EpistemisPresyncope
Specialty: General.
Why it occurs
- Reflex orthostatic hypotension (due to mild hypovolemia, dehydration, prolonged rest or dysautonomia)
- Transient decrease in cerebral blood flow due to self-limited cardiac arrhythmias (transient atrioventricular blocks, supraventricular tachycardias or short sinus pauses)
- Intense reflex vagal stimulation (vasovagal presyncope caused by severe pain, prolonged standing, urination, defecation or cough)
- Effect of antihypertensive or vasodilator drugs in excessive doses or inappropriate combinations
- Moderate aortic stenosis or hypertrophic cardiomyopathy in early stages.
Initial workup
12-lead electrocardiogram during the episode (if possible), 24- to 48-hour Holter heart rate, transthoracic echocardiogram, 10-minute active standing test (or tilt-table), and complete blood count.
red flags
Presyncope that occurs in a recumbent position, associated with chest pain, rapid palpitations prior to the event, sudden dyspnea, or that occurs during moderate or intense physical effort.
Standard management
- Fludrocortisone — 0.1 mg orally daily if orthostatic hypotension of autonomic origin due to refractory volume depletion is confirmed
- Midodrine — 2.5 to 5 mg orally three times a day, an alpha-1 adrenergic agonist that promotes peripheral vasoconstriction, avoiding its intake before bedtime
- Increase dietary Sodium Chloride intake under strict medical control in the absence of heart failure or hypertension.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3