Zusammenfassung
Die Ursachen für eine Synkope sind vielfältig. Der wichtigste Aspekt ist die Risikostratifikation, um eine bedrohliche Ursache der Synkope frühzeitig zu erkennen und zu behandeln. Die häufigste Form bzw. Ursache einer Synkope ist die Reflexsynkope. Sie ist pathophysiologisch von der orthostatischen Synkope zu unterscheiden. Unter die Reflexsynkope subsumiert man die klassische vasovagale Synkope, die Situationssynkope, die Karotis-Sinus-Hypersensitivität, und atypische Formen, die vorwiegend beim älteren Patienten zu finden sind. Der wichtigste Aspekt bei der Diagnosestellung ist die Anamnese. Die Behandlungsoptionen bei der Reflexsynkope sind eingeschränkt. Wichtig ist die Aufklärung der Patienten über den benignen Verlauf und das Meiden von Auslösesituationen. Physikalische Maßnahmen, wie z. B. isometrische Manöver sind effektiver als die medikamentöse Therapie. In seltenen Fällen ist eine Schrittmachertherapie indiziert. Zuvor sollte jedoch ein eindeutiger Zusammenhang einer reflektorischen Bradykardie mit einer Synkope nachgewiesen werden. Dies ist selten durch ein konventionelles EKG bzw. Langzeit-EKG zu erreichen. Deshalb sollte frühzeitig in der Diagnostik über die Implantation eines Ereignisrekorders nachgedacht werden.
Abstract
Reflex-mediated syncope is a common cause for syncope. The first step in evaluating the cause of syncope is to assess the risk of a life-threatening cause for syncope, e.g., ventricular arrhythmias. Reflex-mediated syncope has to be differentiated from orthostatic syncope. In orthostatic syncope, there is an insufficient autonomic response. In contrast to a reflex-mediated syncope, in which the autonomic nervous system acts inappropriately, reflex-mediated syncope is classified into the classical vasovagal form, the situational form, or due to carotid sinus hypersensitivity. In the elderly, often a mixed form is present. Treatment is difficult. Most important is educating the patient and avoiding precipitating factors. Physical maneuvers, e.g., counter pressure maneuvers, are more effective than drug treatment. Permanent pacing is rarely needed. However, before indicating a pacemaker, a correlation between bradycardia and syncope should be documented. This is often only possible by implanting a monitoring device at an early stage.
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Seidl, K., von Scheidt, W. & Pfafferott, C. Reflexsynkope. Herzschr. Elektrophys. 22, 93–98 (2011). https://doi.org/10.1007/s00399-011-0130-5
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DOI: https://doi.org/10.1007/s00399-011-0130-5