Synkope – Abklärung und Therapie anhand von Fallbeispielen

Die Synkope, eine kurzzeitige spontan reversible Bewusstlosigkeit, ist ein häufiges Symptom im klinischen Alltag. Es gilt potenziell lebensbedrohliche kardiale Ursachen rasch zu erkennen und zu behandeln. Wesentlich häufiger sind jedoch prognostisch günstige Mechanismen wie die Reflexsynkope (RS) oder die orthostatische Hypotonie (OH). Eine initiale Abklärung und Risikostratifizierung in unklaren Fällen sollen im Rahmen des Erstkontakts erfolgen.

Schlüsselwörter

Synkope - Karotissinussyndrom - Reflexsynkope - POTS - unklare Synkope - Diagnostik

• Literatur

• 1 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
• 2 Krediet CT, van Dijk N, Linzer M. et al. Management of Vasovagal Syncope. Circulation 2002; 106: 1684-1689
• 3 Brignole M, Menozzi C, Moya A. et al. Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology 3 (ISSUE-3): a randomized trial. Circulation 2012; 125: 2566-2571
• 4 Occhetta E, Bortnik M, Audoglio R. et al. Closed loop stimulation in prevention of vasovagal syncope. Inotropy controlled pacing in vasovagal syncope (INVASY). Europace 2004; 6: 538-547
• 5 Brignole M, Menozzi C. The natural history of carotid sinus syncope and the effect of cardiac pacing. Europace 2011; 13: 462-464
• 6 Leitliniengruppe Hessen, DEGAM. S3-Leitlinie Multimedikation, Langfassung, AWMF-Registernummer: 053–043. 2. Auflage. 2021 Accessed September 26, 2023 at: https://register.awmf.org/de/leitlinien/detail/053–043
• 7 Norcliffe-Kaufmann L, Kaufmann H, Palma J. et al. Orthostatic Heart Rate Changes in Patients with Autonomic Failure caused by Neurodegenerative Synucleinopathies. Ann Neurol 2018; 83: 522-531
• 8 Fanciulli A, Indelicato E, Wenning GK. Autonomic History Taking and Key Symptoms: where is the autonomic Disease?. In: Struhal W, Lahrmann H, Fanciulli A, Wenning GK. Bedside Approach to autonomic Disorders A clinical Tutor. Cham: Springer; 2017: 15-36
• 9 Donateo P, Brignole M, Alboni P. et al. A standardized conventional evaluation of the mechanism of syncope in patients with bundle branch block. Europace 2002; 4: 357-360
• 10 Lempert T. Synkopen – Phänomenologie und Differenzierung von epileptischen Anfällen. Nervenarzt 1997; 68: 620-624
• 11 Bergfeldt L. Differential Diagnosis of Cardiogenic Syncope and Seizure Disorders. Heart 2003; 89: 353-358
• 12 Soteriades ES, Evans JC, Larson MG. et al. Incidence and Prognosis of Syncope. N Engl J Med 2002; 347: 878-885
• 13 Brignole M, Vardas P, Hoffmann E. et al. Indications for the use of diagnostic implantable and external ECG loop recorders. Europace 2009; 11: 671-687
• 14 Alciati A, Shiffer D, Dipaola F. et al. Psychogenic Pseudosyncopy: Clinical Features, Diagnosis and Management. J Atrial Fibrillation 2020; 13: 2399
• 15 Blad H, Lamberts RJ, van Dijk JG. et al. Tilt-induced vasovagal syncope and psychogenic pseudosyncope: Overlapping clinical entities. Neurology 2015; 85: 2006-2010
• 16 Sorajja D, Nesbitt GC, Hodge DO. et al. Syncope While Driving. Circulation 2009; 120: 928-934
• 17 Kenny RA, Brignole M, Dan G. et al. Syncope Unit: rationale and requirement – the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society. Europace 2015; 17: 1325-1340
• 18 Shen WK, Decker WW, Smars PA. et al. Syncope Evaluation in the Emergency Department Study (SEEDS). Circulation 2004; 110: 3636-3645