Desmayos y síncopes

  1. P. Irimia Sieira 1
  2. E. Martínez-Vila 1
  3. M. Imaz 1
  1. 1 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2015

Serie: 11

Número: 73

Páginas: 4357-4363

Tipo: Artículo

DOI: 10.1016/J.MED.2015.02.001 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

El síncope es un episodio transitorio de pérdida de conocimiento de inicio súbito, duración breve y con recuperación completa de forma espontánea, que se produce por una reducción breve del flujo sanguíneo cerebral. La causa más frecuente de síncope es el síncope vasovagal, que afecta a pacientes jóvenes y tiene buen pronóstico. El síncope cardiogénico aumenta con la edad y, dependiendo de la cardiopatía responsable, puede asociarse a un riesgo aumentado de muerte súbita. La hipotensión ortostática es también una de las causas de síncope, afecta sobre todo a pacientes ancianos y puede ser secundario al uso de determinados fármacos o enfermedades que producen un fallo autonómico como la diabetes. El diagnóstico del síncope está basado en la historia clínica y la exploración física, y se recomienda la realización de un electrocardiograma en todos los pacientes. En el diagnóstico diferencial del síncope debe considerarse la epilepsia, determinados trastornos vasculares y la posibilidad de un origen psicógeno. El tratamiento de los pacientes con síncope depende de la causa subyacente.

Referencias bibliográficas

  • Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines on management (diagnosis and treatment) of syn-cope - 2009. The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Guidelines for the diagnosis and management of syncope (version 2009). Euro-pean Heart J. 2009;30:2631-71.
  • Moya-I-Mitjans Á, Rivas-Gándara N, Sarrias-Mercè A, Pérez-Rodón J, Roca-Luque I. Syncope. Rev Esp Cardiol. 2012;65:755-65.
  • Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Ben-jamin EJ, et al. Incidence and prognosis of syncope. N Engl J Med. 2002;347:878-85.
  • Baron-Esquivias G, Martínez-Alday J, Martín A, Moya A, Gar-cía-Civera R, Paz López-Chicharro M, et al. Epidemiological cha-racteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for syn-cope Study in the Emergency Room (GESINUR) study. Europace. 2010;12:869-76.
  • Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthos-tatic hypotension, neurally mediated syncope and the postural ta-chycardia syndrome. Clin Auton Res. 2011;21:69-72.
  • Wieling W, Thijs RD, van Dijk N, Wilde AA, Benditt DG, van Dijk JG. Symptoms and signs of syncope: a review of the link bet-ween physiology and clinical clues. Brain. 2009;132:2630-42.
  • Bassetti CL. Transient loss of consciousness and syncope. Handb Clin Neurol. 2014;119:169-91.
  • Wehrens XH, Vos MA, Doevendans PA, Wellens HJ. Novel insights in the congenital long QT syndrome. Ann Intern Med. 2002;137:981-92.
  • Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, et al. Brugada syndrome: report of the Second Consensus Conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation. 2005;111:659-70.
  • Giustetto C, Di Monte F, Wolpert C, Borggrefe M, Schimpf R, Sbragia P, et al. Short QT syndrome: clinical findings and diagnostic–therapeutic implications. Eur Heart J. 2006;27:2440-7.
  • Naschitz J, Rosner I. Orthostatic hypotension: framework of the syndro-me. Postgrad Med J. 2007;83:568-74.
  • Petkar S, Cooper P, Fitzpatrick AP. How to avoid a misdiagnosis in pa-tients presenting with transient loss of consciousness. Postgrad Med J. 2006;82:630-41.
  • Shen WK, Decker WW, Smars PA, Goyal DG, Walker AE, Hodge DO, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management. Circulation 2004;110:3636-45.
  • Van Dijk N, Quartieri F, Blanc JJ, Garcia-Civera R, Brignole M, Moya A, et al. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J Am Coll Cardiol. 2006;48:1652-7.
  • Takata TS, Wasmund SL, Smith ML, Li JM, Joglar JA, Banks K, et al. Serotonin reuptake inhibitor (Paxil) does not prevent the vasovagal reac-tion associated with carotid sinus massage and/or lower body negative pressure in healthy volunteers. Circulation. 2002;106:1500-4.
  • DiGirolamo E, Di Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhi-bitor, on refractory vasovagal syncope: a randomized, double-blind, pla-cebo-controlled study. J Am Coll Cardiol. 1999;33:1227-30.
  • Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C, et al. Prevention of syncope trial (POST): a randomized, placebo-contro-lled study of metoprolol in the prevention of vasovagal syncope. Circula-tion. 2006;113:1164-70.
  • Ventura R, Maas R, Zeidler D, Schoder V, Nienaber CA, Schuchert A, et al. A randomized and controlled pilot trial of beta-blockers for the treatment of recurrent syncope in patients with a positive or nega- tive response to head-up tilt test. Pacing Clin Electrophysiol. 2002;25:816-21.
  • Madrid AH, Ortega J, Rebollo JG, Manzano JG, Segovia JG, Sánchez A, et al. Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-blind, randomized and placebo-controlled study. J Am Coll Cardiol. 2001;37: 544-9.
  • Flevari P, Livanis EG, Theodorakis GN, Zarvalis E, Mesiskli T, Kremas-tinos DT. Vasovagal syncope: a prospective, randomized, crossover evaluation of the effect of propranolol, nadolol and placebo on syncope recurrence and patients’ well-being. J Am Coll Cardiol. 2002;40: 499-504.
  • Mahanonda N, Bhuripanyo K, Kangkagate C, Wansanit K, Kulcho B, Nademanee K, et al. Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J. 1995;130:1250-3.
  • Moya A, Permanyer-Miralda G, Sagrista-Sauleda J, Carne X, Rius T, Mont L, 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; 25:65-9.
  • Moore A, Watts M, Sheehy T, Harmett T, Clinch D, Lyons D. Treatment of vasodepressor carotid sinus syndrome with midodrine: a randomized, controlled pilot study. J Am Geriatr Soc. 2005;53:114-8.
  • Kaufmann H, Saadia D, Voustianiouk A. Midodrine in neutrally mediated syncope: a double-blind, randomized, crossover study. Ann Neurol. 2002;52:342-5.
  • Pérez-Lugones A, Schweikert R, Parra S, Sra J, Akhtar M, Jaeger F, et al. Usefulness of midodrine in patients with severely symptomatic neurocar-diogenic syncope: a randomized control study. J Cardiovasc Electrophy-siol. 2001;12:935-8.
  • Sud S, Massel D, Klein GJ, Leong-Sit P, Yee R, Skanes AC, et al. The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med. 2007;120:54-62.
  • Brignole M, Sutton R, Menozzi C, García-Civera R, Moya A, Wieling W, et al. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope. Eur Heart J. 2006;27:1085-92.
  • Salim MA, Di Sessa TG. Effectiveness of fludrocortisone and salt in pre-venting syncope recurrence in children: a double-blind, placebo-contro-lled, randomized trial. J Am Coll Cardiol. 2005;45:484-8.
  • Van Lieshout JJ, ten Harkel AD, Wieling W. Fludrocortisone and sleeping in the head-up position limit the postural decrease in CO in autonomic failure. Clin Auton Res. 2000;10:35-42.
  • Izcovich A, González Malla C, Manzotti M, Catalano HN, Guyatt G. Midodrine for orthostatic hypotension and recurrent reflex synco-pe: A systematic review. Neurology. 2014 23;83:1170-7.
Fuente de los datos: Dialnet