Background Little is known about the epidemiology and prognosis of syncope in the general population. Methods We evaluated the incidence, specific causes, and prognosis of syncope among women and men participating in the Framingham Heart Study from 1971 to 1998. Results Of 7814 study participants followed for an average of 17 years, 822 reported syncope. The incidence of a first report of syncope was 6.2 per 1000 person-years. The most frequently identified causes were vasovagal (21.2 percent), cardiac (9.5 percent), and orthostatic (9.4 percent); for 36.6 percent the cause was unknown. The multivariable-adjusted hazard ratios among participants with syncope from any cause, as compared with those who did not have syncope, were 1.31 (95 percent confidence interval, 1.14 to 1.51) for death from any cause, 1.27 (95 percent confidence interval, 0.99 to 1.64) for myocardial infarction or death from coronary heart disease, and 1.06 (95 percent confidence interval, 0.77 to 1.45) for fatal or nonfatal stroke. The...

Incidence and prognosis of syncope

Resume La iatrogenie est une cause bien connue de pertes de connaissance ou de lipothymies. En revanche, la part de responsabilite des differentes therapeutiques est moins bien individualisee. Sur une periode de six ans, 1611 patients ont ete hospitalises dans notre etablissement pour syncope ou lipothymie, dont 688 en cardiologie. Parmi ces patients, 420 etaient âges de 70 ans ou plus. La recherche d'une cause iatrogene est systematique, validee par la methode francaise d’imputabilite : connaissance de criteres « extrinseques » (donnees bibliographiques concernant l’effet iatrogene du medicament incrimine) mais surtout attribution d’un score sur la base de criteres « intrinseques », chronologiques et semiologiques. Soixante quinze patients (11 % des syncopes a l'origine d'une hospitalisation en cardiologie) ont ainsi ete retenus : score = I2, « iatrogenie plausible », pour 28 patients (37 %) ; score = I3, « iatrogenie vraisemblable », pour 47 patients (63 %). L’attribution du score I4, « iatrogenie certaine » n’a pas ete possible car necessitant la reintroduction du medicament pour rechercher la recidive de l’effet iatrogene. L’âge moyen est de 78 ans, avec une majorite feminine de 69 %. Soixante douze patients (96 %) presentent des antecedents de pathologie cardiovasculaire, 37 (50 %) ont deja presente un episode syncopal ou presyncopal. Outre le bilan de base, un enregistrement Holter a ete pratique chez 56 patients, retrouvant une arythmie d’origine medicamenteuse dans trois cas. Dans la majorite des cas (59 patients, 79 %), l’effet secondaire consiste en une hypotension, evidente cliniquement dans 49 cas. Pour les dix restants, la preuve d’un syndrome vasovagal potentialise par les therapeutiques a necessite un test d’inclinaison. Les autres effets secondaires regroupent huit troubles du rythme et huit troubles metaboliques majeurs. Les traitements sont toujours multiples. Le medicament incrimine est a visee cardiovasculaire dans 66 % des cas. Les autres classes sont essentiellement representees par les alphabloquants a visee urologique (12 %) et les psychotropes (22 %). Parmi les traitements a visee cardiovasculaire, les IEC et les diuretiques, le plus souvent en association, sont au premier rang (59 %). Cette etude confirme la responsabilite des traitements antihypertenseurs dans la syncope iatrogene, sa grande frequence chez le patient âge mais aussi la responsabilite d’une classe medicamenteuse moins souvent evoquee, les alphabloquants a visee urologique.

Syncopes et lipothymies d’origine iatrogène

Resume La perte de connaissance breve est une pathologie frequente qui semble plus redoutee des malades que des medecins. Une etude est realisee a partir de 90 malades hospitalises dans un service de Medecine interne, comprenant une partie retrospective de recueil des donnees et une enquete par questionnaire aupres des medecins traitants et des malades. Un diagnostic est pose 74 fois (82 %), dont 73 a l'aide d'un bilan simple comprenant: examen clinique; electrocardiogramme de base; ionogramme sanguin; glycemie et recherche d'hypotension orthostatique. Les medecins et leurs malades estiment differemment la frequence des recidives (respectivement 17 et 51 %) et les consequences de la perte de connaissance (respectivement 27 et 96 %). Les recidives sont le plus souvent precoces et multiples et ne sont pas influencees par l'etiologie de la perte de connaissance, mis a part celles d'origine psychiatrique qui recidivent toujours. La mortalite est de 4 % au bout de 21 mois, mais un seul deces est lie a la cause (cardio-vasculaire) du malaise. Aucun deces n'est survenu dans le groupe des malades pour lesquels l'etiologie n'a pu etre precisee. Si l'on excepte celles d'origine cardio-vasculaire, les consequences des pertes de connaissance sont plus d'origine psychologique que physique. Un bilan simple est le plus souvent suffisant.

Pertes de connaissance brèves dans un service de Médecine Interne. Étude du bilan initial et du devenir à moyen terme

Les pertes de connaissance du sujet âgé

In a prospective multicentre study a series of 188 patients over 65 years of age admitted for syncope (90) or transient loss of consciousness (98) was collected. There were 120 women and 68 men; mean age was 78.7 +/- 6.6 years; 140 patients had a significant history mainly of arterial hypertension and coronary disease; 81 patients were taking drugs (4.1 on average) and notably diuretics, antihypertensive agents, antiarrhythmic agents, nitrites and psychotropic drugs. The most frequent diagnoses were arrhythmia (20.2 p. 100), postural hypotension (15.4 p. 100), reflex and vasodepressive syncope (12.2 p. 100) and coronary disease (5.3 p. 100). Taken together, these diagnoses could be divided into cardiac diseases (26.5 p. 100), extracardiac diseases (54.2 p. 100), diagnosis unknown (19 p. 100). The condition was iatrogenic in 45 patients (24 p. 100). The means by which the diagnosis was reached were studied: in two-thirds of the cases, careful physical examination and electrocardiography alone provided a diagnosis. Seven patients died during their stay in hospital. Among the 181 survivors 148 (81.7 p. 100) were discharged and returned home.

Etiological diagnosis of syncope and brief loss of consciousness in patients over 65. Results of a multicenter prospective study of 188 cases

The one-year outcome of syncope and transient loss of consciousness was studied prospectively in 188 patients aged over 65 admitted to internal medicine departments. Thirty-seven patients (19.6 p. 100) died. This mortality rate at one year was 2.34 times higher than that of a non-hospitalized french population of the same age group (standardized mortality ratio, SMR = 2.34, P less than 0.001). The frequency of sudden death (7 cases) was much higher than that observed in the reference population (0.05 expected deaths, P less than 0.0001). Overmortality was clearly apparent in groups with an initial diagnosis of heart disease (SMR = 2.36, P less than 0.01) or neurological disease (SMR = 4.25, P less than 0.001). The relapse rate was 28 p. 100 globally and up to 43 p. 100 in cardiac patients. In the group with iatrogenic symptoms treatment was appropriately corrected in 86 p. 100 of the patients, and none of these relapsed. One year after the initial episode 11 p. 100 of the surviving patients had been institutionalized.

[1-year prognosis of syncope and brief loss of consciousness in patients over 65. A multicenter study of 188 cases].

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Etiological diagnosis of syncope and brief loss of consciousness in patients over 65. Results of a multicenter prospective study of 188 cases

[1-year prognosis of syncope and brief loss of consciousness in patients over 65. A multicenter study of 188 cases].