Diagnostik und Therapie autonom-nerval vermittelter (vasovagaler) Synkopen - Banale Ohnmacht des Herzgesunden

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

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1 Prevention of Syncope Trial

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