Synkopen

Die Synkope ist eine plötzlich eintretende, kurzzeitige Bewusstseinsstörung mit Tonusverlust, die ohne weitere Intervention vollständig reversibel ist. Eine Abgrenzung von anderen kurzzeitigen Veränderungen des Bewusstseins wie bei Epilepsien, Durchblutungsstörungen des Hirnstamms, metabolischen Störungen, Intoxikationen, psychogenen Anfällen und traumatischen Bewusstseinsstörungen ist wichtig, da sie die weitere Diagnostik leitet und die Therapie bedingt.

Syncopes are defined as sudden and short unconsciousness with loss of muscular tonus which are reversible without further intervention. Differentiation from other short-lasting changes of consciousness as in seizures, blood flow abnormalities of brainstem, metabolic disorders, intoxication or traumatic loss of consciousness is important for further diagnostic and adequate treatment.

Schlüsselwörter

Synkope - Bewusstseinsverlust - vasovagale Synkope - Krampfanfall - posturales - Tachykardie- - Syndrom

Key words

Syncope - loss of consciousness - vasovagal syncope - seizure - postural tachycardia syndrome

Publikationsverlauf

Artikel online veröffentlicht:
20. August 2020

• Literatur

• 1 Thijs RD, Wieling W, Kaufmann H. et al. Defining and classifying syncope. Clin Auton Res. 2004 14. (Suppl 1): 4-8.
• 2 Haensch C-A. Synkope. In: Haensch C-A, Jost WH. Hrsg. Das autonome Nervensystem. Stuttgart: Kohlhammer; 2009: 198-217
• 3 Wieling W, Thijs RD, van Dijk N. et al. Symptoms and signs of syncope: a review of the link between physiology and clinical clues. Brain 2009; 132: 2630-2642.
• 4 Brignole M, Moya A, de Lange FJ. et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39: 1883-1948.
• 5 Tan MP, Duncan GW, Parry SW. Head-up Tilt Table Testing: a state-of-the-art review. Minerva Med 2009; 100: 329-338
• 6 Lancaster JF, Gotley D, Bartolo DC. et al. Hypoxia and hypotension during endoscopy and colonoscopy. Aust NZ J Surg 1990; 60: 271-273
• 7 Goodman BP. Evaluation of postural tachycardia syndrome (POTS). Auton Neurosci 2018; 215: 12-19.
• 8 Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol 1994; 36: 233-237.
• 9 Patten JP. Anfälle von Bewußtseinsveränderung. In: Patten JP. ed. Neurologische Differentialdiagnose. London: Springer; 1996: 411-430
• 10 Diehl R, Hilz M, Steinhoff B, Schuchert A, Humm A, Wenning GK. Synkopen. In: Diener H-C. Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart: Thieme; 2012: S58-S73
• 11 Moya A, Permanyer-Miralda G, Sagrista-Sauleda J. et al. Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope: results of a controlled study of etilefrine versus placebo. J Am Coll Cardiol 1995; 25: 65-69
• 12 Gibbons CH, Schmidt P, Biaggioni I. et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264: 1567-1582 . doi:10.1007/s00415-016-8375-x
• 13 Ziemssen T, Siepmann T. The Investigation of the Cardiovascular and Sudomotor Autonomic Nervous System-A Review. Frontiers Neurol 2019; 10: 53 . doi:10.3389/fneur.2019.00053
• 14 Strickberger SA, Benson DW, Biaggioni I. et al. AHA / ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. Circulation 2006; 113: 316-327 . doi:10.1161/CIRCULATIONAHA. 105.170274
• 15 Krediet CT, Parry SW, Jardine DL. et al. The history of diagnosing carotid sinus hypersensitivity: why are the current criteria too sensitive?. Europace 2011; 13: 14-22 . doi:10.1093/europace/euq409
• 16 Pasquier M, Clair M, Pruvot E. et al. Carotis sinus massage. N Engl J Med 2017; 377: e21
• 17 Diener HC, Putzki N, Berlit P, Deuschl G, Elger C, Gold R, Hacke W, Hufschmidt A, Mattle H, Meier U, Oertel WH, Reichmann H, Schmutzhard E, Wallesch CW, Weller M. Leitlinien für Diagnostik und Therapie in der Neurologie. 4. überarb. Aufl. Stuttgart: Thieme; 2008
• 18 Munro NC, McIntosh S, Lawson J. et al. Incidence of complications after carotid sinus massage in older patients with syncope. J Am Geriatr Soc 1994; 42: 1248-1251
• 19 Puggioni E, Guiducci V, Brignole M. et al. Results and complications of the carotid sinus massage performed according to the “method of symptoms”. Am J Cardiol 2002; 89: 599-601
• 20 Davies AJ, Kenny RA. Frequency of neurologic complications following carotid sinus massage. Am J Cardiol 1998; 81: 1256-1257
• 21 Scheidt W, Bosch R, Klingenheben T. et al. ESC / DGK Pocket-Leitlinien: Diagnose und Management von Synkopen. Herausgegeben von der DGK; 2019. ( https://leitlinien.dgk.org/files/2019_PLL_Synkope_Version_2018.pdf
• 22 Claydon VE, Hainsworth R. Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension 2004; 43: 809-813 . doi:10.1161/01.HYP.0000122269.05049.e7
