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Die neurokardiogene Synkope ist Ergebnis eines durch autonome Reflexbögen fehlregulierten Blutdruckabfalls mit oder ohne Bradykardie. Die durch diese Mechanismen hervorgerufene Vasodepression und Kardioinhibition ist transient, selbstlimitierend und prognostisch benigne. Zu den neurokardiogenen Synkopen, die die insgesamt häufigste Ursache eines plötzlichen Bewusstseinsverlusts darstellen, werden neben der eigentlichen vasovagalen Ohnmacht auch die Situationssynkope – z.B. Miktionssynkope, Synkopen bei Glossopharyngeus- oder Trigeminusneuralgie sowie die Synkopen bei Karotissinus-Syndrom gerechnet. Das eindrucksvolle klinische Bild kann zu einer kostenintensiven Überdiagnostik verleiten, die nur durch Befolgen rationeller Algorithmen der Synkopenabklärung zu umgehen ist. In der Mehrzahl der Fälle führt bereits die gezielte Anamnese zu einer begründeten Verdachtsdiagnose. Mit der Kipptischuntersuchung nach standardisierten Protokollen unter Einschluss medikamentöser Provokation steht ein technisches Untersuchungsverfahren zur Verfügung, das die Diagnose sichert, wenn die spontan aufgetretene Synkope reproduziert werden kann.
Herzschrittmachertherapie + Elektrophysiologie – Springer Journals
Published: Feb 8, 2014
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