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Синкопальные состояния - Справочник поликлинического врача №4 (2017)
Синкопальные состояния
Скрипкина Н.А. Синкопальные состояния. Справочник поликлинического врача. 2017; 4: 20–24.
________________________________________________
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Аннотация
Обморок – кратковременный эпизод нарушения сознания, сопровождающийся утратой постурального тонуса и в большинстве случаев приводящий к падению пациента. Причина обмороков – остро возникшее нарушение перфузии головного мозга. Выделяют нейрорефлекторные, кардиогенные и ортостатические обмороки. В статье рассматриваются основные клинические варианты обмороков, вопросы диагностики, дифференциальной диагностики обмороков с другими пароксизмальными состояниями несинкопальной природы, алгоритм диагностики пациентов с пароксизмальными состояниями.
Ключевые слова: обморок, синкопальное состояние, кардиогенные обмороки, ортостатические обмороки, нейрорефлекторные обмороки, ситуационные обмороки, синдром гиперчувствительности каротидного синуса, липотимия, несинкопальные пароксизмальные состояния.
Key words: syncope, syncope, cardiogenic syncope, orthostatic syncope, neuroreflex syncope, situational syncope, carotid sinus hypersensitivity syndrome, lipotymia, non-syncopal paroxysmal conditions.
Ключевые слова: обморок, синкопальное состояние, кардиогенные обмороки, ортостатические обмороки, нейрорефлекторные обмороки, ситуационные обмороки, синдром гиперчувствительности каротидного синуса, липотимия, несинкопальные пароксизмальные состояния.
________________________________________________
Key words: syncope, syncope, cardiogenic syncope, orthostatic syncope, neuroreflex syncope, situational syncope, carotid sinus hypersensitivity syndrome, lipotymia, non-syncopal paroxysmal conditions.
Полный текст
Список литературы
1. Brignole M, Alboni P, Benditt DG et al.; Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope – update 2004. Europace 2004; 6: 467–37.
2. Thijs RD, Benditt DG, Mathias CJ et al. Unconscious confusion – a literature search for definitions of syncope and related disorders. Clin Auton Res 2005; 15: 35–9.
3. Soteriades ES, Evans JC, Larson MG et al. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878–85.
4. Strickberger SA, Benson DW, Biaggioni I et al.; American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke; Quality of Care and Outcomes Research Interdisciplinary Working Group; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF scientific statement on the evaluation of syncope. J Am Coll Cardiol 2006; 47: 473–84.
5. Hoefnagels WA, Padberg GW, Overweg J et al. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. J Neurol 1991; 238: 39–43.
6. Stephenson J. Fits and Faints. Oxford: Blackwell Scientific Publications, 1990: p. 41–57.
7. Van Dijk JG, Sheldon R. Is there any point to vasovagal syncope? Clin Auton Res 2008; 18: 167–9.
8. Tea SH, Mansourati J, L’Heveder G et al. New insights into the pathophysiology of carotid sinus syndrome. Circulation 1996; 93: 1411–6.
9. Alboni P, Alboni M, Bertorelle G. The origin of vasovagal syncope: to protect the heart or to escape predation? Clin Auton Res 2008; 18: 170–8.
10. Mathias CJ, Mallipeddi R, Bleasdale-Barr K. Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 1999; 246: 893–8.
11. Naschitz J, Rosner I. Orthostatic hypotension: framework of the syndrome. Postgrad Med J 2007; 83: 568–74.
12. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurol Sci 1996; 144: 218–9.
13. Wieling W, Krediet P, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 2007; 112: 157–65.
14. Podoleanu C, Maggi R, Brignole M et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in the elderly. A randomized placebo-controlled study. J Am Coll Cardiol 2006; 48: 1425–32.
15. Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006; 67: 28–32.
16. Verheyden B, Gisolf J, Beckers F et al. Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing. Clin Sci (Lond) 2007; 113: 329–37.
17. Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin Electrophysiol 1997; 20: 2205–12.
18. Leitch JW, Klein GJ, Yee R et al. Syncope associated with supraventricular tachycardia: an expression of tachycardia or vasomotor response? Circulation 1992; 85: 1064–71.
