Presyncope: What You Need to Know

Introduction

Presyncope refers to the sensation of almost fainting without actually losing consciousness. It is a serious symptom because it can indicate underlying cardiovascular or neurological conditions.

Symptoms of Presyncope

• Dizziness or lightheadedness
• Blurred vision
• Weakness or feeling of instability
• Nausea
• Sweating
• A rapid or irregular heartbeat

Common Causes of Presyncope

1. Cardiac Causes:
   • Arrhythmias (irregular heartbeats)
   • Structural heart disease (e.g., aortic stenosis)
   • Heart failure
2. Neurological Causes:
   • Autonomic dysfunction
   • Seizures
3. Orthostatic Hypotension:
   • A sudden drop in blood pressure when standing up
4. Vasovagal Reaction:
   • Triggered by emotional distress or pain
5. Medications:
   • Antihypertensives, diuretics, and certain psychiatric drugs

Diagnosis and Evaluation

• Electrocardiogram (ECG) – Checks for serious heart rhythm problems.
• Holter Monitor – A 24-hour heart rhythm monitor to detect intermittent arrhythmias.
• Tilt Table Test – Evaluates autonomic dysfunction and orthostatic hypotension.
• Echocardiography – Assesses the structure of the heart.
• Blood Tests – Looks for anemia, electrolyte imbalances, or metabolic issues.

Management and Treatment

General Recommendations:

• Stay hydrated and avoid sudden position changes.
• Avoid prolonged standing in hot environments.
• If presyncope occurs, lie down and raise your legs.

Specific Treatments:

• Cardiac Causes: Medication or pacemaker implantation if necessary.
• Orthostatic Hypotension: Compression stockings, increased salt intake, and medication adjustments.
• Vasovagal Presyncope: Lifestyle modifications and avoidance of triggers.

Conclusion

Presyncope should not be taken lightly, as it can indicate life-threatening conditions, especially if associated with heart disease. If you experience frequent episodes, consult a doctor for thorough evaluation.

Source recommendations

1. European Society of Cardiology Guidelines on Syncope

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of
2. https://academic.oup.com/eurheartj/article/39/21/1883/4939241
3. https://pubmed.ncbi.nlm.nih.gov/29562304/
4. https://www.hrsonline.org/guidance/clinical-resources/2009-guidelines-diagnosis-and-management-syncope
5. https://pubmed.ncbi.nlm.nih.gov/19713422/

2. American College of Cardiology/American Heart Association Guidelines on the Evaluation and Management of Syncope

1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000499
2. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/03/07/23/36/2017-acc-aha-hrs-guideline-for-syncope
3. https://pubmed.ncbi.nlm.nih.gov/28280231/
4. https://www.jacc.org/doi/10.1016/j.jacc.2017.03.003
5. https://www.heartrhythmjournal.com/article/S1547-5271%2817%2930298-9/abstract