The causes of syncope are many and very different from each other. The most frequent are of neuro-vegetative origin. These are almost always benign phenomena
I am 58 years old and have been suffering from chest pain and symptomatic ventricular extrasystole for 37 years. Despite dozens of visits, I have not been diagnosed with heart disease. I have a resting heart rate of 115 beats per minute, a murmur of intensity 2/6, I have had three syncopes. What tests can I do to diagnose heart disease?
He answers Fabrizio TundoDepartment of Arrhythmology, Monzino Cardiology Center, Milan (GO TO THE FORUM)
The ventricular extrasystoleshowever annoying, are not synonymous with heart disease and the presence of this arrhythmia for 37 years proves a benign form. The cause of extrasystoles is not always identifiable but they certainly do not imply the presence of heart disease, although sometimes they represent an alarm bell which must be disproved with investigations. Heart rate at rest, even if accelerated beyond 100 beats/minute, does not represent a risk criterion. Heart murmur intensity 2/6 may be indicative of a valve problem, but a color Doppler echocardiogram has probably already been performed to exclude significant valve defects. The most relevant anamnestic data is instead represented by the syncopeif confirmed as an episode of transient loss of consciousness, especially since it was repeated in three episodes.
The causes of syncope are many and very different from each other. The most frequent are vasovagal syncopei.e. of neuro-vegetative origin (the autonomic nervous system that regulates vital functions that do not depend on our will, such as the regulation of blood pressure, heart rate, breathing or digestion). These are benign phenomena in most cases. The most typical situations occur after blood sampling, after urination (especially going to the bathroom at night after sleep interruption), following emotional stress, following intense pain or in conjunction with evacuation in the course of gastroenteritis or in hot places and crowded. They are characterized by onset preceded by a more or less fleeting malaise, followed by an almost immediate recovery of consciousness (within a few seconds): they are generally due to a sudden drop in blood pressure or heart rate on a neuro-mediated basis.
These episodes are more typical of young age (starting from adolescence) and generally benefit from simple behavior advice. Other causes of syncope can be more serious and arise from arrhythmic problems (both tachycardias and extreme bradycardias), or hemodynamics (valvular disorders, carotid atherosclerosis, ischemic heart disease). Then there is the chapter of non-syncopal loss of consciousness, on a neurological basis (typically epileptic seizures), which generally have very different clinical characteristics. Since these are transitory phenomena and which determine a complete regression of the symptoms upon their resolution, syncope may remain unexplaineddespite the checks, in almost a third of cases.
The tests to rule out heart disease with certainty are: standard electrocardiogram, color-Doppler echocardiogram, 24h Holter Ecg and ergometric test (Exercise ECG). You might consider performing more in-depth tests later, such as cardiac magnetic resonance or electrophysiological study (minimally invasive procedure that requires a short hospital stay and which consists in evaluating the “electrical unit” of your heart and any propensity for arrhythmias). In case of negativity of the investigations, one could still hypothesize drug therapy to reduce extrasystoles and improve his quality of life.
January 1, 2023 (change January 1, 2023 | 2:17 pm)
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