19. Brignole M, Gianfranchi L, Menozzi C et al. Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol 1993; 22: 1123–9.
20. Ebert SN, Liu XK, Woosley RL. Female gender as a risk factor for drug-induced cardiac arrhythmias: evaluation of clinical and experimental evidence. J Womens Health 1998; 7: 547–57.
21. Zareba W, Moss AJ, Le Cessie S et al. Risk of cardiac events in family members of patients with Long QT syndrome. J Am Coll Cardiol 1995; 26: 1685–91.
22. Lombroso CT, Lerman P. Breathholding spells (cyanotic and pallid infantile syncope). Pediatrics 1967; 39: 563–81.
23. Wieling W, Ganzeboom KS, Saul JP. Reflex syncope in children and adolescents. Heart 2004; 90: 1094–100.
24. Ganzeboom KS, Colman N, Reitsma JB et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91: 1006–8.
25. Serletis A, Rose S, Sheldon AG, Sheldon RS. Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J 2006; 27: 1965–70.
26. Colman N, Nahm K, Ganzeboom KS et al. Epidemiology of reflex syncope. Clin Auton Res 2004; 14 (Suppl. 1): i9–i17.
27. Ganzeboom KS, Mairuhu G, Reitsma J et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. J Cardiovasc Electrophysiol 2006; 17: 1172–6.
28. OldeNordkamp LAR, van Dijk N, Ganzeboom KS et al. Syncope prevalence in the ED compared to that in the general practice and population: a strong selection process. Am J Emerg Med 2009; 27: 271–9.
29. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial – the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J 2000; 21: 935–40.
30. Blanc JJ, L’Her C, Touiza A et al. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002; 23: 815–20.
31. Blanc JJ, L’Her C, Gosselin G et al. Prospective evaluation of an educational programme for physicians involved in the management of syncope. Europace 2005; 7: 400–6.
32. Brignole M, Menozzi C, Bartoletti A et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006; 27: 76–82.
33. Crane SD. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J 2002; 19: 23–7.
34. Disertori M, Brignole M, Menozzi C et al. Management of patients with syncope referred urgently to general hospitals. Europace 2003; 5: 283–91.
35. Sarasin FP, Louis-Simonet M, Carballo D et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med 2001; 111: 177–84.
36. Chen LY, Gersh BJ, Hodge DO et al. Prevalence and clinical outcomes of patients with multiple potential causes of syncope. Mayo Clin Proc 2003; 78: 414–20.
37. Kenny RA. Syncope in the elderly: diagnosis, evaluation, and treatment. J Cardiovasc Electrophysiol 2003; 14: S74–S77.
38. Romme JJ, van Dijk N, Boer KR et al. Influence of age and gender on the occurrence and presentation of reflex syncope. Clin Auton Res 2008; 18: 127–33.
39. Del Rosso A, Alboni P, Brignole M et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol 2005; 96: 1431–5.
40. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med 1997; 29: 459–66.
41. Colivicchi F, Ammirati F, Melina D et al.; OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24: 811–9.
42. Del Rosso A, Ungar A, Maggi R et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 2008; 94: 1620–6.
43. Sarasin FP, Hanusa BH, Perneger T et al. A risk score to predict arrhythmias in patients with unexplained syncope. Acad Emerg Med 2003; 10: 1312–7.
44. Quinn J, McDermott D, Stiell I et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 2006; 47: 448–54.
45. Middlekauff R, Stevenson WG, Stevenson LW, Saxon LA. Syncope in advanced heart failure; high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993; 21: 110–6.
46. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 2008; 358: 615–24.
47. Hennerici M, Klemm C, Rautenberg W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology 1988; 38: 669–73.
48. Parry SW, Kenny RA. Drop attacks in older adults: systematic assessment has a high diagnostic yield. J Am Geriatr Soc 2005; 53: 74–8.
49. Moya A. The European Society of Cardiology Guidelines for the Diagnosis and Management of Syncope Reviewed by Angel Moya, Md, Fesc, Chair of the Guideline Taskforce with J.Taylor, Mphil. Eur Heart J 2009; 30: 2539–40.
50. Moya A, Sutton R, Ammirati F et al. Guidelines for the Diagnosis and Management of Syncope (Version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (Esc). Eur Heart J 2009.
