What about cardiac causes? I subdivide cardiac causes into mechanical and electrical. Metabolic and endocrine abnormalities include hypoglycemia, hypoxia, volume deple-tion, and hypocapnia. This includes vertebrobasilar disease, subclavian steal, and bilateral carotid disease. People whose blood pressure drops can also have pseudoseizure-like movements, and deciding which came first can be confusing.Ĭerebrovascular disease is an uncommon cause of noncardiac syncope. Neurologic causes include seizure disorders (probably the most common), narcolepsy, hydrocephalus, migraine headaches, etc. There aren't that many noncardiac causes. My approach as a cardiologist is simple: there are 2 categories of syncope-either it's cardiac or it's not ( Table I).
About 20% of what I see in my office is syncope. About 3% to 5% of emergency room visits and 1% of hospital admissions are because of syncope. The cost of syncope is significant: $750 million a year. In the Framingham study, as subjects get over the age of 60, the incidence of fainting becomes quite significant, with no real difference between women and men. Twenty-five percent of those episodes of fainting recur. About 30% of people will faint over the course of their lives. There are about a half a million new cases every year in the Framingham cohort, about 11% of people fainted over 17 years. Syncope is defined as the abrupt and transient loss of consciousness associated with loss of postural tone, typically followed by rapid recovery.
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