Structural heart disease refers to processes affecting valves, ventricles, pericardium, myocardium, and elements of the conduction system. As a result, the ventricle has a predisposition (e.g. due to scarring, disruption of aspects of depolarization and/or the conduction system) to development of VT or VF, which in turn causes syncope (and/or sudden death).
Can lead to syncope through decreased cardiac output (impaired contractility or outflow), predisposition to arrhythmias (e.g. VT), or can be combined with other processes to cause cerebral hypoperfusion (e.g. hypovolemia, bradycardia)
Pericardial disease
Severely reduced LV systolic function
Stenosis of the aortic valve
Ischemia/MI with resultant dysrhythmia
Hypertrophic heart disease
Infiltrative heart disease (predispose to malignant dysrhythmias): Amyloid, sarcoid, hemochromatosis
Arrhythmogenic right ventricular cardiomyopathy
Long QT syndromes
Pulmonary hypertension, other
Risk Factors
DM, HTN, hyperlipidemia, smoking, family history for CAD, age > 50, known CAD, known depressed LV fxn
Family history of sudden death, people dying unexpectedly/unexplained at young age--> underlying hypertrophic cardiomyopathy/other predisposition to malignant dysrhythmia
Symptoms
The underlying disease process may cause sub-acute or chronic symptoms, prior to the development of syncope
Sarcoid: affects multiple symptoms, leading to SOB, DOE, wheezing, neuropathy, etc