2. Thijs RD, Benditt DG, Mathias CJ et al. Unconscious confusion – a literature search for definitions of syncope and related disorders. Clin Auton Res 2005; 15: 35–9.
3. Soteriades ES, Evans JC, Larson MG et al. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878–85.
4. Strickberger SA, Benson DW, Biaggioni I et al.; American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke; Quality of Care and Outcomes Research Interdisciplinary Working Group; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF scientific statement on the evaluation of syncope. J Am Coll Cardiol 2006; 47: 473–84.
5. Hoefnagels WA, Padberg GW, Overweg J et al. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. J Neurol 1991; 238: 39–43.
6. Stephenson J. Fits and Faints. Oxford: Blackwell Scientific Publications, 1990: p. 41–57.
7. Van Dijk JG, Sheldon R. Is there any point to vasovagal syncope? Clin Auton Res 2008; 18: 167–9.
8. Tea SH, Mansourati J, L’Heveder G et al. New insights into the pathophysiology of carotid sinus syndrome. Circulation 1996; 93: 1411–6.
9. Alboni P, Alboni M, Bertorelle G. The origin of vasovagal syncope: to protect the heart or to escape predation? Clin Auton Res 2008; 18: 170–8.
10. Mathias CJ, Mallipeddi R, Bleasdale-Barr K. Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 1999; 246: 893–8.
11. Naschitz J, Rosner I. Orthostatic hypotension: framework of the syndrome. Postgrad Med J 2007; 83: 568–74.
12. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurol Sci 1996; 144: 218–9.
13. Wieling W, Krediet P, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 2007; 112: 157–65.
14. Podoleanu C, Maggi R, Brignole M et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in the elderly. A randomized placebo-controlled study. J Am Coll Cardiol 2006; 48: 1425–32.
15. Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006; 67: 28–32.
16. Verheyden B, Gisolf J, Beckers F et al. Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing. Clin Sci (Lond) 2007; 113: 329–37.
17. Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin Electrophysiol 1997; 20: 2205–12.
18. Leitch JW, Klein GJ, Yee R et al. Syncope associated with supraventricular tachycardia: an expression of tachycardia or vasomotor response? Circulation 1992; 85: 1064–71.
19. Brignole M, Gianfranchi L, Menozzi C et al. Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol 1993; 22: 1123–9.
20. Ebert SN, Liu XK, Woosley RL. Female gender as a risk factor for drug-induced cardiac arrhythmias: evaluation of clinical and experimental evidence. J Womens Health 1998; 7: 547–57.
21. Zareba W, Moss AJ, Le Cessie S et al. Risk of cardiac events in family members of patients with Long QT syndrome. J Am Coll Cardiol 1995; 26: 1685–91.
22. Lombroso CT, Lerman P. Breathholding spells (cyanotic and pallid infantile syncope). Pediatrics 1967; 39: 563–81.
23. Wieling W, Ganzeboom KS, Saul JP. Reflex syncope in children and adolescents. Heart 2004; 90: 1094–100.
24. Ganzeboom KS, Colman N, Reitsma JB et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91: 1006–8.
25. Serletis A, Rose S, Sheldon AG, Sheldon RS. Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J 2006; 27: 1965–70.
26. Colman N, Nahm K, Ganzeboom KS et al. Epidemiology of reflex syncope. Clin Auton Res 2004; 14 (Suppl. 1): i9–i17.
27. Ganzeboom KS, Mairuhu G, Reitsma J et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. J Cardiovasc Electrophysiol 2006; 17: 1172–6.
28. OldeNordkamp LAR, van Dijk N, Ganzeboom KS et al. Syncope prevalence in the ED compared to that in the general practice and population: a strong selection process. Am J Emerg Med 2009; 27: 271–9.
29. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial – the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J 2000; 21: 935–40.
30. Blanc JJ, L’Her C, Touiza A et al. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002; 23: 815–20.
31. Blanc JJ, L’Her C, Gosselin G et al. Prospective evaluation of an educational programme for physicians involved in the management of syncope. Europace 2005; 7: 400–6.
32. Brignole M, Menozzi C, Bartoletti A et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006; 27: 76–82.
33. Crane SD. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J 2002; 19: 23–7.
34. Disertori M, Brignole M, Menozzi C et al. Management of patients with syncope referred urgently to general hospitals. Europace 2003; 5: 283–91.
