Cardiogenic syncope in therapeutic practice

Recent publications devoted to the etiology, diagnosis and treatment of cardiogenic syncope were reviewed. The analysis of the current state of views on a pathogenesis, classification and features of a clinical picture of syncope of cardiogenic etiology was performed. Cardiogenic syncope has a 20-30% mortality. The highest risk is characteristic for the age more than 45 years, heart failure, history of ventricular tachycardia, nonspecific changes on ECG. With three and more risk factors the probability of a sudden cardiac death within the next year can reach 80%. The cause of cardiogenic syncope is reduction of cerebral blood flow. Cardiogenic syncope can be caused by a fall in blood pressure, cardiac output and total peripheral vascular resistance. Cardiogenic syncope may be the result of bradycardia and asystole, supraventricular and ventricular tachycardia, pulmonary embolism, dissecting aortic aneurysm, structural defects and cardiac anomalies, presence of myxoma or mobile atrial clot, cardiac tamponade, constrictive pericarditis, acute myocardial ischemia, abnormalities of the coronary arteries, dysfunction of prosthetic valve and cardiac pacemakers. In the diagnosis of cardiogenic syncope anamnesis and data received on physical examination are important. Instrumental examination should include electrocardiography, detection of comorbid conditions, exercise stress tests such as cycle ergometry or treadmill test, Holter ECG monitor, echocardiography, and coronary angiography for suspected acute myocardial ischemia.