Chester County Medicine Winter 2021 - 12

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Syncope: Not Just for the Faint of Heart
continued from page 11

Managing Syncope
Management of syncope is centered on treating its underlying
cause. Due to the wide variety of pathology that causes loss
of consciousness, different approaches must be taken for each
subtype.
Treatment for reflex syncope usually necessitates patients to
modify their eating habits and daily lifestyle. Staying hydrated and
increasing salt intake can help some patients experience syncope
less frequently. Furthermore, situations that have previously
caused reflex syncope should be avoided.
	 Postural syncope can be managed by changing one's habits
when standing up. Patients are advised to stand up more gradually
while bracing themselves. In addition to this, compression
garments can be worn by patients to restrict blood flow to the
legs when standing up, possibly negating drops in blood pressure.
Finally, laying down or sleeping with legs elevated can also help in
managing postural syncope.
Figure 6 - A patient undergoing a tilt table test.
*	Electrocardiogram (ECG/EKG) - A device that monitors the
electrical activity of the heart and determines heart rate and
rhythm. Abnormal results can indicate cardiac arrhythmic
syncope.
*	Echocardiogram - A test that uses high frequency sounds
to see into the body, looking for abnormalities. This test
can be used to determine if a patient suffers from structural
cardiopulmonary syncope.

Prognosis
	 Outlook for patients experiencing syncope varies with what
causes it. The most determinant factor for patient outcomes is
whether syncope is of cardiac origin. Patients suffering from
cardiac arrhythmic or structural cardiopulmonary syncope
generally have worse outcomes than patients with reflex or postural
syncope. This is due to the nature of the underlying conditions
that produce syncopal episodes being severe. If left untreated,
patients experiencing syncope of cardiac origin can die.
Patients with reflex and postural syncope generally have a better
outlook due to the less serious nature of underlying conditions.
It is important to note, however, patients experiencing delayed
orthostatic hypotension syncope generally have worse outcomes
than other patients with syncope of non-cardiac origin because of
complications arising from falls.
Patients with syncope of unknown origin generally have
the best prognosis, as most will only experience one episode of
fainting.

12 CHESTER COUNT Y Medicine | WINTER 2021

	 Patients with cardiac arrhythmic syncope are managed
differently depending on the arrhythmia. Patients with
bradyarrhythmias generally require pacemaker implantation
that will set the number of heart beats per minute. On the
other hand, patients with tachyarrhythmias will often first be
treated with medications that slow heart rate like beta-blockers
or antiarrhythmic medications. If medications are not sufficient
alone, implantable cardioverter-defibrillator (ICD) intervention or
cardiac ablation may be required.
	 Management of structural cardiopulmonary syncope depends
on the condition that produces the fainting. For some patients,
surgery is required to correct their condition. Regardless of the
underlying condition, the goal of treatment is to increase cardiac
output.
In summary syncope is really a prevention of a cascade
of causes. Some of them can be benign, others complex and
malignant but the end result can be devastating because of falls or
loss of consciousness. So it's important to thoroughly investigate
the etiology and find ways to prevent and protect against falls.
This article was
written in collaboration
between Mian Jan, M.D.,
Chairman, Department of
Medicine, Penn Medicine
Chester County Hospital,
and Jonathan Luciani
who worked as an intern
and medical assistant at
West Chester Cardiology,
and will matriculate to
medical school in 2021.
Chester County Medicine Winter 2021

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