35. Sarasin FP, Louis-Simonet M, Carballo D et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med 2001; 111: 177–84.
36. Chen LY, Gersh BJ, Hodge DO et al. Prevalence and clinical outcomes of patients with multiple potential causes of syncope. Mayo Clin Proc 2003; 78: 414–20.
37. Kenny RA. Syncope in the elderly: diagnosis, evaluation, and treatment. J Cardiovasc Electrophysiol 2003; 14: S74–S77.
38. Romme JJ, van Dijk N, Boer KR et al. Influence of age and gender on the occurrence and presentation of reflex syncope. Clin Auton Res 2008; 18: 127–33.
39. Del Rosso A, Alboni P, Brignole M et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol 2005; 96: 1431–5.
40. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med 1997; 29: 459–66.
41. Colivicchi F, Ammirati F, Melina D et al.; OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24: 811–9.
42. Del Rosso A, Ungar A, Maggi R et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 2008; 94: 1620–6.
43. Sarasin FP, Hanusa BH, Perneger T et al. A risk score to predict arrhythmias in patients with unexplained syncope. Acad Emerg Med 2003; 10: 1312–7.
44. Quinn J, McDermott D, Stiell I et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 2006; 47: 448–54.
45. Middlekauff R, Stevenson WG, Stevenson LW, Saxon LA. Syncope in advanced heart failure; high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993; 21: 110–6.
46. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 2008; 358: 615–24.
47. Hennerici M, Klemm C, Rautenberg W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology 1988; 38: 669–73.
48. Parry SW, Kenny RA. Drop attacks in older adults: systematic assessment has a high diagnostic yield. J Am Geriatr Soc 2005; 53: 74–8.
49. Moya A. The European Society of Cardiology Guidelines for the Diagnosis and Management of Syncope Reviewed by Angel Moya, Md, Fesc, Chair of the Guideline Taskforce with J.Taylor, Mphil. Eur Heart J 2009; 30: 2539–40.
50. Moya A, Sutton R, Ammirati F et al. Guidelines for the Diagnosis and Management of Syncope (Version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (Esc). Eur Heart J 2009.
2. Thijs RD, Benditt DG, Mathias CJ et al. Unconscious confusion – a literature search for definitions of syncope and related disorders. Clin Auton Res 2005; 15: 35–9.
3. Soteriades ES, Evans JC, Larson MG et al. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878–85.
4. Strickberger SA, Benson DW, Biaggioni I et al.; American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke; Quality of Care and Outcomes Research Interdisciplinary Working Group; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF scientific statement on the evaluation of syncope. J Am Coll Cardiol 2006; 47: 473–84.
5. Hoefnagels WA, Padberg GW, Overweg J et al. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. J Neurol 1991; 238: 39–43.
6. Stephenson J. Fits and Faints. Oxford: Blackwell Scientific Publications, 1990: p. 41–57.
7. Van Dijk JG, Sheldon R. Is there any point to vasovagal syncope? Clin Auton Res 2008; 18: 167–9.
8. Tea SH, Mansourati J, L’Heveder G et al. New insights into the pathophysiology of carotid sinus syndrome. Circulation 1996; 93: 1411–6.
9. Alboni P, Alboni M, Bertorelle G. The origin of vasovagal syncope: to protect the heart or to escape predation? Clin Auton Res 2008; 18: 170–8.
10. Mathias CJ, Mallipeddi R, Bleasdale-Barr K. Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 1999; 246: 893–8.
11. Naschitz J, Rosner I. Orthostatic hypotension: framework of the syndrome. Postgrad Med J 2007; 83: 568–74.
12. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurol Sci 1996; 144: 218–9.
13. Wieling W, Krediet P, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 2007; 112: 157–65.
14. Podoleanu C, Maggi R, Brignole M et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in the elderly. A randomized placebo-controlled study. J Am Coll Cardiol 2006; 48: 1425–32.
15. Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006; 67: 28–32.
16. Verheyden B, Gisolf J, Beckers F et al. Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing. Clin Sci (Lond) 2007; 113: 329–37.
17. Grubb BP, Kosinski DJ, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin Electrophysiol 1997; 20: 2205–12.
18. Leitch JW, Klein GJ, Yee R et al. Syncope associated with supraventricular tachycardia: an expression of tachycardia or vasomotor response? Circulation 1992; 85: 1064–71.
