Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Avenue Alfredo Balena, 190, room 246, Centro, ZIP Code 30.130-100, Belo Horizonte, MG, Brazil.
Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Curr Cardiol Rep. 2022 Oct;24(10):1241-1249. doi: 10.1007/s11886-022-01757-7. Epub 2022 Aug 1.
Among the most common causes of cardiac syncope are arrhythmias and ischemic heart disease, both of which can coexist. The purpose of this review is to discuss the main causes of cardiac and vascular syncope related to atherosclerosis, its epidemiological and clinical aspects, warning signs, and initial approach.
Cardiac syncope may have a frequency of up to 34% in elderly people. Atherosclerosis-related causes of cardiac and vascular syncope may be due to cardiac arrhythmia and/or structural impairment of the heart or arteries. Late ventricular tachycardia and late-onset high-grade atrioventricular block associated with myocardial ischemia may occur with syncope, which is related to higher mortality. Besides ventricular dysfunction, concentric remodeling is also a prognostic factor. In calcific degenerative aortic stenosis, syncope carries a worse prognosis than the other cardinal signs. Cardiac syncope has a high recurrence and mortality rate. There are red flag alerts that must be considered in risk stratification.
引起心源性晕厥的最常见原因包括心律失常和缺血性心脏病，这两种情况可同时存在。本文旨在讨论与动脉粥样硬化相关的心脏和血管性晕厥的主要病因、流行病学和临床特征、预警信号以及初步处理方法。
老年人中，心源性晕厥的发生率可达 34%。心脏和血管性晕厥的动脉粥样硬化相关病因可能是由于心律失常和/或心脏或动脉的结构损伤所致。与晕厥相关的心肌缺血可能导致迟发性室性心动过速和迟发性高度房室传导阻滞，死亡率更高。除了心室功能障碍，向心性重构也是一个预后因素。在钙化性退行性主动脉瓣狭窄中，晕厥的预后比其他主要体征更差。心脏性晕厥的复发率和死亡率都很高。在风险分层时必须考虑到一些危险信号。
