottawa rule for subarachnoid hemorrhage”:
- Age ≥ 40 years
- Meningismus (symptom of painful neck stiffness in irritation and disease of the meninges).
- Syncope (brief loss of consciousness) or impaired consciousness (somnolence, sopor and coma).
- Onset of cephalgia (headache) during physical activity.
- Thunderclap headache/destructive headache (about 50% of cases).
- Restricted mobility of the cervical spine (Cervical spine).
- Venous thromboembolism (VTE) 1.4%.
- Cerebral ischemia – reduced blood flow to the brain.
Neurogenic – affecting the nervous system – causes
Psyche – Nervous System (F00-F99; G00-G99).
- Basilar migraine – form of migraine.
- Epileptic seizures
- Hyperventilation – increased breathing beyond what is required.
- Hysteria
- Narcolepsy – belongs to the group of hypersomnia (sleep addiction).
- Neurogenic syncope, e.g., due to pain, anxiety, stress [here, neurocardiogenic syncope, orthostatic hypotension and postural tachycardia syndrome ( have recently been distinguished]Postural tachycardia syndrome (POTS) ((lat. ) posture = affecting the posture of the body; synonyms: postural orthostatic tachycardia syndrome or orthostatic intolerance)-special form of orthostatic dysregulation in which there is no drop in blood pressure when changing to the upright position; increase in heart rate of at least 30 beats/min within 10 minutes of being upright or to at least 120 beats/min absolute and no pathological drop in blood pressure (systolic drop not more than by 20 mmHg and diastolic drop not more than by 10 mmHg); incidence: Women (80% of cases), esp. younger women; age between 15 and 50 years; spontaneous recovery in about 50% of patients within one year.
- Orthostatic syncope, e.g., due to medications such as antihypertensives (antihypertensives), decreased blood volume, or impaired physical condition
- Psychogenic syncope (exclusion is a IIb-can recommendation).
- Sleep apnea syndrome (cessation of breathing during sleep).
- Transient ischemic attack (TIA) – sudden circulatory disturbance of the brain, leading to neurological disorders that regress within 24 hours.
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).
- Vasovagal reaction (fainting) – syncope triggered by irritation of the vagus, belonging to the autonomic nervous system.
Further
- Reflex syncope, mainly due to defecation (bowel movement), cough, micturition (urination): micturition and cough syncope.
- Risky situations such as standing in warm environments, hot baths; during eating; when turning the head or pressure on the carotid sinus; after physical exertion → neurogenic orthostatic hypotension/orthostatic hypotension.
- Severe pain
Metabolic – affecting the metabolism – causes
Blood, hematopoietic organs – immune system (D50-D90).
- Anemia (anemia)
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Dehydration (lack of fluid).
- Hyperventilation (excessively rapid and deep breathing) with hypocapnia (too low a level of carbon dioxide in the blood)
- Hypoglycemia (hypoglycemia).
- Hypoxia (oxygen deficiency)
Injuries, poisoning, and other consequences of external causes (S00-T98).
- Alcohol intoxication
Other causes
Biographical causes
- Age: increase with age
Neoplasms – tumor diseases (C00-D48)
- Atrial myxoma – benign neoplasm in the atrium of the heart.
Psyche – nervous system (F00-F99; G00-G99)
- Anxiety attack
- Epileptic seizure
- Psychogenic disorder of consciousness (in this case, psychogenic pseudosyncope: high frequency of attacks with low propensity for injury; some with unusual dislocations in the attack or eye closure)
Injuries, poisonings, and other consequences of external causes (S00-T98)
- Traumatic brain injury (TBI).
- Fall (in this case: cryptogenic fall attack, this occurs without disturbance of consciousness; cause is not clear)
Medication
- Acetylcholinesterase inhibitors (AChE inhibitors).
- Angiotensin receptor neprilysin antagonists (ARNI) – dual drug combination: sacubitril/valsartan.
- Antiarrhythmics – amiodarone (QT prolongation).
- Antidepressants – tricyclic antidepressants* .
- Antihypertensives – alpha blockers* (drugs that act as antagonists at α1- and at α2-adrenoceptors to reduce the effects of epinephrine and norepinephrine), beta blockers* .
- Diuretics*
- Dopamine agonists*
- Nitrates*
- Pentamidine
- Prostacyclin analogues – epoprostenol, iloprost, treprostinil.
- Psychotropic drugs that prolong the QT interval.
- Vasodilators*
* insb. in neurogenic orthostatic hypotension/orthostatic hypotension.
Further