19. Brignole M, Gianfranchi L, Menozzi C et al. Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol 1993; 22: 1123–9.
20. Ebert SN, Liu XK, Woosley RL. Female gender as a risk factor for drug-induced cardiac arrhythmias: evaluation of clinical and experimental evidence. J Womens Health 1998; 7: 547–57.
21. Zareba W, Moss AJ, Le Cessie S et al. Risk of cardiac events in family members of patients with Long QT syndrome. J Am Coll Cardiol 1995; 26: 1685–91.
22. Lombroso CT, Lerman P. Breathholding spells (cyanotic and pallid infantile syncope). Pediatrics 1967; 39: 563–81.
23. Wieling W, Ganzeboom KS, Saul JP. Reflex syncope in children and adolescents. Heart 2004; 90: 1094–100.
24. Ganzeboom KS, Colman N, Reitsma JB et al. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003; 91: 1006–8.
25. Serletis A, Rose S, Sheldon AG, Sheldon RS. Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J 2006; 27: 1965–70.
26. Colman N, Nahm K, Ganzeboom KS et al. Epidemiology of reflex syncope. Clin Auton Res 2004; 14 (Suppl. 1): i9–i17.
27. Ganzeboom KS, Mairuhu G, Reitsma J et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. J Cardiovasc Electrophysiol 2006; 17: 1172–6.
28. OldeNordkamp LAR, van Dijk N, Ganzeboom KS et al. Syncope prevalence in the ED compared to that in the general practice and population: a strong selection process. Am J Emerg Med 2009; 27: 271–9.
29. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial – the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J 2000; 21: 935–40.
30. Blanc JJ, L’Her C, Touiza A et al. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002; 23: 815–20.
31. Blanc JJ, L’Her C, Gosselin G et al. Prospective evaluation of an educational programme for physicians involved in the management of syncope. Europace 2005; 7: 400–6.
32. Brignole M, Menozzi C, Bartoletti A et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006; 27: 76–82.
33. Crane SD. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J 2002; 19: 23–7.
34. Disertori M, Brignole M, Menozzi C et al. Management of patients with syncope referred urgently to general hospitals. Europace 2003; 5: 283–91.
35. Sarasin FP, Louis-Simonet M, Carballo D et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med 2001; 111: 177–84.
36. Chen LY, Gersh BJ, Hodge DO et al. Prevalence and clinical outcomes of patients with multiple potential causes of syncope. Mayo Clin Proc 2003; 78: 414–20.
37. Kenny RA. Syncope in the elderly: diagnosis, evaluation, and treatment. J Cardiovasc Electrophysiol 2003; 14: S74–S77.
38. Romme JJ, van Dijk N, Boer KR et al. Influence of age and gender on the occurrence and presentation of reflex syncope. Clin Auton Res 2008; 18: 127–33.
39. Del Rosso A, Alboni P, Brignole M et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol 2005; 96: 1431–5.
40. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med 1997; 29: 459–66.
41. Colivicchi F, Ammirati F, Melina D et al.; OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24: 811–9.
42. Del Rosso A, Ungar A, Maggi R et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 2008; 94: 1620–6.
43. Sarasin FP, Hanusa BH, Perneger T et al. A risk score to predict arrhythmias in patients with unexplained syncope. Acad Emerg Med 2003; 10: 1312–7.
44. Quinn J, McDermott D, Stiell I et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 2006; 47: 448–54.
45. Middlekauff R, Stevenson WG, Stevenson LW, Saxon LA. Syncope in advanced heart failure; high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993; 21: 110–6.
46. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 2008; 358: 615–24.
47. Hennerici M, Klemm C, Rautenberg W. The subclavian steal phenomenon: a common vascular disorder with rare neurologic deficits. Neurology 1988; 38: 669–73.
48. Parry SW, Kenny RA. Drop attacks in older adults: systematic assessment has a high diagnostic yield. J Am Geriatr Soc 2005; 53: 74–8.
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Авторы
Н.А.Скрипкина
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
manakry@mail.ru
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
manakry@mail.ru
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
manakry@mail.ru
________________________________________________
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
manakry@mail.ru
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