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Syncope pp 227-240 | Cite as

The Autonomic Laboratory for Evaluating Syncope/Collapse: Investigations and Their Implications

  • Christopher J. Mathias
  • Andrew P. Owens
  • Valeria Iodice
Chapter
  • 27 Downloads

Abstract

Syncope and collapse may result from a number of causes—neurological (autonomic and non-autonomic), cardiac, and metabolic. In addition, syncopal behaviour (loss of postural tone and unresponsiveness) may manifest in the form of a conversion disorder (functional non-syncopal collapse or pseudosyncope). There are many autonomic nervous system causes of syncope and they vary across the entire age spectrum. Intermittent and transient autonomic dysfunction, classed as autonomic mediated syncope (AMS), include those in all age groups (e.g., vasovagal syncope), in the >50’s (e.g., carotid sinus hypersensitivity/syndrome), and in different predisposing situations (situational syncope). An increasingly recognised new millennium autonomic cause of pre-syncopal symptoms (principally palpitations and dizziness) when upright is the postural tachycardia syndrome (PoTS), that can be associated with fainting. Many diseases and disorders within the brain, spinal cord, or periphery, although less common can result in autonomic damage and failure, often with orthostatic (postural) hypotension. Drugs also can cause or contribute to syncope. This chapter will provide an overview of the role of the autonomic laboratory in the evaluation of syncope/collapse, with the key aims being able to confirm (or exclude) an autonomic condition, to ascertain the cause or associated disorder contributing, and to determine additional factors that aid the management of autonomic mediated syncope/collapse.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Christopher J. Mathias
    • 1
    • 2
    • 3
  • Andrew P. Owens
    • 4
  • Valeria Iodice
    • 1
    • 2
    • 5
  1. 1.Queen Square Institute of Neurology, University College LondonLondonUK
  2. 2.Autonomic & Neurovascular Medicine Centre, Hospital of St John & St ElizabethLondonUK
  3. 3.Lindo Wing, St Mary’s Hospital, Imperial College Healthcare TrustLondonUK
  4. 4.Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s CollegeLondonUK
  5. 5.Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, UCLH TrustLondonUK

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