Koene Ryan J, Adkisson Wayne O, Benditt David G
Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
J Arrhythm. 2017 Dec;33(6):533-544. doi: 10.1016/j.joa.2017.07.005. Epub 2017 Sep 1.
Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC) caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints) with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies); in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD). Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death), and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk.
晕厥是一种临床综合征，定义为因脑营养物质供应不足一段时间而导致的相对短暂的自限性意识丧失（TLOC）。最常见的诱因是全身血压突然下降。必须将真正的晕厥与其他可能出现真实或明显TLOC的常见非晕厥情况区分开来，如癫痫发作、脑震荡或意外跌倒。晕厥的病因多种多样，但在大多数情况下相对良性（如反射性和体位性晕厥），主要风险是意外和/或受伤。然而，在某些情况下，晕厥可能由更令人担忧的情况引起（特别是那些与心脏结构疾病或离子通道病相关的情况）；在这种情况下，晕厥可能是发病率和死亡率增加风险的指标，包括心源性猝死（SCD）。为了启动有效的治疗，确定晕厥病因的准确依据至关重要。在本综述中，我们主要关注与SCD风险增加相关的晕厥病因（即心律失常性心源性猝死）以及这些患者的管理。此外，我们讨论了我们对与晕厥相关的SCD理解的局限性，并提出了未来可能最终解决如何改善晕厥患者预后并降低SCD风险的研究。