• 23 Valbusa F, Labat C, Salvi P. et al. Orthostatic hypotension in very old individuals living in nursing homes: the PARTAGE study. J Hypertens 2012; 30: 53-60 . doi:10.1097/HJH.0b013e32834d3d73
• 24 Romero-Ortuno R, OʼConnell MD, Finucane C. et al. Insights into the clinical management of the syndrome of supine hypertension-orthostatic hypotension (SH‑OH): the Irish Longitudinal Study on Ageing (TILDA). BMC Geriat 2013; 13: 73 . doi:10.1186/1471-2318-13-73
• 25 Canney M, OʼConnell MD, Murphy CM. et al. Single agent antihypertensive therapy and orthostatic blood pressure behaviour in older adults using beat-to-beat measurements: The Irish Longitudinal Study on Ageing. PLoS One 2016; 11: e0146156 . doi:10.1371/journal.pone.0146156
• 26 Fogari R, Zoppi A, Mugellini A. et al. Efficacy and safety of two treatment combinations of hypertension in very elderly patients. Arch Gerontol Geriat 2009; 48: 401-405 . doi:10.1016/j.archger.2008.03.012
• 27 Jankovic J, Gilden JL, Hiner BC. et al. Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine. Am J Med 1993; 95: 38-48
• 28 Low PA, Gilden JL, Freeman R. et al. Efficacy of midodrine vs. placebo in neurogenic orthostatic hypotension. A randomized, double-blind multicenter study. Midodrine Study Group. JAMA 1997; 277: 1046-1051
• 29 Wright RA, Kaufmann HC, Perera R. et al. A double-blind, doseresponse study of midodrine in neurogenic orthostatic hypotension. Neurology 1998; 51: 120-124
• 30 Fedorowski A. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. J Intern Med 2019; 285: 352-366.
• 31 Bhatia R, Kizilbash SJ, Ahrens SP. et al. Outcomes of Adolescent-Onset Postural Orthostatic Tachycardia Syndrome. J Pediatr 2016; 173: 149-153 . doi:10.1016/j.jpeds.2016.02.035
• 32 Wells R, Elliott AD, Mahajan R. et al. Efficacy of therapies for postural tachycardia syndrome: a systematic review and meta-analysis. Mayo Clin Proc 2018; 93: 1043-1053 . doi:10.1016/j.mayocp.2018.01.025
• 33 Mathias CJ, Mallipeddi R, Bleasdale-Barr K. Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 1999; 246: 893-898
• 34 Naschitz JE, Rosner I. Orthostatic hypotension: framework of the syndrome. Postgrad Med J 2007; 83: 568-574 . doi:10.1136/pgmj.2007.058198
• 35 Freeman R, Wieling W, Axelrod FB. et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69-72 . doi:10.1007/s10286-011-0119-5
• 36 Wieling W, Krediet CT, van Dijk N. et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (London) 2007; 112: 157-165 . doi:10.1042/CS20060091
• 37 Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006; 67: 28-32 . doi:10.1212/01.wnl.0000223828.28215.0b
• 38 Alboni P, Alboni M, Bertorelle G. The origin of vasovagal syncope: to protect the heart or to escape predation?. Clin Auton Res 2008; 18: 170-178 . doi:10.1007/s10286-008-0479-7
• 39 Ganzeboom KS, Colman N, Reitsma JB. et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91 1006-1008, A1008
• 40 Serletis A, Rose S, Sheldon AG. et al. Vasovagal syncope inmedical students and their first-degree relatives. Eur Heart J 2006; 27: 1965-1970 . doi:10.1093/eurheartj/ehl147
• 41 Sheldon R, Rose S, Connolly S. et al. Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J 2006; 27: 344-350 . doi:10.1093/eurheartj/ehi584
• 42 Sarasin FP, Hanusa BH, Perneger T. et al. A risk score to predict arrhythmias in patients with unexplained syncope. Acad Emerg Med 2003; 10: 1312-1317
• 43 Quinn J, McDermott D, Stiell I. et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 2006; 47: 448-454 . doi:10.1016/j.annemergmed.2005.11.019
• 44 Middlekauff HR, Stevenson WG, Stevenson LW. et al. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993; 21: 110-116
• 45 Steinberg JS, Beckman K, Greene HL. et al. Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics Versus Implantable Defibrillators. J Cardiovasc Electrophysiol 2001; 12: 996-1001
• 46 Pezawas T, Stix G, Kastner J. et al. Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantable cardioverter defibrillator therapy. Europace. Eur Pacing Arrhythm Cardiac Electrophysiol 2003; 5: 305-312
• 47 Olshansky B, Poole JE, Johnson G. et al. Syncope predicts the outcome of cardiomyopathy patients: analysis of the SCDHeFT study. J Am Coll Cardiol 2008; 51: 1277-1282 . doi:10.1016/j.jacc.2007.11.065
• 48 Del Rosso A, Alboni P, Brignole M. et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol 2005; 96: 1431-1435 . doi:10.1016/j.amjcard.2005.07.047
• 49 Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med 1997; 29: 459-466
• 50 Colivicchi F, Ammirati F, Melina D. et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24: 811-819