Review
The pathophysiology of common causes of syncope
W Arthur, G C KayeCardiology
Department, Castle Hill Hospital, Castle Road, Cottingham, East
Yorkshire HU16 5JQ, UK
Correspondence to: Dr Arthur
Submitted 30 December
1999;
Accepted 16 February 2000
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Introduction |
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Syncope is a transient loss of consciousness secondary to inadequate cerebral perfusion with oxygenated blood. It is a common medical problem, accounting for around 5% of acute medical admissions and 3% of emergency department visits.1 Syncope secondary to cardiac causes carries the worst prognosis, with a one year mortality rate of 20-30%.2 An understanding of the events preceding syncope is essential if the correct diagnostic strategy is to be implemented.
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General pathophysiological concepts |
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A state of consciousness is maintained by adequate cerebral blood flow. Cerebral vascular autoregulation ensures that the cerebral blood flow is kept within a narrow range, independent of the underlying systemic blood pressure. In a young healthy adult the systolic blood pressure may fall to 70 mm Hg without significant cerebral ischaemia.3 Elderly people and those with chronic hypertension are susceptible to relatively small falls in systemic blood pressure, leading to an increased incidence of syncope in this population.4
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