Synkopen sind ein häufiges Problem im Praxis- und Klinikalltag. Sie können je nach Ursache eine banale Ohnmacht sein, aber auch Vorläufer des plötzlichen Herztodes. Bei Herzgesunden sind sie zumeist autonom-nervaler (vasovagaler) Genese. Vasovagale Synkopen besitzen eine exzellente Prognose, können jedoch selten, bei fehlenden Prodromi, zu gefährlichen Verletzungen führen. Bei Verdacht auf neurokardiogene Synkopen ist die Kipptischuntersuchung diagnostisch wegweisend. Neurokardiogene Synkopen werden mittels Patientenaufklärung, Stehtraining, erhöhter Flüssigkeitszufuhr und gegebenenfalls medikamentös behandelt. Während der Prodromalphase eignen sich isometrische Manöver (z.B. Jendrassik-Handgriff), um das Einsetzen der Synkope zu verhindern.
Syncopes are a frequent problem in daily practice. They may be due to a common faint or represent a precursor of sudden death. Subjects without structural heart disease usually suffer from neurally-mediated (vasovagal) syncopes. Vasovagal syncopes show a benign prognosis, severe injuries however may happen in rare cases without prodromi. Tilt table testing is the diagnostic procedure of choice, if neurocardiogenic syncope is suspected. Therapeutic recommendations include information and education of the patient, tilt training, increase of fluid intake, and occasionally drugs. During the prodromal phase isometric arm counterpressure maneuvres (e.g. Jendrassik's grip) are able to prevent the onset of the syncope.
Key words
vasovagal syncope - neurally-mediated syncope - neurocardiogenic syncope - tilt table
Literatur
-
1
Brignole M, Alboni P, Benditt DG. et al. .
Guidelines on management (diagnosis and treatment) of syncope - update 2004.
Europace.
2004;
6
467-537
-
2
Brignole M, Croci F, Menozzi C. et al. .
Isometric arm counter pressure maneuvers to abort impending vasovagal syncope.
J Am Coll Cardiol.
2002;
40
2053-2059
-
3
Connolly SJ, Sheldon R, Roberts RS, Gent M.
The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope.
J Am Coll Cardiol.
1999;
33
16-20
-
4
Connolly SJ, Sheldon R, Thorpe KE. et al. .
Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal-syncope in patients with recurrent severe vasovagal-syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial.
JAMA.
2003;
289
2224-2229
-
5
Kaufmann H, Saadia D, Voustianiouk A.
Midodrine in neurally mediated syncope: a double-blind, randomized crossover study.
Ann Neurol.
2002;
52
342-345
-
6
Krediet CTP, Dijk N van, Linzer M.
Management of vasovagal syncope.
Circulation.
2002;
106
1684-1690
-
7
Morillo CA.
Evidence-based common sense: the role of clinical history for the diagnosis of vasovagal syncope.
Eur Heart J.
2006;
27
253-254
-
8
Perez-Lugones A, Schweikert R, Pavia S. et al. .
Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study.
J Cardiovasc Electrophysiol.
2001;
12
935-938
-
9
Reybrouck T, Heidbuchel H, van F de Werf, Ector H.
Long-term follow-up results of tilt training therapy in patients with recurrent neurocardiogenic syncope.
Pacing Clin Electrophysiol.
2002;
25
1441-1446
-
10
Santini M, Colivicchi F.
In-hospital management of syncope: the European perspective.
Eur Heart J.
2002;
33
767-768
-
11
Sheldon RS, Raj SR, Rose S, Connolly SJ.
Beta-blockers in syncope: the jury is still out.
J Am Coll Cardiol.
2001;
38
2135-2136
-
12
Sheldon RS, Rose S, Connolly S. et al. .
Diagnostic criteria for vasovagal syncope based on a quantitative history.
Eur Heart J.
2006;
27
344-350
-
13
Sheldon RS, Connolly S, Rose S. et al. .
Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope.
Circulation.
2006;
113
1164-1170
-
14
Sra JS, Jazayeri MR, Avitall B. et al. .
Comparison of cardiac pacing with drug therapy in the treatment of neurocardiogenic (vasovagal) syncope with bradycardia or asystole.
N Engl J Med.
1993;
328
1085-1090
-
15
Sutton R, Brignole M, Menozzi C. et al. .
Dual-chamber pacing in treatment of neurally-mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: a multicentre randomised study (VASIS trial).
Circulation.
2000;
102
294-299
1 Prevention of Syncope Trial
Korrespondenz
Prof. Dr. Wolfgang von Scheidt
I. Medizinische Klinik, Herzzentrum Augsburg-Schwaben, Klinikum Augsburg
Stenglinstraße 2
86156 Augsburg
Email: w.scheidt.med1@klinikum-augsburg.de
