An individual that has experienced a cardiogenic syncope may describe the presence of an aura prior to the event, consisting of dizziness, amaurosis, diaphoresis, nausea or blurred vision. The duration of the aura is different in various cases, depending on the mechanism of the disease. If the substrate is arrhythmic, the aura lasts for about 3 seconds, whereas in vasovagal episodes its duration may be as long as 2.5 minutes. This period is followed by a complete, short duration loss of consciousness. Convulsions, myoclonic jerks or tonic spasms caused by brain hypoperfusion [1] may occur during the episode. Urine and fecal matter loss, confusion and oral trauma suggest epilepsy, whereas dysarthria and focal neurologic signs imply cerebrovascular disease. The recovery after a cardiogenic syncope is usually complete and spontaneous.

A careful history inquiry is a key tool in evaluating a syncope patient [2]. It should always be combined with clinical examination and a 12 lead electrocardiogram (class A recommendations [3]). The victim should be asked about the position of the body before symptoms set in [4] [5], the activity he or she was involved in and other precipitating factors. Anamnesis should determine if the person has a history of myocardial infarction, structural heart disease, arrhythmia, channelopathy or cardiomyopathy. Prior medication (diuretics, beta blockers, vasodilators, nitrates, antiarrhythmic, tricyclic antidepressants) is always important to know.

The physical evaluation must highlight the vital signs and heart auscultation. Tachycardia is suggestive for an acute cardiovascular event, such as a myocardial infarction, pulmonary embolism or signifies an ongoing tachyarrhythmia. An acute coronary syndrome may also be accompanied by bradycardia, especially if a cardiac conduction defect is present. Murmurs also point to a cardiac cause of the syncope but do not warrant it. Cardiovascular evaluation should be completed by assessment of the jugular veins, auscultation of lung rales, palpation of the liver and possible abdominal masses signifying abdominal aneurysms and evaluation of peripheral edema.

A Schellong test is a useful maneuver, indicating orthostatic hypotension if positive. A carotid sinus massage should only be performed by an experienced physician since it can induce prolonged cardiac pauses or severe bradycardia. The maneuver is to be avoided if carotid bruits are present.

Multiple recurrences during a short period of time require immediate cause diagnosis and therapeutic intervention.

Blood workup is nonspecific in this disease, but certain tests may show predisposing factors for a cardiogenic syncope: abnormal electrolytes levels, heart enzymes or B-type natriuretic peptide [6]. An echocardiography is indicated when mechanical cardiac causes are suspected, whereas an electrocardiogram is useful in all cardiogenic syncope patients. A normal aspect implies good prognosis, but clinical judgment may still dictate the need for Holter monitoring or loop event recording [7]. The standard electrocardiogram may show atrioventricular blocks of various degrees [8], Brugada syndrome, Wolff-Parkinson-White syndrome or acute ischemia. Sinus pauses, sustained and nonsustained ventricular tachycardia episodes may also be substrates for a cardiogenic syncope. A positive tilt table test indicates a vasodepressor mechanism.

The treatment of cardiogenic syncope focuses on addressing the underlying heart condition. Depending on the cause, treatment options may include:

• Medications: To manage heart rhythm disorders or heart failure.
• Pacemaker or Implantable Cardioverter-Defibrillator (ICD): Devices implanted to regulate heart rhythm.
• Lifestyle Modifications: Such as avoiding triggers and ensuring adequate hydration.
• Surgical Interventions: In cases where structural heart problems are identified.

The prognosis for cardiogenic syncope varies depending on the underlying cause. If the heart condition is identified and treated effectively, the risk of recurrent syncope and complications can be significantly reduced. However, if left untreated, cardiogenic syncope can lead to serious outcomes, including sudden cardiac arrest.

Cardiogenic syncope is caused by heart-related issues that affect blood flow to the brain. Common causes include:

• Arrhythmias: Abnormal heart rhythms that can disrupt blood flow.
• Structural Heart Disease: Such as aortic stenosis or hypertrophic cardiomyopathy.
• Heart Failure: Where the heart is unable to pump blood effectively.
• Myocardial Infarction: Also known as a heart attack, which can impair heart function.

Cardiogenic syncope is less common than other types of syncope, such as vasovagal syncope. It is more prevalent in older adults and those with known heart disease. The exact prevalence is difficult to determine, as it often requires specialized testing to diagnose.

The pathophysiology of cardiogenic syncope involves a disruption in the heart's ability to maintain adequate blood flow to the brain. This can occur due to:

• Electrical Disturbances: Such as tachycardia (fast heart rate) or bradycardia (slow heart rate).
• Mechanical Obstruction: Where blood flow is physically blocked, as in aortic stenosis.
• Pump Failure: Where the heart muscle is too weak to pump effectively.

Preventing cardiogenic syncope involves managing the underlying heart condition. This can include:

• Regular Medical Check-ups: To monitor heart health.
• Adhering to Treatment Plans: Including taking prescribed medications.
• Lifestyle Changes: Such as maintaining a healthy diet, exercising regularly, and avoiding smoking and excessive alcohol consumption.

Cardiogenic syncope is a serious condition caused by heart-related issues that lead to a temporary loss of consciousness. It requires careful evaluation and management to prevent complications. Understanding the symptoms, causes, and treatment options is essential for effective care.

If you experience sudden fainting spells, it is important to seek medical evaluation to determine the cause. Cardiogenic syncope can be a sign of an underlying heart condition that needs attention. Treatment options are available and can significantly improve outcomes. Regular check-ups and following your doctor's advice are key to managing this condition effectively.

1. Walsh K, Hoffmayer K, Hamdan MH. Syncope: diagnosis and management. Curr Probl Cardiol. 2015;40 (2):51-86
2. Huff JS, Decker WW, Quinn JV, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49(4):431-44.
3. Atkins D, Hanusa B, Sefcik T, et al. Syncope and orthostatic hypotension. Am J Med. 1991;91(2):179-85.
4. Calkins H, Shyr Y, Frumin H, et al. The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope. Am J Med. 1995;98(4):365-73.
5. Bergfeldt L. Differential diagnosis of cardiogenic syncope and seizure disorders. Heart 2003;89(3): 353-8.
6. Reed MJ, Newby DE, Coull AJ, et al. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010;23. 55(8):713-21.
7. Rockx MA, Hoch JS, Klein GJ, et al. Is ambulatory monitoring for "community-acquired" syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring. Am Heart J. 2005;150(5):1065.
8. Dovgalyuk J, Holstege C, Mattu A, et al. The electrocardiogram in the patient with syncope. Am J Emerg Med. 2007;25(6):688-701.