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Vom Bewusstseinsverlust zur Synkope

From loss of consciousness to syncope

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Synkopen sind die häufigste Ursache eines kurzzeitigen Bewusstseinsverlustes. Die aktuellen Leitlinien der ESC geben eine genaue Positionsbestimmung der Synkopen im Kontext der Bewusstlosigkeiten vor. Das individuelle Synkopenrisiko hängt von vielen Faktoren ab. Wahrscheinlich erleidet fast jede zweite Frau und jeder vierte Mann in seinem Leben mindestens eine Synkope. Die altersabhängige Häufigkeit zeigt einen doppelgipfligen Verlauf um das 15. Lebensjahr und jenseits des 60. Lebensjahres. Nur ein Bruchteil dieser Ereignisse wird letztlich von einem Arzt gesehen, wodurch die epidemiologische Aufarbeitung dieser klinischen Entität erschwert wird.

Die Prognose nach einer Synkope ist streng an das Vorhandensein einer strukturellen Herzerkrankung gebunden, welche an erster Stelle zu diagnostizieren und zu therapieren ist. Gleichzeitig ist unabhängig von der Grunderkrankung im Falle eines hohen Rückfallrisikos das Symptom „Synkope“ adäquat zu therapieren, um erneute Rezidive zu verhindern.

Die Klassifikation der Synkopen wird auf der Basis der pathophysiologischen Ursache einer Synkope vorgenommen. Dabei wird zwischen Reflexsynkopen, orthostatischen Synkopen, arrhythmogen bedingten kardialen Synkopen, mechanisch ausgelösten Synkopen bei strukturellen Herz-Gefäß-Erkrankungen sowie Synkopen bei zerebrovaskulären Erkrankungen unterschieden. In bis zu einem Drittel der Fälle bleibt die Synkopenursache unklar, wobei die meisten ungeklärten Synkopen reflektorischen Ursprungs sein dürften.

Abstract

Syncope is the most frequent cause for transient loss of consciousness. Recent ESC guidelines pinpoint the position of syncope within the context of loss of consciousness. The individual risk of syncope is determined by various factors. Odds are that almost one in two women and one in four men suffers from syncope at least once in their lives. Age-dependent risk is highest at both the age of 15 and after the 60th birthday. Only a fraction of cases are witnessed by a doctor, which makes it difficult to analyze. Prognosis after syncope is strictly related to the existence of structural heart disease. Therefore, its diagnosis and therapy should be given priority. In case of high risk of recurrence, syncope should be adequately treated to prevent further relapse, regardless of the primary disease. Syncopes are classified on the basis of their pathophysiological cause: reflex syncope, orthostatic syncope, arrhythmic cardiac syncope, mechanically caused syncope due to structural cardiovascular disease, and syncope due to cerebrovascular disease. The cause of up to one third of syncopes remains unknown; however, the majority of which are probably reflex syncopes.

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  1. Klinik für Innere Medizin/Kardiologie, Erzgebirgsklinikum Annaberg, Chemnitzer Str. 15, 09456, Annaberg-Buchholz, Deutschland

    H.-H. Ebert, C. Walter &  H. Volkmann

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  1. H.-H. Ebert
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  2. C. Walter
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  3. H. Volkmann
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Correspondence to H. Volkmann.

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Ebert, HH., Walter, C. & Volkmann, H. Vom Bewusstseinsverlust zur Synkope. Herzschr. Elektrophys. 22, 65–71 (2011). https://doi.org/10.1007/s00399-011-0127-0

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